Arteries of the upper limb. Vessels of the upper limb

To supply oxygen to the trunk, head, legs and hands in the human body, a blood supply system is provided. It includes many vessels. The subclavian arteries of the upper limb originate in the mediastinum in front at the level of the first rib. The left is longer than the right and starts from the aortic arch. Right - directly from the brachiocephalic trunk.

Crossing the area of the sternum muscles, the vessels go over to the shoulder, branched at the site of the elbow joint in two directions. They carry blood supply to the forearm and hands.

Axillary artery

A. axillaris is the next site beyond the subclavian vessel originating from the outer surface of the lower rib. It passes in the deepening of the armpit and is surrounded by a braid of brachial muscles. The axillary artery flows into the humerus in the lower part of the tendon, which refers to the widest dorsal muscle. Depending on the conditional division of the anterior wall of the cavity, three sections of the axillary aorta are distinguished.

Artery of the humerus

A. brachialis is also referred to as a variety of upper body arteries. The vessel continues the previous section of the axillary artery of the upper limbs (the photo shows its location). Its origin can be traced from the very bottom of the large pectoral muscle, the continuation goes from the front of the beak-like process. The artery passes to the anterior part of the brachial muscle and branches into the radial and ulnar areas.

Radial artery

A. radialis originates next to the siphole in the joint of the radial and elbow joints and sequentially continues the previous artery, passing between the muscles and the pronator. Pulsation inside the vessel is easily audible on the third lower part of the forearm, where it passes close to the surface and is separated only by the skin. Further, the artery bends around the subulate portion of the radial process and is located from the rear of the hand, on the palm it passes through the gap in the bones.

The ulnar artery

A. ulnaris, as traces the anatomy of the arteries of the upper limbs, departs from the shoulder segment in the area of the elbow joint in the cavity of the coronary bone process. Then the vessel passes under the round pronator, simultaneously supplying it with blood by means of two branches. The direction feeding the deep and superficial flexors of the fingers passes parallel to the ulnar nerve. Through the gap between the bases of the flexors and under the muscles of the little finger, the artery goes to the inner surface of the palm and ends with a merger with the lower section of the radial vessel. Together they form a surface arc of the brush.

Collateral blood supply of the arteries of the trunk and upper limbs in their defeat

A variety of collateral circulation develops when there is a sharp stenosis or occlusion in the initial part of the artery, before its transition to the vertebral artery. This condition was called the syndrome subclavian-vertebral stealing. A full blood supply to the hand with axillary vessel defects is possible if there are anastomoses of the arteries of the upper limb in the dorsal and brachial system.

To such substitute species include anastomoses:

• Between the transverse scapular branch of the artery under the clavicle from the system of the thyreocervical gap and the thoracic acromial vessel from the axillary system.
• Between the cervical artery of the transverse direction in the last region of the subclavian system and the envelope of the vessel vane.

In case of defeat of the brachial artery, a deep vessel of the shoulder is included in the work. Its branches extend to the elbow region with the lower and upper collateral systems and form a dense network of anastomoses.

When the artery and the vein of the upper limb are damaged, multiple anastomoses are formed in the forearm site. On the path of blood in the radial and ulnar vessels, the nutrition of the periarticular regions is organized by means of branching processes. They interact with a network diverging from the brachial artery. With the help of palmar arcs, the defeat of the vessels of the hand is compensated by numerous branches of anastomoses between the branches of the ulnar and radial arteries.

Anastomoses take an active compensatory part in actions in any of the systems where blood circulation in the arteries of the upper and lower extremities is disturbed. By nature, the collateral circulation replacement has a significant perfection. The most vulnerable in this regard are the areas of the lower axillary and upper region of the brachial artery to the site of the deep vessel. Dangerous in terms of restoring blood supply is a violation of the integrity of the superficial palmar arc. All other injuries and diseases that violate the passage of blood, with the help of collateral nutrition, exclude the development of ischemia of the hand.

Methods of conducting surveys

Ultrasound dopplerography of arteries of the upper extremities is performed to study the condition of patients. Examination of the axillary and humeral aortas is done with the help of wave devices with a frequency of 4 MHz, and the state of the ulnar and radial vessels is checked with a device with a working power of 8 MHz. The palpation of the arteries is carried out: unlike the vessels of the legs, the circulatory system of the upper part can be traced practically in all areas:

• Axillary arteries of the trunk and upper limbs are easily accessible in the field of depressions;
• The humeral vessel of the system is probed on a long section between the biceps muscle and the shoulder bone, in the pit of the elbow joint, the pulsation of the blood is revealed and in the wrist region from the palm.

Determine the level of lesion of the artery of the upper limb can be listening to the location along the tree branching. In the normal state, the nourishment of the hands occurs along the main type, the transition to collateral blood supply occurs in the case of vessel stenosis or occlusion.

Indication for surgical intervention

Reconstruction of vessels with significant deviations in work is performed strictly in accordance with the recommendations. Arteries of the upper extremities are subject to ischemia much less often, this is due to the effect of a lesser load on them, compared to the body weight and excess kilograms acting on the legs. In addition, the collateral blood supply is better developed in the upper part of the trunk, shoulders and arms relative to the same system in the foot and lumbar regions.

The main and most important indication for surgical intervention in the work of the arteries is chronic non-passing ischemia and a pronounced danger for the normal functioning of the upper body. Sometimes the condition is accompanied by a threat to the life of the patient. Based on arterial, hemodynamic, clinical symptoms, a number of indications for the operation were identified.

Arteries of the upper limb are subjected to forced reconstruction, if as a result of the work of the hands there are periods of prolonged fatigue in a person who leads an active lifestyle. This symptom negatively affects the work activity, reduces the quality of life of the patient. Indications take into account the individual characteristics of the body, the style of work and the presence of concomitant diseases.

If the patient does not have pain at rest, is poorly controlled by local effects and general therapeutic drugs, vascular reconstruction is prescribed. Sometimes the condition worsens as a result of the appearance of open non-healing ulcers and wounds localized in the area of fingers and hand. Before surgery, in any case, medical treatment is performed, reconstruction is appointed only after its final results.

Pain from ischemic disease, tissue necrosis and the appearance of ulcers indicate the need for surgery, the physician takes into account individual anatomical indicators. Often a contraindication to reconstruction is the patient's advanced age.

Types of operations

Anatomy of the arteries of the upper limbs can reduce the results of vascular lesions in various ways:

• The major majority is bypass surgery, which creates bypasses between healthy aortic areas bypassing the altered part of the vessel;
• With proximal changes in the axillary aorta and brachycephalic trunk, balloon plastic procedures are performed;
• Operations for revascularization using microsurgical devices are less frequent.

Vascular Shunting Technology

The operation is done under general or local anesthesia. For a shunt, the material of the subcutaneous femoral vein is most often used. Deprivation of the patient of this vessel has practically no effect on the blood supply of the lower limb. The choice is made on the basis that the femoral veins are usually rarely affected by atherosclerosis and their large diameter is well suited for creating a bypass site.

For coronary-aortal bypass surgery, the internal radial and thoracic arteries on the left side are most often taken. After the incision, incisions are made in the area of the affected vessel in the places where the shunt is supposed to be inserted. It is sewn to the aorta incisions to restore blood flow. After a certain time after the operation, repeated examinations are carried out.

Using an X-ray to determine the state of blood vessels

On the border of the union of surgery and medical radiology, a new discipline is emerging and developing, manifesting itself as vascular surgery based on radiation exposure. All arteries of the free upper limb, veins and their branches, lymphatic pathways become accessible to X-ray studies. All the radiation effects become methods for studying the system of blood vessels:

• Radionuclide;
• ultrasonic;
• Magnetic resonance;
• X-ray.

These methods of detecting violations make it possible to compare data that are complementary to each other when they are used together, which makes it possible to obtain more stable results. The morphology of the arteries of the upper limb is investigated by radial methods, especially such an application of waves to determine blood flow. Under the control of X-ray observation, medical microoperations on the vessels, the so-called endovascular corrections, are performed, which represent an alternative to surgical intervention with certain changes in the veins.

Study of the pulse in the hematopoiesis system

The heart represents a single whole with the vascular system, so the abnormal work of the aorta and veins is largely determined by the pathology of this organ. The trunk arteries of the upper limb are examined for the value of the peripheral pulse and pressure. Small vessels are usually first viewed visually, using the palpation method, as a result, detect areas of visible pulsation, for example, in the region of the carotid artery on the neck. However, the main thing in the survey is to determine the value of the pulse in peripheral vessels. This indicator is determined in the radial, humeral, axillary, femoral, popliteal and arteries in the feet. The general value of the pulse is usually considered according to the frequency at the arteries of the wrist joint.

Measurement of blood pressure

If we talk about the magnitude of the pressure in different vessels, the highest values are given by the main arteries of the upper limb. In peripheral and small vessels, the value of the indicator will be reduced. Pressure is divided into systolic (at the time of the rise of the pulse load) and diastolic (during the fall of the wave). The difference between them is a significant indicator in the survey. The specialists approximately estimate the result in terms of power and pulse voltage. The higher these values, the higher the blood pressure.

Determination of the index of venous pulse and pressure

Increased blood flow, moving through the veins to the right atrium, respectively, increases central pressure. In case of a violation, called heart failure, the peripheral vessels expand and swell, first of all it happens in the neck area. The pressure increases when the right ventricle is insufficient, the valvular defects, pericarditis and many other cardiac pathologies. A specialist in swelling of the veins on the arm assesses the magnitude of the central pressure in the veins.

Visual swelling of the veins on the hand can be determined if you lower it below the level of the left atrium. Raising the brush to a height of more than 10 cm above this mark will show a lingering filling of blood vessels and a decrease in blood filling.

Study of arteries

Disorders of the peripheral system of arterial nutrition of tissues allow talking about partial occlusion against the background of the presence of atherosclerosis. Usually disorders of such circulation of blood are connected with age in connection with deterioration of collateral supply. The arteries of the upper limb manifest their disturbances in the symptoms of intermittent claudication, which is the first herald of the disease. The patient notes the appearance of pain during walking in calves, these convulsions do not bother the person. Over time, the time of action of the load decreases, which passes without pain.

Such symptoms are typical for lesions of the internal femoral and iliac vessels, if the process progresses, then spasms are manifested even in a state of rest. A little decrease in the manifestation of pain is the lowering of the arm or leg in an upright position, although an increase in venous pressure will provoke local edema.

Diagnosis of veins

It allows to reveal a violation in them of the passage of the blood flow associated with occlusion after thrombosis, external pressure or phlebitis. Initial examination is performed by palpation. Collateral vessels that replace the movement of blood become visible under the skin, depending on the site of the primary disorder. In order to determine the direction of the blood flow, the vein anastomosis is pressed and after the release, a further picture of the restoration of motion is traced.

Research of vessels by ultrasonic dopplerography

The Doppler effect is based on the device and the survey method . Its action consists in changing the frequency of the released ultrasonic signals when the position of the medium chosen for their reflection changes. The second option is to move the very source of the frequency sound.

If the arteries of the upper and lower extremities are examined, then the reflected signals are reflected from the blood particles and the change in the response waves indicates the flow rate of the fluid in the vessels. Modern Doppler devices use only one sound emitter, combined with a catcher of reflected waves. The basis of laboratory studies is the index of the velocity vector of movement along the observed line.

Procedure for the survey

For the procedure, no special preliminary preparation is required, but the patient can not be examined if there are purulent diseases and inflammatory foci on the skin. The procedure takes up to 40 minutes.

The person is laid on the back, the skin areas where the arteries of the upper extremities of the blood supply area are located, are lubricated with a thick layer of gel soluble in the aqueous medium. This is required to improve the conductivity of ultrasonic signals and creates an obstacle to the flow of excess air into the study area. By pressing the sensor to the site of the study, the specialist makes translational and circular movements along the skin.

The patient lies still, so as not to blur the picture of the results, sometimes the doctor may require you to stop breathing for a second to get a clearer picture. The procedure of ultrasound of the arteries of the upper lower extremities passes absolutely painlessly and does not cause the patient any other discomfort. Traces of gel after the end are removed with a napkin.

Causes of examination of blood vessels

For a detailed examination of the circulatory system of the body, there are a number of indications:

• The appearance of pain in the hands without known and visible causes, a violation of the sensitivity of the skin;
• Previously diagnosed atherosclerosis leading pathways;
• Various rheumatic pathologies, because of which the vascular sites are affected;
• Thrombosis of the leading aorta of the upper body, forearms, and brushes;
• Compression of the arteries of the upper limbs (photos of problematic areas can be seen in the picture);
• Suspicion of benign and malignant neoplasms in the veins;
• Congenital malformations of the circulatory system;
• The previous shunting of the main direction and branch sections.

Results of the conducted researches

If the movement of the blood flow is directed to the sensor, the frequency of the signals becomes larger, and the movement in the opposite direction decreases the value of the indicators. The device converts the reflected response into a pulse of electricity, which is processed in an ultrasonic device and displayed for viewing on the screen.

Ultrasound, duplex and triplex scanning, which examines the arteries and veins of the upper limbs, the anatomy of which has been damaged, makes it possible to evaluate their internal structure and the size of the transmission diameter. With the help of the method, reliable information on the hemodynamics of the circulatory system is obtained, it allows you to see the vessels on the screen. The study helps determine the structure and condition of the wall and the exact location of cholesterol plaques.

When examining the arteries of the upper body using the duplex method, the device can be used in two modes. In the first version, the device acts as an ordinary ultrasound machine, which allows you to visually trace the entire structure under study. The second option uses the blind Doppler method in the spectral mode.

If a triplex survey is used, a third method of color mapping is added to the two above modes. The method visualizes the blood flow in the observation area. In fact, this is a picture of ultrasound, colored depending on the density of the passing fluid and its speed.

In conclusion, it should be noted that modern methods of examining patients for the detection of anomalies and damage to the arteries and veins have significant advantages over the previously used methods of examination. The design of ultrasound medications allows them to be used directly at the patient's bed, there is no harmful radiation for the patient.