Axillary artery, a. axillaris The branches of the axillary artery.

The axillary artery is a direct continuation of the subclavian artery, a. axillaris, which in turn continues into the brachial artery. The proximal border of the axillary artery trunk is the outer edge of the I rib, the distal border is the lower edge m. teres major (the origin of the brachial artery). The axillary artery lies in cavitas axillaris medially from the shoulder joint and the humerus; front and medial it is located v. axillaris and on three sides – the nerve trunks of the brachial plexus; From below, this neurovascular bundle is covered with skin, fascia, and accumulation of fatty tissue that contains lymph nodes.

In the course of a. axillaris distinguish three divisions:
1) from the clavicle to the upper edge, m. pectoralis minor (trigonum clavipectorale);
2) behind this muscle (trigonum pectorale);
3) from the bottom edge m. pectoralis minor to the bottom edge m. pectoralis major (trigonum subpectorale).

Branches a. axillaris in clagonpectorale trigonum:
1. A. thoracica superior, superior thoracic artery, forks into m. subclavius, both pectoral muscles, m. serratus anterior to the nearest intercostal muscles.
2. A. thoracoacromialis, hematoacromial, takes part in the nutrition of the shoulder joint, m. deltoideus and both pectoral muscles. In trigonum pectorale:
3. A. thoracica lateralis, the lateral pectoral artery, descends along the side wall of the rib cage and sends branches to the mammary gland and surrounding mshtsam.

In trigonum subpectorale:
4. A. subscapulars, the subscapularis artery, the largest branch of the axillary artery, begins near the lower margin m. subscapularis and goes down along this muscle, giving it branches; soon divided into two trunks:
a) a. The circumflexa scapulae leaves through the foramen trilaterum to the dorsal surface of the scapula, where it anastomoses with a. suprascapularis;
b) a. thoracodorsalis serves as a continuation of the subscapularis artery along the lateral edge of the scapula.
5. A. circumflexa humeri posterior, the posterior artery, which goes around the humerus, goes back to the foramen quadrilaterum, bypassing the surgical neck of the humerus behind; covered with deltoid muscle, which she gives branches.
6. A. circumflexa humeri anterior, the anterior artery that goes around the humerus, begins at the same level as the previous one, goes in the lateral direction, bends around the surgical neck of the shoulder from the front, anastomizing with the posterior surrounding artery, and gives branches to the muscles and shoulder joint .

All the branches of the axillary artery are widely anastomized with the branches of the subclavian artery; therefore, the ligation of the axillary artery is higher than a discharge from it a. subscapularis is more profitable than applying a ligature below. Also, ligation of the subclavian artery in its initial part often leads to gangrene, while ligation distal to the discharge of the truncus thyrocervicalis does not give such complications.

Subclavian artery, a. subclavia. The branches of the first division of the subclavian artery.

Left subclavian artery only, a. subclavia, refers to the number of branches extending from the aortic arch directly, while the right branch is the branch of truncus brachiocephalicus.

The artery forms a convex upward arc, enveloping the dome of the pleura. She leaves the chest cavity through apertura superior, approaches the collarbone, lies down in sulcus a. subclaviae I ribs and bends over it. Here, the subclavian artery can be pressed to stop bleeding to the I rib behind tuberculum m. scaleni. Then the artery continues into the axillary fossa, where, starting from the outer edge of the I rib, it is called a. axillaris On its way, the subclavian artery goes along with the brachial nerve plexus through the spatium interscalenum, so there are 3 sections: the first is from the beginning to the entrance to the spatium interscalenum, the second is in the spatium interscalenum and the third is at the exit from it, before going to a . axillaris

The branches of the first division of the subclavian artery (before entering the spatium interscalenum):
1. A. vertebralis, vertebral artery, the first branch extending upward between m. scalenus anterior and m. longus colli, is sent to the foramen processus transversus VI of the cervical vertebra and rises up through the holes in the transverse processes of the cervical vertebrae to the membrana atlantooccipitalis posterior, which, through the foramen magnum of the occipital bone, enters the cranial cavity. In the cranial cavity, the vertebral arteries of the one and the other sides converge to the midline and merge into one unpaired basilar artery near the posterior edge of the bridge, a. basilaris. On its way, it gives small branches to the muscles, spinal cord and hard shell of the occipital lobes of the brain, as well as large branches:
a) a. spinalis anterior departs in the cavity of the skull near the confluence of two vertebral arteries and goes down and to the midline towards the artery of the same side of the opposite side, from which it merges into one trunk;
b) a. The spinalis posterior departs from the vertebral artery immediately after it enters the cranial cavity and is also directed down the sides of the spinal cord. As a result, three arterial trunks descend along the spinal cord: unpaired – on the front surface (a. Spinalis anterior) and two paired – on the posterolateral surface, one on each side (aa. Spinales posteriores). All the way to the lower end of the spinal cord, they receive reinforcements in the form of rr through the intervertebral holes. spinales: in the neck – from aa. vertebrales, in the thoracic – from aa. intercostales posteriores, in lumbar – from aa. lumbales. Through these branches, the anastomoses of the vertebral artery are established with the subclavian artery and the descending aorta;
c) a. Cerebelli inferior posterior is the largest of the branches a. vertebralis, starts near the bridge, goes back and, bypassing the medulla oblongata, forks on the lower surface of the cerebellum.

A. basilaris, the basilar artery, is obtained from the fusion of both vertebrates, unpaired, lies in the median sulcus of the bridge, at the front edge of it is divided into two aa. cerebri posteriores (one on each side), which are directed back and up, bend around the lateral surface of the legs of the brain and branch out on the lower, inner and outer surfaces of the occipital lobe. Taking into account the above aa. communicantes posteriores from a. carotis interna, posterior cerebral arteries are involved in the formation of the arterial circle of the brain, circulus arteriosus cerebri. From the trunk a. The basilaris branch off small branches to the bridge, into the inner ear, passing through meatus acusticus internus, and two branches to the cerebellum: a. cerebelli inferior anterior and a. cerebelli superior.

A. vertebralis, which runs parallel to the trunk of the common carotid artery and participates along with it in the blood supply to the brain, is a collateral vessel for the head and neck. Merged into one trunk, a. basilaris, two vertebral arteries and two aa fused into one trunk. spinales anteriores, form the arterial ring, which, along with the circulus arteriosus cerebri – the Willisian arterial circle, is important for the collateral circulation of the medulla.

2. Truncus thyrocervicalis, the thymus, moves away from a. subclavia up at the medial edge m. The scalenus anterior, has a length of about 4 cm and is divided into the following branches: a)
a. thyroidea inferior goes to the posterior surface of the thyroid gland, renders a. laryngea inferior, which branches in the muscles and mucous membrane of the larynx and anastomoses with a. laryngea superior; branches to the trachea, esophagus and thyroid gland; the latter anastomose with branches a. thyroidea superior from system a. carotis externa;
b) a. cervicalis ascendens rises above m. scalenus anterior and supplies deep neck muscles;
c) a. The suprascapularis goes from the trunk downwards and laterally to the incusura scapulae, and bending over lig. transversum scapulae, branched in the dorsal muscles of the scapula; anastomoses with a. circumflexa scapulae.

3. A. thoracica interna, internal artery moving away from a. subclavia versus beginning a. vertebralis, goes down and medially, adjacent to the pleura; starting from the I rib cartilage, goes vertically downwards at a distance of about 12 mm from the edge of the sternum. Reaching the bottom edge of VII rib cartilage, a. thoracica interna is divided into two final branches: a. musculophrenica stretches laterally along the line of attachment of the diaphragm, giving to it both the nearest intercostal spaces of the branch and a. epigastrica superior – continues the way a. down thoracica interna, penetrates the vagina of the rectus abdominis muscle and, reaching the level of the navel, anastomose with a. epigastica inferior (from a. iliaca externa).

On the way a. thoracica interna gives branches to the nearest anatomical structures: connective tissue of the anterior mediastinum, thymus gland, lower end of the trachea and bronchi, to the six upper intercostal spaces and the mammary gland. Its long branch, a. pericardiacophrenica, together with n. phrenicus goes to the diaphragm, giving branches along the path to the pleura and pericardium. Her rami intercostales anteriores run in the upper six intercostal spaces and anastomose with aa. intercostales posteriores (from the aorta).

Branches of the internal carotid artery

1. Rr. caroticotympanici penetrating the tympanic cavity.
2. A. ophthalmica, the ophthalmic artery, penetrates through the canalis opticus into the cavity of the orbit along with n. opticus, where it splits into its final branches. On the way to the eye socket gives a number of branches.

Branches a. ophthalmica:
1) to the dura mater of the brain, anastomosing with a. meningea media (branch a. maxilaris from system a. carotis externa);
2) to the lacrimal gland a. lacrimalis;
3) to the eyeball aa. ciliares, ending in the choroid; among them a. centralis retinae, penetrates into the optic nerve and, with it, forks into the retina;
4) to the muscles of the eyeball;
5) to the aa centuries. palpebralis laterales et mediales;
6) to the mucous membrane of the nasal cavity aa. ethmoidales anterior et posterior;
7) a. supraorbitalis emerges from the orbit through incisura supraorbitalis;
8) a. dorsalis nasi descends along the edge of the back of the nose.

3. A cerebri anterior, the smaller cerebral artery, moves forward and medially to the beginning of the longitudinal groove of the brain, bends around the corpus calorus and stretches back along the inner surface of the brain hemisphere to the beginning of the occipital lobe, giving it back to the cortex. At the beginning of the longitudinal groove of the brain connects with the same side artery of the other side with the help of the transverse stem, a. communicans anterior.

Internal carotid artery.

A. carotis interna, the internal carotid artery, starting from the common carotid artery, rises to the base of the skull and enters the canalis caroticus of the temporal bone. In the neck it does not give branches; at the very beginning lies outwards from a. carotis externa, respectively, the development of the lateral trunk of the dorsal aorta, but soon begins to go to the medial surface of the latter. According to the curvature of canalis caroticus, the internal carotid artery, passing first vertically in it, then bends in the anteromedial direction and, at the apex of the temporal bone, enters the cranial cavity through the foramen lacerum; curving upward, it rises along the sulcus caroticus of the sphenoid bone, turns back forward at the bottom of the Turkish saddle, passes through the thickness of the cavernous sinus, and in the canalis opticus makes the last bend upwards and backwards, giving its first branch, a. ophthalmica, after which it pierces the hard and spider shells and, finally, is divided into its final branches.

The branches of the maxillary artery. Segments of the maxillary artery (a. Maxillaris).

The branches of the first division of the maxillary artery go up to the external auditory canal, into the tympanum, where they penetrate through the fissura petrotympanica; to the hard shell of the brain – a. meningea media, the average meningeal artery (the largest branch), where it penetrates through the foramen spinosum, and down to the lower teeth, a. alveolaris inferior, inferior alveolar artery. The latter passes into the lower jaw through canalis mandibulae. Before joining the channel a. alveolaris inferior gives r. mylohyoideus to the muscle of the same name, and in the canal supplies the lower teeth with its branches and leaves it through the foramen mentale, receiving the name a. mentalis (submental artery), which branches in the skin and muscles of the chin.

The branches of the second section of the maxillary artery go to all the masticatory and cheek muscles, getting the names corresponding to the muscles, as well as to the sinus maxillaris mucosa and the upper molars – aa. alveolares superiores posteriores, posterior superior alveolar arteries.

The branches of the third division of the maxillary artery:

1) a. The infraorbital, the infraorbital artery, enters through the fissura orbitalis inferior into the eye socket, then through the canalis infraorbitalis enters the front surface of the upper jaw and sends branches to the lower eyelid, to the lacrimal sac and down to the upper lip and cheek. Here, she anastomoses with the branches of the facial artery, so that if there is difficulty in the blood flow in the trunk, a. maxillaris blood to its pool can flow through a. facialis. Still in the eye socket a. infraorbitalis gives branches to the muscles of the eyeball; passing in the infraorbital canal, it supplies canines and incisors {aa. alveolares superiores anteriores) and sinus maxillaris mucosa;

2) branches to the palate, pharynx and the auditory tube, some of which descend down to the canalis palatinus major, comes out through the foramina palatina majus et minores and forks in a hard and soft palate;

3) a. sphenopalatina, the sphenoid-palatine artery, penetrates through the eponymous opening into the nasal cavity, giving branches to its lateral wall and to the septum; the front of the nose gets blood through aa. ethmoidales anterior et posterior.

The middle group of branches of the external carotid artery: ascending pharyngeal artery, superficial temporal artery, maxillary artery.

1. A. pharyngea ascendens, the ascending pharyngeal artery, is directed upwards along the pharyngeal wall, supplying it with a soft palate, palatine tonsil, auditory tube, tympanic cavity, and a hard shell of the brain.

2. A. temporalis superficialis, the superficial temporal artery, one of the two terminal branches of the external carotid artery, proceeds as a continuation of the trunk a. carotis externa in front of the external auditory canal to the temple, located under the skin on the fascia of the temporal muscle. Here the artery can be pressed against the temporal bone. Its terminal branches, ramus frontalis and ramus parietalis, branch in the region of the vertex and temple. On the way, it gives branches to the parotid gland, to the lateral surface of the auricle and to the external auditory canal; part of the branches goes to the back of the face, to the outer corner of the eye, to m. orbicularis oculi and zygomatic bone. A. temporalis superficialis also supplies m. temporalis.

3. A. maxillaris, the maxillary artery, is another terminal branch of the external carotid artery. Its short trunk is divided into three sections to facilitate the study of branches: the first goes around the neck of the jaw, the second passes into the fossa infratemporalis on the surface m. pterygofdeus lateralis, third penetrates fossa pterygopalatina.

External carotid artery, a. carotis externa. Anterior group of branches of the external carotid artery. Triangle Pirogov.

External carotid artery, a. carotis externa, supplies blood to the outer parts of the head and neck, which is why it received the name of the external part, unlike the internal carotid artery, which penetrates the cavity of the skull. From the place of its origin, the external carotid artery rises upward, passes inwards from the posterior abdomen m. digastrici and m. stylohyoideus, pierces the parotid gland and behind the neck of the condylar process of the mandible, splits into its final branches.

The branches of the external carotid artery for the most part are remnants of arterial arcs and nourish organs arising from the gill arches. They go (number 9) as if along the radii of a circle corresponding to the head, and can be divided into three groups of three arteries in each — anterior, middle, and posterior groups, or triples.

The anterior group is caused by the development and location of the organs supplied by the arteries of this group and derived from the gill arches, namely: the thyroid gland and the larynx – a. thyroidea superior, tongue – a. lingualis and face – a. facialis.

1. A. thyroidea superior, the upper artery of the thyroid gland, which leaves the external carotid artery immediately above its beginning, goes down and forward to the thyroid gland, where it anastomoses with other thyroid arteries. Along the way gives a. laryngea superior, which together with n. laryngeus superior pierces lig. thyrohyoideum and supplies the branches of the muscles, ligaments and mucous membrane of the larynx.

2. A. lingualis, the lingual artery, departs at the level of the large horns of the hyoid bone, goes up through the Pirogov triangle, covered with m. hyoglossus, and goes to the tongue. Before joining, it gives branches to the hyoid bone, the palatine tonsils and the hyoid gland. Entering the tongue, the lingual artery trunk extends to the tip of the tongue called a. profunda linguae, which along the way gives multiple branches to the back of the tongue, rr. dorsales linguae.

3. A. facialis, the facial artery, departs somewhat higher than the previous one at the level of the angle of the mandible, runs medially from the posterior abdomen m. digastricus and reaches the leading edge m. masseter, where she bends over the edge of the jaw on the face. Here, ahead of m. masseter, it can be pressed to the lower jaw. Then it goes to the medial corner of the eye, where the end branch (a. Angularis) anastomoses with a. dorsalis nasi (a. ophthalmica branch from the system of the internal carotid artery). To bend through the lower jaw, it gives branches to nearby formations: to the pharynx and soft palate, to the tonsils, to the submandibular gland and the diaphragm of the mouth, to the salivary glands; after the bend – to the upper and lower lips.

Common carotid artery.

Common carotid artery, a. carotis communis (cara – plunge into sleep), develops from the ventral aorta over the 3rd to 4th aortic arches; on the right, it departs from truncus brachiocephalicus, on the left, independently from the aortic arch. The common carotid arteries are directed up the sides of the trachea and esophagus. The right common carotid artery is shorter than the left, since the latter consists of two sections: the thoracic (from the aortic arch to the left sternoclavicular joint) and the cervical, the right only from the cervical. A carotis communis passes into the trigonum caroticum and at the level of the upper edge of the thyroid cartilage or the body of the hyoid bone is divided into its final a. carotis externa et a. carotis interna (bifurcation). The common carotid artery is pressed to stop bleeding to the tuberculum caroticum VI of the cervical vertebra at the level of the lower edge of the cricoid cartilage. Sometimes, the external and internal carotid arteries do not depart from the common trunk, but independently from the aorta, which reflects the nature of their development. From the trunk a. carotis communis all over the small branches for the surrounding vessels and nerves – vasa vasorum and vasa nervorum, which can play a role in the development of collateral circulation around the neck.

The branches of the ascending part of the aorta.

The branches of the aortic arch. Shoulderhead. The branches of the ascending part of the aorta. Since, according to the law of the shortest distance, the heart from which it comes out lies closest to the aorta, the first vessels extending from the aorta are its branches to the heart – aa. coronariae dextra et sinistra, described above.

The branches of the aortic arch. From the concave side of the aortic arch, the arteries move to the bronchi and to the thymus, and from the convex side of the arch, three trunks go from right to left: truncus brachiocephalicus, a. carotis communis sinistra and a. subclavia sinistra.

The brachiocephalic trunk, truncus brachiocephalicus, about 3–4 cm long, represents the remnant of the right ventral aorta of the embryo; it goes obliquely up, back and to the right, being located in front of the trachea, where it gives a branch to the thyroid gland – a. thyroidea ima, and is divided behind its right branches: right common carotid and right subclavian arteries behind the right sternoclavicular joint.

Veins of the small (pulmonary) circulation.

Pulmonary veins. Venae pulmonales, pulmonary veins, carry arterial blood from the lungs to the left atrium. Starting from the capillaries of the lungs, they merge into larger veins, reaching the bronchi, segments and lobes, respectively, and in the gates of the lungs they form large trunks, two trunks from each lung (one is the top, the other is the bottom) to the left atrium and fall into its upper wall, each trunk flows into a separate hole: the right – at the right, left – at the left edge of the left atrium. The right pulmonary veins on the way to the left atrium cross transversely the back wall of the right atrium. The symmetry of the pulmonary veins (two on each side) is obtained because the trunks extending from the upper and middle lobes of the right lung merge into one trunk. The pulmonary veins are not completely separated from the veins of the pulmonary circulation, as they anastomose with the bronchial veins flowing into the v. azygos. Valves pulmonary veins do not have.