Brachial artery

Introduction:
Brachial artery is the main arterial supply of the upper limb providing the blood supply
to nearly all of its structures. It is a medium sized artery and is actually a continuation of
the axillary artery from the region of the axilla into the arm.

brachial artery

Origin and termination of Brachial artery:

Brachial artery originates at the inferior border of the teres major muscle as a
continuation of the axillary artery into the arm. It terminates in the cubital fossa at the
level of the neck of the radius bone and divides into two terminal braches; the ulnar
artery and the radial artery.
Course of Brachial artery:
Brachial artery is rather superficial in its course. It is overlapped from the lateral side by
biceps brachii muscle. It lies upon the triceps and the coracobrachialis muscles. In the
proximal region the artery lies medial to the humerus where it is palpable. In the lower
part of its course the artery gains an anterior position relative to the humerus. The
brachial artery accompanies the median nerve which crosses it from lateral to medial
side in the middle of the arm.

brachial artery scheme

Branches of Brachial artery:

Brachial artery has following important branches;

1. Muscular branches: It supplies all the muscles of arm directly or through

its branches.
2. Nutrient artery to the humerus:
3. Deep artery of the arm (Profunda brachii artery): Profunda brachii
artery arises from medial and posterior part of brachial artery as a large branch just
 below the lower border of teres major muscle. It closely follows the radial nerve and
passes between the lateral and medial heads of triceps muscle. After passing through
the radial grove of humerus along the radial nerve, it pierces the lateral
intermuscular septum and reaches the front of lateral epicondyle of humerus. It ends
by anastomosing with the radial recurrent artery.
Profunda brachii artery supplies the deltoid muscle (which is primarily supplied by the
posterior circumflex humeral artery) and occasionally also gives an unusual nutrient
artery to the humerus. At its end, it takes part in the formation of anastomoses
around elbow joint.
4. Superior ulnar collateral artery: It is a small sized artery arising from
the brachial artery just below the middle of the arm. It pierces the medial
intermuscular septum of the arm and reaches behind the medial epicondyle of
humerus. It ends by taking part in anastomoses around the elbow joint.
5. Inferior ulnar collateral artery: It arises from brachial artery about two
and half inches above the elbow joint. Near its origin it pierces the medial
intermuscular septum and reaches behind the medial epicondyle of humerus. It ends
by taking part in anastomoses around the elbow joint.
6. Radial artery
7. Ulnar artery

AXILLARY ARTERY
Introduction:
Axillary artery is the continuation of the subclavian artery into the axilla. The artery is
closely related to the cords of the brachial plexus and in fact the cords of the brachial
plexus are named according to their relation with the second part of the axillary artery;
the posterior cord of the brachial plexus lies posterior to the second part of the axillary
artery, the medial cord lies medial and the lateral cord lies lateral to it.
 axillary artery

Origin and termination of axillary artery:

The axillary artery begins at the lateral border of the first rib as a continuation of the
subclavian artery into the axilla. It terminates at the lower border of the teres major
muscle and then continues downward in the arm as the brachial artery.

Parts of the axillary artery:

The axillary artery is customarily divided into three parts;

1st part of axillary artery: It lies between the lateral border of the first rib and the
medial border of the pectoralis minor muscle. It gives one branch named as the “highest
thoracic artery”.
2nd part of the axillary artery: It lies under the pectoralis minor muscle. It gives two
branches; the lateral thoracic artery and the thoracoacromial artery. The lateral thoracic
artery continues downward along the lateral border of pectoralis minor. The
thoracoacromial artery divides into 4 terminal branches namely acromial branch,
clavicular branch, deltoid branch and pectoral branch.
3rd part of axillary artery: It lies between the lateral border of pectoralis minor and
the lower border of the teres major muscle. It gives three branches; the subscapular
artery, the anterior circumflex humeral artery and the posterior circumflex humeral
artery.

Branches of the axillary artery:

In the lines below, I have provided the details of each branch of axillary artery.

Highest thoracic artery:

It passes between the pectoralis major and minor muscles to the side of the chest and
supplies blood to the first and second intercostals spaces and to the superior portion of
serratus anterior muscle. It ends by anastomosing with internal mammary and
intercostals arteries.

Lateral thoracic artery:

It supplies blood to lateral structures of thorax and breast. Muscles supplied by this
branch include the serratus anterior muscle, pectoralis major muscle and subscapularis
muscle. It also supplies the axillary lymph nodes. It ends by anastomosing with internal
thoracic artery and intercostals arteries. In females it gives an external mammary
branch to supply the breast.

Thoracoacromial artery
It gives 4 branches immediately after its origin from second part of axillary artery. The
branches are;

• Pectoral Branch: It descends between the pectoralis major and minor, and
supplies the mammary gland. It ends by anastomosing with intercostals branches of
internal mammary artery.
 • Acromial branch: It supplies the deltoid muscle and runs laterally over the
coracoids process. It ends on acromion in an arterial network formed by branches
from the suprascapular, thoracoacromial, and posterior humeral circumflex arteries.
• Clavicular branch: It supplies the sternoclavicular joint and the subclavius muscle.
• Deltoid branch: It supplies the pectoralis major and deltoid muscle.
Subscapular artery: It is the largest branch of axillary artery. It follows the
subscapularis muscle to inferior angle of scapula where it anastomoses with lateral
thoracic and intercostals arteries. It forms the arterial anastomoses around scapula.
Anterior circumflex humeral artery: It is considerably smaller than the posterior
circumflex artery. It supplies the shoulder joint and the head of the humerus. It takes
part in the formation of anastomoses around the shoulder joint.
Posterior circumflex humeral artery: It passes through the quadrangular space and
winds around the neck of humerus. It supplies the deltoid muscle and shoulder joint. It
takes part in the formation of anastomoses around shoulder joint.

RADIAL ARTERY
Introduction:

Radial artery is one of the two arteries of the forearm (the other is ulnar artery). It lies to the lateral side along
the radius bone according to which it is named. The radial artery is the smaller of the two terminal
braches of the brachial artery.

Origin and termination of Radial artery:

The radial artery originates as the smaller terminal branch of the brachial artery in the elbow region at the level
of head of the radius bone. It lies on the lateral side on the forearm and ends by taking part in the deep palmar
arch of hand.

Course of Radial artery:

It runs inferolaterally under cover of brachioradialis muscle. Then it lies lateral to flexor carpi radialis tendon in
distal forearm and finally it winds around lateral aspect of radius and crosses the floor of anatomical snuff box
to pass between the two heads of first dorsal interosseous muscle and take part in forming the deep palmar arch
of the hand.

Branches of Radial artery:

Branches of radial artery can be divided into three groups according to the region of upper limb where they
arise;

In the forearm:
1. Radial recurrent artery: It arises from the lateral side just below the
origin of radial artery and passes upward to anastomoses with the radial collateral
branch of Profunda brachii artery. It helps in the formation of anastomoses near the
elbow joint.
2. Palmar carpal branch: It arises near the lower border of pronator
quadratus muscle. It runs across the fond of the wrist and ends by anastomosing
with palmar carpal branch of ulnar artery.
 3. Superficial palmar branch: It arises from medial side of radial artery just
when it is winding around the lateral side of the wrist. It ends by anastomosing with
the terminal portion of ulnar artery, thus completing the superficial palmar arch of
hand.

radial artery
At the wrist:
1. Dorsal carpal branch: It is a small vessel arising from the radial artery
that anastomoses with corresponding branch coming from the ulnar artery to form
the dorsal carpal arch of hand.
2. First dorsal metacarpal artery: It arises just before the radial artery
passes between the two heads of the first dorsal interosseous muscle. It divides into
two branches to supply the adjacent sides of thumb and index finger.
In the hand:
 1. Princeps pollicis artery: It is also known as the principal artery of the
thumb. It arises from the radial artery just at the point where it turns to the medial
side of the hand. It supplies the lateral part of the thumb.
2. Radialis indicis artery: It is the radial artery of index finger. It arises near
the origin of princeps pollicis artery, and runs between the heads of first dorsal
interosseous muscle to reach the lateral side of index finger. It supplies blood to the
index finger.
3. Deep palmar arch: It exists as an arterial network found in the palm,
formed by terminal part of radial artery and deep palmar branch of ulnar artery.

Radial artery in the hand:

The radial artery leaves the lower end of the radius and slopes across the snuffbox over the trapezium and so
passes into the hand between the two heads of the first dorsal interosseous muscle. Lying now between this
muscle and adductor pollicis it gives off two large branches. The arteria radialis indicis passes distally between
the two muscles to emerge on the radial side of the index finger, which it supplies. The princeps pollicis artery
passes distally along the metacarpal bone of the thumb and divides into its two palmar digital branches at the
metacarpal head. The main trunk of the radial artery now passes into the palm between the oblique and
transverse heads of adductor pollicis to form the deep palmar arch.

The deep palmar arch is an arterial arcade formed by the terminal branch of the radial artery anastomosing with
the deep branch of the ulnar artery. Unlike the superficial arch the deep arch is usually complete. The radial
artery gains the palm by passing between the oblique and transverse heads of adductor pollicis, and runs across
the palm at a level about 1 cm proximal to the superficial arch. The deep branch of the ulnar nerve lies within
the concavity of the deep arch. From its convexity three palmar meta carpal arteries pass distally and in the
region of the metacarpal heads they anastomose with the common palmar digital branches of the superficial
arch. Branches perforate the interosseous spaces to anastomose with the dorsal metacarpal arteries.
Accompanying veins drain most of the blood from the palm into the dorsal venous network. Branches from the
anterior carpal arch also anastomose with the deep arch.

For a visual assessment of the contribution of the radial and ulnar arteries in the blood supply of the hand, make
a clenched fist and occlude the radial and ulnar arteries. When the fist is released the skin of the palm is seen to
be pale, but color should return rapidly on the release of either one of the arteries. If there is an obvious delay
after releasing the ulnar artery compared with the radial, it suggests that the radial supply is dominant and that
procedures that might damage the radial artery (such as cannulation) should be avoided.
External carotid artery
Artery: External carotid artery

Arteries of the neck - right side. The external carotid artery arises from the common carotid artery - labeled Common caroti on the figure.

Plan of branches of internal maxillary artery. (External carotid labeled at bottom left.)

Latin arteria carotis externa

Gray's subject #144 551

 Source common carotid artery

Branches superior thyroid, lingual, facial,ascending pharyngeal, occipital,posterior auricular, maxillary, superficial temporal

MeSH Carotid+Artery,+External

In human anatomy, the external carotid artery is a major artery of the head and neck. It arises from
the common carotid artery when it bifurcates into the external and internal carotid artery.

[edit]Course

The external carotid artery begins at the level of the upper border of thyroid cartilage, and, taking a slightly
curved course, passes upward and forward, and then inclines backward to the space behind the neck of
the mandible, where it divides into the superficial temporal andmaxillary artery within the parotid gland.

It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches
given off from it.

In the child, it is somewhat smaller than the internal carotid; but in the adult, the two vessels are of nearly
equal size. At its origin, this artery is more superficial, and placed nearer the middle line than the internal
carotid, and is contained within the carotid triangle.

[edit]Relations

The external carotid artery is covered by the skin, superficial fascia, Platysma, deep fascia, and anterior
margin of theSternocleidomastoideus; it is crossed by the hypoglossal nerve, by
the lingual, ranine, common facial, and superior thyroid veins; and by the Digastricus and Stylohyoideus;
higher up it passes deeply into the substance of the parotid gland, where it lies deep to the facial nerveand
the junction of the temporal and internal maxillary veins.

Medial to it are the hyoid bone, the wall of the pharynx, the superior laryngeal nerve, and a portion of
the parotid gland.

Lateral to it, in the lower part of its course, is the internal carotid artery.

Posterior to it, near its origin, is the superior laryngeal nerve; and higher up, it is separated from
the internal carotid by the Styloglossusand Stylopharyngeus, the glossopharyngeal nerve, the pharyngeal
branch of the vagus, and part of the parotid gland.
Branches

Branches of external carotid artery

From inferior to superior:

 Arising in carotid triangle[1]**

 Superior thyroid artery-(arise from anterior aspect)

 Ascending pharyngeal artery-(arise from medial(deep)aspect)

 Lingual artery-(arise from anterior aspect)

 Facial artery-(arise from anterior aspect)

 Occipital artery-(arise from posterior aspect)

  Posterior auricular artery-(arise from posterior aspect)

 Terminal branches

 Maxillary artery

 Superficial temporal artery

Mnemonics
Mnemonics are traditionally used to commit these branches to memory.[2] Perhaps referring to the medical
school interviewing process, a commonly taught mnemonic for the external carotid branches is "Some
Attendings Like Freaking Out Potential Medical Students." A similar but more memorable and vulgar
mnemonic omits the minor Occipital . Another is "Some Ancient Lovers Find Old Positions More
Stimulating." As well as, "Some Anatomists Like Fornicating, Others Prefer S & M" and "Some angry lady
figured out PMS."

[edit]Older versions
A memorable mnemonic appears in Samuel Shem’s classic novel The House of God (1978). Here Shem
uses the older terms External maxillary artery for Facial artery and Internal maxillary artery for Maxillary
artery. TheAscending pharyngeal and Superior thyroid appear in their correct sequence, while the names
of the two terminal branches are reversed:
The internal carotid and vertebral arteries. Right side. Some of the branches labeled

Running through my mind, over and over like Muzak, was a mnemonic for the branches of the
external carotid artery: As She Lay Extended Olaf’s Potato Slipped In. And even there, the only
one I could remember was Olaf’s, which stood for Occipital. And what the hell use was that?

Additional images

The veins of the neck, viewed from in front.

 The veins of the thyroid gland.

Muscles of the pharynx, viewed from behind, together with the associated vessels and nerves.

Side of neck, showing chief surface markings.

Magnetic Resonance Angiography

Internal carotid artery

From Wikipedia, the free encyclopedia

Artery: Internal carotid artery

 Arteries of the neck. The internal carotid arteries arise from the common
carotid arteries - labeled Common caroti on the figure.

Latin arteria carotis interna

Gray's subject #146 566

Source common carotid artery

Branches ophthalmic artery, anterior choroidal artery, anterior

cerebral artery, middle cerebral artery, posterior

communicating artery

Vein internal jugular vein

Precursor aortic arch 3

MeSH Carotid+Artery,+Internal
 Dorlands Internal carotid artery

/ Elsevier

In human anatomy, the internal carotid arteries are major arteries of the head and neck that
supply blood to the brain. There is a left and a right internal carotid artery; each one arises
from the corresponding common carotid artery in the neck and divides in the brain into the
corresponding anterior cerebral artery and middle cerebral artery.
Classification
Terminologia Anatomica in 1998 subdivided the artery into four parts: "cervical", "petrous", "cavernous",
and "cerebral".[1][2] However, in clinical settings, the classification system of the internal carotid artery
follows the 1996 recommendations by Bouthillier,[3] and describes seven anatomical segments of the
internal carotid artery. The Bouthillier system is often used clinically by neurosurgeons, neuroradiologists
and neurologists. This nomenclature system is a clinical one, based on the angiographic appearance of the
artery and its relationship to surrounding anatomy, in contrast to an embryologic classification system. An
older clinical classification is based on work by Fischer in 1938 is also commonly used, as well as
classification schemes based on the embryologic anatomy of the carotid artery.

The segments of the internal carotid artery are as follows:

 Cervical segment, or C1, identical to the commonly used Cervical portion

 Petrous segment, or C2

 Lacerum segment, or C3

 C2 and C3 comprise the commonly used Petrous portion

 Cavernous segment, or C4, almost identical to the commonly used Cavernous portion

 Clinoid segment, or C5. This segment is not identified in some earlier classifications, and lies
between the commonly used Cavernous portion and Cerebral or Supraclinoid portion

 Ophthalmic, or supraclinoid segment, or C6

 Communicating, or terminal segment, or C7

 C6 and C7 together comprise the commonly used Cerebral or Supraclinoid portion

Course
Segments of the internal carotid artery, delineated on an MRA of the head.

The internal carotid artery is a terminal branch of the common carotid artery; it arises around the level of
the third cervical vertebra when the common carotid bifurcates into this artery and its more superficial
counterpart, the external carotid artery.

[edit]C1: Cervical segment

Level of 6th cervical vertebrae -- still at level of common carotid, but relationships are similar to those of cervical
segment of internal carotid.

The cervical segment, or C1, of the internal carotid extends from the carotid bifurcation until it enters
the carotid canal in the skull anterior to the jugular foramen.

At its origin, the internal carotid artery is somewhat dilated. This part of the artery is known as the carotid
sinus or the carotid bulb. The ascending portion of the cervical segment occurs distal to the bulb, when the
vessel walls are again parallel.

The internal carotid runs perpendicularly upward in the carotid sheath, and enters the skull through
the carotid canal. During this part of its course, it lies in front of the transverse processes of the upper three
cervical vertebrae.

It is relatively superficial at its start, where it is contained in the carotid triangle of the neck, and lies behind
and lateral to the external carotid, overlapped by the sternocleidomastoid muscle, and covered by the deep
fascia, the platysma, and integument: it then passes beneath theparotid gland, being crossed by
the hypoglossal nerve, the digastric muscle and the stylohyoid muscle, the occipital artery and
the posterior auricular artery. Higher up, it is separated from the external carotid by
the styloglossus and stylopharyngeus muscles, the tip of the styloid process and the stylohyoid ligament,
the glossopharyngeal nerve and the pharyngeal branch of the vagus nerve. It is in relation, behind, with
the longus capitis, the superior cervical ganglion of the sympathetic trunk, and the superior laryngeal
nerve; laterally, with the internal jugular vein and vagus nerve, the nerve lying on a plane posterior to the
artery; medially, with the pharynx, superior laryngeal nerve, and ascending pharyngeal artery. At the base
of the skull the glossopharyngeal, vagus, accessory, and hypoglossal nerves lie between the artery and the
internal jugular vein.

Unlike the external carotid artery, the internal carotid normally has no branches in the neck.

[edit]C2: Petrous segment

The petrous segment, or C2, of the internal carotid is that which is inside the petrous part of the temporal
bone. This segment extends until the foramen lacerum. The petrous portion classically has three sections:
an ascending, or vertical portion; the genu, or bend; and the horizontal portion.

When the internal carotid artery enters the canal in the petrous portion of the temporal bone, it first
ascends a short distance, then curves anteriorly and medially. The artery lies at first in front of
the cochlea and tympanic cavity; from the latter cavity it is separated by a thin, bony lamella, which is
cribriform in the young subject, and often partly absorbed in old age. Farther forward it is separated from
the trigeminal ganglion by a thin plate of bone, which forms the floor of the fossa for the ganglion and the
roof of the horizontal portion of the canal. Frequently this bony plate is more or less deficient, and then the
ganglion is separated from the artery by fibrous membrane. The artery is separated from the bony wall of
the carotid canal by a prolongation of dura mater, and is surrounded by a number of small veins and by
filaments of the carotid plexus, derived from the ascending branch of the superior cervical ganglion of the
sympathetic trunk.

The named branches of the petrous segment of the internal carotid artery are:

 the vidian artery or artery of the pterygoid canal

 the caroticotympanic artery

[edit]C3: Lacerum segment

The lacerum segment, or C3, is a short segment that begins above the foramen lacerum and ends at
the petrolingual ligament, a reflection of periosteum between the lingula and petrous apex (or petrosal
process) of the sphenoid bone. The lacerum portion is still considered to be 'extra-dural', as it is
surrounded by periosteum and fibrocartilage along its course. The lacerum segment normally has no
named branches, though the vidian artery may occasionally arise from this segment. It is erroneously
stated in several anatomy text books that the internal carotid artery passes through the foramen lacerum.
This at best has only ever been a partial truth in that it passes through the superior part of the foramen on
its way to the cavernous sinus. As such it does not exit the skull through it. The inferior part of the foramen
is actually filled with fibrocartilage. Recent consensus is that the Internal Carotid Artery should not be
described as travelling through the foramen lacerum. [4]

[edit]C4: Cavernous segment

Oblique section through the cavernous sinus.

The cavernous segment, or C4, of the internal carotid artery begins at the petrolingual ligament and
extends to the proximal dural ring, which is formed by the medial and inferior periosteum of the anterior
clinoid process. The cavernous segment is surrounded by the cavernous sinus.

In this part of its course, the artery is situated between the layers of the dura mater forming the cavernous
sinus, but covered by the lining membrane of the sinus. It at first ascends toward the posterior clinoid
process, then passes forward by the side of the body of the sphenoid bone, and again curves upward on
the medial side of the anterior clinoid process, and perforates the dura mater forming the roof of the sinus.
This portion of the artery is surrounded by filaments of the sympathetic trunk, and on its lateral side is
the abducent nerve, or cranial nerve VI.

The named branches of the cavernous segment are:

 the meningohypophyseal artery

 the inferolateral trunk

The cavernous segment also gives rise to small capsular arteries that supply the wall of the cavernous
sinus.
[edit]C5: Clinoid segment
The clinoid segment, or C5, is another short segment of the internal carotid that begins after the artery
exits the cavernous sinus at the proximal dural ring and extends distally to the distal dural ring, after which
the carotid artery is considered 'intra-dural' and has entered the subarachnoid space.

The clinoid segment normally has no named branches, though the ophthalmic artery may arise from the
clinoid segment.

[edit]C6: Ophthalmic segment

The ophthalmic artery and its branches.

The ophthalmic segment, or C6, extends from the distal dural ring, which is continuous with the falciform
ligament, and extends distally to the origin of the posterior communicating artery. The ophthalmic segment
courses roughly horizontally, parallel to the optic nerve which runs superomedially to the carotid at this
point.

The named branches of the ophthalmic segment are:

 the ophthalmic artery

 the superior hypophyseal artery

[edit]C7: Communicating segment

The communicating segment, or terminal segment, or C7, of the internal carotid artery passes between
the optic and oculomotor nerves to the anterior perforated substance at the medial extremity of the lateral
cerebral fissure. Angiographically, this segment extends from the origin of the posterior communicating
artery to the bifurcation of the internal carotid artery.

The named branches of the communicating segment are:

 the posterior communicating artery

  the anterior choroidal artery

The internal carotid then divides to form the anterior cerebral artery and middle cerebral artery. The
internal carotid artery can receive blood flow via an important collateral pathwaysupplying the brain, the
cerebral arterial circle, which is more commonly known as the Circle of Willis.

Branches
The following are the branches of the internal carotid artery, listed by segment:[5]

 C1: Branches from the cervical portion - none.

 C2: Branches from the petrous portion

 Caroticotympanic arteries

 vidian artery

 C3: Branches from the lacerum portion - none

 C4: Branches from the cavernous portion

 Branches of the meningohypophyseal trunk:

 Tentorial basal branch

 Tentorial marginal branch

 Meningeal branch - helps supply blood to the meninges of the anterior cranial
fossa

 Clivus branches - tiny branches that supply the clivus

 Inferior hypophyseal artery

 Capsular branches - supplies wall of cavernous sinus

 Branches of the inferolateral trunk:

 Branches to trigeminal ganglion - provide blood to trigeminal ganglion

 Artery of the foramen rotundum

 Branches to nerves

 C5: Branches from the clinoid portion - none

 C6: Branches from the ophthalmic portion

 Ophthalmic artery

 Superior hypophysial artery

  C7: Branches from the communicating portion

 Posterior communicating artery

 Anterior choroidal artery

 Anterior cerebral artery (a terminal branch)

 Middle cerebral artery (a terminal branch)

[edit]Carotid plexus
Main article: Internal carotid plexus

The sympathetic trunk forms a plexus of nerves around the artery known as the carotid plexus. The internal
carotid nerve arises from the superior cervical ganglion, and forms this plexus, which follows the internal
carotid into the skull.

Additional images

The arteries of the base of the brain.

Circle of Willis

Diagram of the arterial circulation at the base of the brain.

Tentorium cerebelli from above.

 Nerves of the orbit, and the ciliary ganglion. Side view.

Horizontal section through left ear; upper half of section.

Auditory tube, laid open by a cut in its long axis.

Muscles of the pharynx, viewed from behind, together with the associated vessels and nerves.

The position and relation of the esophagus in the cervical region and in the posterior mediastinum.

Seen from behind.

Human brain dura mater (reflections)

Magnetic Resonance Angiography