Arteries free lower limbs. Femoral artery

The branches of the femoral artery A. femoralis, the femoral artery, represents the continuation of the trunk of the external iliac artery, deriving its name from the site of passage under the inguinal ligament through the lacuna vasorum near the middle of the extension of this ligament. To stop bleeding, the femoral artery is pressed against the pub pub at the place of its exit to the thigh. Medially from the femoral artery lies the femoral vein, with which it passes in the femoral triangle, going first to sulcus iliopectineus, then to sulcus femoralis anterior, and then penetrates through the canalis adductorius into the popliteal fossa, where it continues to a. poplitea

The branches of the femoral artery, a. femoralis:

1. A. epigastrica superficialis, superficial epigastric artery, retires at the very beginning of the femoral artery and goes under the skin to the navel.

2. A. circumflexa ilium superficialis, the superficial artery enveloping the iliac bone, is directed to the skin in the spina iliaca anterior superior region.

3. Ah. pudendae externae, the external genital arteries, depart in the region of hiatus saphenus and are directed to the external genitals (usually two in number) – to the scrotum or to the labia majora.

4. A. profunda femoris, the deep artery of the femur, is the main vessel through which the vascularization of the femur. It is a thick trunk that departs from the back side of a. femoralis 4–5 cm below the inguinal ligament, lies first behind the femoral artery, then appears on the lateral side and, giving up numerous branches, rapidly decreases in its caliber.

a) a. circumflexa femoris medialis, going medially and upward, gives branches to m. pectineus, leading to the muscles of the thigh, and to the hip joint;
b) a. The circumflexa femoris lateralis departs somewhat lower than the previous one, is sent to the lateral side under m. rectus, where it is divided into ramus ascendens (goes up and laterally to the greater skewer) and ramus descendens (branches out in tons quadriceps);
c) aa. perforantes (three) move away from the posterior surface of the deep artery of the thigh and, piercing the adductors, pass to the posterior surface of the thigh; the first piercing artery gives the upper feeding thigh artery to the femur (a. diaphyseos femoris superior), and the third to the lower artery (a. diaphyseos femoris inferior); aa perforantes are of paramount importance when bandaging the femoral artery below the level of discharge of the deep femoral artery.

5. Rami musculares femoral artery – to the thigh muscles.

6. A. genus descendens, the descending artery of the knee, moves away from a. femoralis on its way to canalis adductorius and, going out through the front wall of this channel together with n. sap-henus, supplies m. vastus medialis; participates in the formation of the arterial network of the knee joint.

Internal iliac artery.

Parietal branches of the internal iliac artery. A. iliaca interna, starting from the lower end of the common iliac artery at the level of the sacroiliac joint, descends into the small pelvis and extends to the upper edge of the large sciatic hole. Its division into branches, near-wall and visceral, is subject to significant individual variations, but more often it is divided at the level of the upper edge of the large sciatic opening first into two main trunks – the rear, giving aa. iliolumbalis, sacralis lateralis, glutea superior, and the front, from which all other branches of a. iliacae internae. On the way a. iliaca interna is covered with the peritoneum, and the ureter runs down the front, which is important to take into account during the operation so as not to bandage it instead of the artery; v lies behind. iliaca interna.

Common iliac artery

A. iliaca communis, common iliac artery. The right and left arteries represent the two terminal branches, into which the aorta splits at the level of the IV lumbar vertebra slightly to the left of the midline, why the right common iliac artery is 6-7 mm longer than the left. From the place of aortic aa split. The iliacae communes diverge at an acute angle (in a man the angle of divergence is approximately 60 °, in a woman due to a greater width of the pelvis 68–70 °) and are directed down and laterally to the sacroiliac joint, at the level of which each is divided into two final branches: a. iliaca interna for the walls and organs of the pelvis and a. iliaca externa mainly for lower limbs.

By origin aa. iliacae communes are the initial segments of the umbilical arteries of the embryo; almost all the rest of the germinal aa. In adults, umbilicales are obliterated and turn into ligg. umbilicalia mediales.

Paired visceral branches: renal artery (a. Renalis), middle adrenal artery

1. A. suprarenalis media, the middle adrenal artery, starts from the aorta near the beginning of a. mesenterica superior and goes to gl. suprarenalis.

2. A. renalis, the renal artery, departs from the aorta at the level of the II lumbar vertebra almost at a right angle and goes in the transverse direction to the gate of the corresponding kidney. The caliber of the renal artery is almost equal to the superior mesenteric, which is explained by the urinary function of the kidney, which requires a large flow of blood. The renal artery sometimes departs from the aorta with two or three trunks and often enters the kidney with multiple trunks not only in the portal area, but throughout the medial edge, which is important to consider when pretreatment of the arteries during a kidney removal operation. At the gate of the kidney a. renalis is usually divided into three branches, which in turn in the renal sinus, in turn, fall into numerous branches (see. “Kidney”).

The right renal artery lies behind v. cava inferior, pancreatic head and pars descendens duodeni, left – behind pancreas. V. renalis is located in front and slightly below the artery. From a. renalis moving upward to the lower part of the adrenal gland a. suprarenalis inferior, as well as a sprig to the ureter.

3. A. testucularis (in women a. Ovarica) is a thin long stem, which starts from the aorta immediately below the beginning of a. renalis, sometimes from this last. Such a high discharge of the artery that feeds the testicle is determined by laying it in the lumbar region, where a. testicularis occurs at the shortest distance from the aorta. Later, when the testicle descends into the scrotum, a is also extended along with it. testicularis, which, at the time of birth, descends along the front surface of m. psoas major, gives a branch to the ureter, goes to the inner ring of the inguinal canal and, together with the ductus deferens, reaches the testicle, which is why it is called a. testicularis. In a woman, the corresponding artery, a. ovarica, in the inguinal canal is not sent, and goes into the small pelvis and then in the lig. suspensorium ovarii to the ovary.

Superior mesenteric artery

A. mesenterica superior, an artery, departs from the anterior surface of the aorta immediately below the cervical trunk, goes down and forward into the gap between the lower edge of the pancreas in front and the horizontal part of the duodenum at the back, enters the mesentery of the small intestine and descends to the right ileal fossa.

Branches, a. mesentericae superioris:

a) a. pancreatieoduodeiialis inferior goes right along the concave side of the duodeni towards aa. pancreaticoduodenales superiores;

b) aa. intestinales — 10–16 branches that extend from a. mesenterica superior in the left side to the lean (aa. jejundles) and ileum (aa. ilei) intestine; along the way, they are divided dichotomously and adjacent branches are connected to each other, which results in aa. jejunales are three rows of arcs, and along aa. ilei – two rows. Arcs are a functional device that provides blood flow to the intestines during any movements and positions of its loops. From the arcs there are many thin branches that circle the intestinal tube;

c) a. ileocolica runs from the a.r mesenterica superior to the right, supplying the lower part of the intestinum ileum and the cecum with sprigs and sending to the vermiform process a. appendicularis, passing behind the final segment of the ileum;

d) a. colica dextra goes behind the peritoneum to colon ascendens and near it is divided into two branches: ascending (going up towards a. colica media) and descending (going down towards a. ileocolica); branches form adjacent arcs of the colon;

e) a. colica media passes between the sheets of mesocolon transversum and, reaching the transverse colon, is divided into right and left branches, which diverge in the appropriate direction and anastomose: the right branch – with a. colica dextra, left – with a. colica sinistra

Unpaired visceral branches: celiac trunk (truncus coeliacus)

1. Truncus coeliacus, the celiac trunk, is short (2 cm), but a thick artery that moves at the level of the XII thoracic vertebra in the hiatus aorticus diaphragm, goes forward over the upper edge of the pancreas and immediately divides into three branches (the division point is called tripus coeliacus ): a. gastrica sinistra, a. hepatica communis and a. lienalis.

1. A. gastrica sinistra, the left gastric artery, goes to the lesser curvature of the stomach, gives branches to both the stomach and pars abdominalis esophagi.

2. A. hepatica communis, the common hepatic artery, goes along the upper edge of the pancreatic head to the superior edge of the duodeni, hence after the release of a. gastroduodenalis (which may be multiple) she is like a. hepatica propria (own hepatic artery) is sent to the gate of the liver, located between two sheets of lig. hepatoduodenal, and in a bundle it lies anterior to v. portae and to the left of ductus choledochus.

In the gates of the liver a. hepatica propria is divided into ramus dexter and ramus sinister; ramus dexter near the junction of ductus hepatic communis with ductus cysticus gives the artery of the gallbladder, a. cystica

From a. hepatica communis or a. hepatica propria leaves a branch to the lesser curvature of the stomach, a. gastrica dextra, going from right to left towards a. gastrica sinistra. Mentioned above a. gastroduodenalis passes behind duodenum and is divided into two branches: a. gastroepiploica dextra, which goes from right to left along the greater curvature of the stomach, gives branches to the stomach and to the omentum, in the front wall of which it passes, and aa. pancreaticoduodenals superiores, which branch out in the pancreas head and descending part of the duodeni.

3. A. lienalis, s. splenica, the splenic artery, the largest of the three terminal branches of the celiac trunk, travels along the upper edge of the pancreas to the spleen, approaching which, splits into 5-8 terminal branches entering the spleen gate.

On the way gives rami pancreatici. Near the division into terminal branches, the splenic artery gives a. gastroepiploica sinistra, which goes from left to right along the greater curvature of the stomach and joins a. gastroepiploica dextra, forms a (non-permanent) arterial arc, similar to the arc on the lesser curvature. From the arc depart numerous branches to the stomach.

In addition, after the discharge a. gastroepiploica sinistra from the splenic artery to the stomach go numerous aa. gastricae breves, which can fully compensate for the obstruction of blood flow in the main four arteries of the stomach. The latter form around the stomach arterial ring, or crown, consisting of two arcs, located along the small and large curvature. Therefore, they are also called coronary arteries.

Arcs and arteries of the hand. Superficial palmar arch.

Deep palmar arch. In the area of ​​the wrist there are two networks: one palmar, rete carpi palmare, the other rear, rete carpi dorsale.

Rete carpi palmare is formed from the junction of the palmar carpal branches of the radial and ulnar arteries and branches from the anterior interosseous. The palm network of the wrist is located on the ligamentous apparatus of the wrist under the flexor tendons; its branches feed the ligaments and articulationes mediocarpea et radiocarpea.

Rete carpi dorsale is formed from the junction of the posterior carpal branches of the radial and ulnar arteries and branches from the interosseous; located under the extensor tendons and gives branches:
a) to the nearest joints {yy. ag-ticuldres)
b) in the second, third and fourth inter-bone gaps {aa. te-tacarpeae dor sales); at the base of the fingers, each of them is divided into branches to the fingers {aa. digitales dorsdles).

On the palm there are two arcs – superficial and deep.

Arcus palmaris superficialis, superficial palmar arch, located under aponeurosis palmaris. Being a continuation of the ulnar artery, the surface arc decreases in its caliber towards the radial side, where it includes the superficial palmar artery branch. From the convex steel side of the arc are four aa. digitales palmares communes. Three of them go to the second, third and fourth interbone spacing, respectively, the fourth – to the ulnar side of the little finger. At the fold of skin between the fingers, each of them is divided into two aa. digitales palmares propriae, which are directed along opposite sides of adjacent fingers.

Arcus palmaris profundus, a deep palmar arch, is located deep beneath the flexor tendons on the bases of the metacarpal bones and ligaments, proximal to the superficial arc. The deep palmar arch, being formed mainly by the radial artery, decreases in its caliber in contrast to the surface towards the ulnar side of the hand, where it joins the relatively thin deep palmar branch of the ulnar artery. From the convex side of the deep arc, in the distal direction to the three inter-bone gaps, starting from the second, three aa. metacarpeae palmares, which in the interdigital folds merge with the ends of the common palmar finger arteries. Three small branches (aa. Perfordntes), which, going to the rear, anastomose with aa, depart from the arc in the dorsal direction through the interosseous gaps (second, third and fourth). metacarpeae dorsales.

The superficial and deep arterial arcs are an important functional device: in connection with the grasping function of the hand, the vessels of the hand are often compressed. When the blood flow in the superficial palmar arch is disturbed, the blood supply to the hand does not suffer, since blood delivery occurs in such cases through the arteries of the deep arc. The same functional devices are the articular networks, due to which blood flows freely into the joint, despite the compression and tension of the vessels during its movements. In the area of ​​the upper limb there are rich opportunities for the development of collateral circulation. Collateral vessel for a. brachialis is a. profunda brachii, for a. ulnaris – a. interossea communis.

Ulnar artery, a. ulnaris. Branches of the ulnar artery

Ulnar artery, a. ulnaris, represents one of the two terminal branches of the (larger) brachial artery. From the place of onset in the cubital fossa (against the neck of the radial bone), it fits under m. pronator teres, up to the middle third of the forearm goes sideways, deviating to the elbow side. In the lower two-thirds, it runs parallel to the ulna, first between the m. flexor digitorum superficialis and so on. flexor carpi ulnaris, in the lower third, due to the transition of muscles into tendons, its position becomes more superficial (sulcus ulnaris). At the radial side of the pea-shaped bone, the ulnar artery passes into canalis carpi ulnaris (spatium interaponeuroticum) and, passing on the palm, is part of the arcus palmaris superficialis.

Branches of the ulnar artery:
1. A. recurrens ulnaris, recurrent ulnar artery, gives two branches – rami anterior et posterior, which run in front of and behind the medial epicondyle, anastomosing with aa. collaterals ulnares superior et inferior. Thanks to these anastomoses, as well as the above anastomoses between the branches a. profunda brachii and a. radialis in the circumference of the elbow joint is obtained arterial network – rete articulare cubiti.
2. A. interossea communis, the common interosseous artery, goes to the interosseous membrane, at the proximal margin of which is divided into two branches:
a) a. interossea anterior to the anterior surface of the interosseous membrane reaches m. pronator quadratus, pierces the membrane and goes to the rear, where it ends in the rete carpi dorsale. At the beginning of your journey a. interossea anterior gives a. mediana (goes to the palm along with medianus), aa. diaphyseos radii et ulnae – to the bones of the forearm and rami musculares – to the surrounding muscles;
b) a. interossea posterior prohrdit through the upper opening of the interosseous membrane on the back side, gives a. interossea recurrens, lies between the superficial and deep extensor layers and anastomose in the wrist area with a. interossea anterior.
3. Ramus carpeus palmaris, the palmar carpal branch, goes towards the same-named branch of the radial artery, with which it anastomoses.

Radial artery, a. radialis Branches of the radial artery

Radial artery, a. radialis, the direction is a continuation of the brachial artery. It goes medially from m. brachioradialis, first covered by it, and later in sulcus radialis; in the lower third of the forearm, where the muscles pass into the tendons, the radial artery is covered from the surface only with the fascia and skin, which is why it serves because of easy accessibility for the study of the pulse. Reaching the top of the styloid process of the radius, a. The radialis passes to the rear, bending around the lateral edge of the wrist and lying down in the so-called snuff box, from where it goes to the palm in the first interosseous gap between the bases I and II of the metacarpal bones. In the palm, the radial artery along with the deep branch a. ulnaris forms the arcus palmaris profundus – a deep palmar arch.

The branches of the radial artery:
1. A. recurrens radialis, the return radial artery, begins in the ulnar fossa, goes in the proximal direction to the front surface of the lateral epicondyle, where it anastomoses with the above a. collateralis radialis of a. produnda brachii.
2. Rami musculares – to the surrounding muscles.
3. Ramus carpeus palmaris, the palm of the carpal branch, begins at the bottom of the forearm and goes to the elbow towards a similar branch from a. ulnaris. From anastomosis with ramus carpeus palmaris a. ulnaris on the palmar surface of the wrist is formed of rete carpi palmare.
4. Ramus palmaris superficialis, the superficial palmar branch, passes over the thenar or pierces its surface layers and, connected to the end of the ulnar artery, enters the arcus palmaris superficialis
5. Ramus carpeus dorsalis, the back carpal branch, moves away in the “snuffbox” area and with the eponymous branch a. ulnaris forms a network on the rear of the wrist, a rete carpi dorsale, which also receives branches from the interosseous arteries (aa. interosseae anterior et posterior).
6. A. metacarpea dorsalis prima, the first dorsal metacarpal artery, goes on the back of the hand to the radial side of the index finger and to both sides of the thumb.
7. A. princeps pollicis, the first artery of the thumb, moves away from the radial one as soon as the last penetrates the first interosseous gap into the palm, goes along the palm of the I metacarpal and divides into branches, aa. digitalis palmares, to both sides of the thumb and to the ray side of the index finger.

Brachial artery. Branches of the brachial artery: deep artery of the shoulder, upper and lower ulnar artery.

Brachial artery, a. brachialis, is a direct continuation of the axillary artery. Starting at the bottom edge m. teres major, it stretches into sulcus bicipitalis up to the elbow bend, where at the level of the neck the radial bone is divided into its final branches – the radial and ulnar arteries. On its way to sulcus bicipitalis medialis, it is accompanied by two brachial veins and nerves (n. Medianus, n. Ulnaris, n. Cutaneus brachii medialis et n. Cutaneus antebrachii medialis). In addition to small branches to the bone and muscles, the brachial artery gives the following branches:

1. A. profunda brachii, deep artery of the shoulder, moving away from a. brachialis shortly after the start of the latter; It is a large branch that, together with n. radialis, passes into canalis humeromuscu-laris, gives in its path an artery that feeds the humerus {a. diaphyseos humeri), and splits into a. collateralis media penetrating the thickness m. triceps and anastomosing with a. interossea recurrens (from a. interossea posterior), and a. collateralis radialis; the latter comes to the surface through the lower opening of the spiral canal, goes anterior to the epicondylus lateralis and anastomoses with a. recurrens radialis (branch a. radialis). The deep brachial artery often (50%) departs along with other branches of the brachial or axillary arteries or (30%) is absent.

2. A. collateralis ulnaris superior, superior ulnar collateral artery, extends from the brachial artery in the middle of the shoulder, descends into the sulcus behind the epicondylus medialis, where it anastomoses with a. recurrens ulnaris posterior (branch a. ulnaris).

3. A. collateralis ulnaris inferior, the lower ulnar collateral artery, extends from the brachial artery about 5 cm above the end of the latter and anastomizes anteriorly from the epicondylus medialis with a. recurrens ulnaris anterior (branch a. ulnaris).