3. Subclavian artery
Subclavian
artery
Vertebral artery
Internal Thoracic artery
Thyrocervical artery
Costocervical Trunk
Dorsal Scapular Artery
No branches from third
part & continues as
axillary artery
Divided into three
parts by the anterior
scalene muscle
14. Anatomic Variations
• Aberrant origin of the subclavian arteries are possible
• Brachial artery trifurcation is a known entity
• Anomalous high origin of radial and ulnar arteries from the brachial
and axillary artery can be seen
• Interosseous artery may continue as median artery in 2% of cases
• Palmar arches may be incomplete/ median and radial predominant/
ulnar predominant
17. Thoracic outlet syndrome:
• Most frequent site of arterial
compression - costoclavicular space
followed by the interscalene triangle
• Doppler has the advantage of
enabling assessment of blood flow
during performance of the clinical
tests used in clinical practice.
20. Deep Venous system
• The deep veins (venae
commitantes) accompany
the arteries
• They are connected to the
superficial system by
perforating veins
• They usually occur in pairs
on either side of the
major arteries
21.
22. Superficial Venous system
• The cephalic vein ascends along the
lateral aspect of the arm, then it
pierces the deep fascia to enter the
axillary vein just distal to the clavicle
• The basilic vein passes along the
medial aspect of the forearm, pierces
the deep fascia at the elbow and joins
the venae comitantes of the brachial
artery forming the axillary vein
• The median cubital vein links the
cephalic and basilic veins in front of
the elbow
25. Anatomic variations
• Superficial veins have more variations then the deep veins
• Accessory cephalic vein may be seen
• There may be a single brachial vein seen instead of the usual paired
veins and paired axillary veins instead of single axillary vein may also
be seen
• Most varied patterns are noted in the cubital veins
26. Clinical implications
• AV fistula mapping –
knowledge of the possible
variations is essential
• The diameter as well as
distance from the skin of
cephalic & basilic vein and
adjacent arteries is vital for
creating an A-V fistula in
patients requiring dialysis
27. Care must be taken not to give
too much pressure while tracing
the superficial veins as they can
get totally obliterated
31. Poplitealartery
Muscular - Supplies muscles in
and around the knee joint
Genicular - Superior(2),
Middle(1) & Inferior(2) genicular
arteries
Cutaneous - One branch usually
accompanies the small
saphenous vein
33. Tibial & Peroneal arteries
• The anterior and posterior tibial
arteries are the terminal
branches of the popliteal artery
with the peroneal artery arising
from the posterior tibial artery
usually.
• They supply the adjacent muscles
in the respective compartments
and end by finally forming the
medial and lateral malleolar
networks as well as the plantar
arch
36. Anatomic variations
• The anterior tibial artery may be partially or completely
replaced by the perforating branch of the peroneal artery or
posterior tibial artery
• The popliteal artery usually divides into anterior and
posterior tibial arteries at the lower border of popliteus
• There can be a number of variations at this point like high
origin of anterior tibial artery, absent posterior tibial artery
or trifurcation of the popliteal artery
39. Lower extremity
venous system
Deep
Femoral Vein
Popliteal Vein
Tibial and peroneal veins
Superficial
Great Saphenous Vein
Short Saphenous Vein
Perforating
5/6 along GSV
1 along SSV
41. Popliteal, Tibial & Peroneal Veins
• Popliteal vein receives the short saphenous vein
and the veins corresponding to the muscular
branches of the artery
• The anterior tibial, posterior tibial, and
peroneal veins drain the calf. In each case, these
are paired veins that accompany an artery of the
same name.
• Proximally, the two posterior tibial veins unite,
forming a short posterior tibial trunk, and the
peroneal pair likewise forms a short trunk. The
trunks subsequently unite in the popliteal fossa to
form the popliteal vein
45. Great Saphenous Vein
• Largest & longest superficial vein of
the body
• Drains into the femoral vein by
piercing the cribriform fascia at the
fossa ovalis
• Before piercing the cribriform
fascia, it receives three named
tributaries corresponding to the
three cutaneous arteries and also
many unnamed tributaries
• It contains 10-15 valves which
prevent backflow of venous blood
46.
47. Short Saphenous Vein
• Formed by union of lateral end of
dorsal venous arch and lateral
marginal vein
• Opens into the popliteal vein
• Drains the lateral border of foot,
heel and back of leg
• NOT accompanied by any artery
48. Perforators
• The GSV is connected to
the deep veins by means of
perforating veins
Site No. of perforators
Above Ankle 3
Below Knee 1/2
Adductor canal 1
Proximal Thigh 1
50. Anatomic variations
• The femoral or popliteal vein may be
duplicated
• There might be single calf veins in the
place of paired veins
• The site of termination of the calf veins
can present variedly
• SSV can continue into the upper thigh
as Vein of Giocomini without
terminating into the popliteal vein
51.
52. Clinical Implications
• Sapheno-femoral junction or
perforator incompetence can result in
varicose veins
• Deep venous thrombosis is a very well
known pathology seen in pro-
thrombotic states or bed ridden
patients
Three distinct syndromes : neurogenic syndrome, arterial syndrome and venous syndrome.
most frequent site of arterial compression - The costoclavicular space is by far the while the interscalene triangle is the second most frequent site. The retropectoralis minor space has rarely been reported as a potential site of compression.
Four basic manoeuvres with several variations have been described: the Roos test, Adson test, Wright test, and costoclavicular test.
