To supply oxygen to the trunk, head, legs and arms 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 begins the path from the aortic arch. Right - directly from the brachiocephalic trunk.
Crossing the area of the sternum muscles, the vessels pass into the shoulder, branching on the elbow joint in two directions. They provide blood supply to the forearm and hands.
Axillary artery
A. axillaris is the next site after the subclavian vessel , originating from the outer surface of the lower rib. It passes in the deepening of the armpit and is surrounded by plexus of the brachial muscles. The axillary artery flows into the brachial artery in the lower part of the tendon, belonging to the broadest spinal muscle. Depending on the conditional division of the anterior wall of the hollow, three sections of the axillary aorta are distinguished.
Shoulder Artery
A. brachialis is also a type of artery of the upper body. The vessel continues the previous section of the axillary artery of the upper extremities (the photo shows its location). Its beginning can be traced from the very bottom of the pectoralis major muscle, the continuation goes in front of the coracoid process. The artery passes to the front of the brachial muscle and branches into the radial and ulnar areas.
Radial artery
A. radialis originates near the slit-like opening in the joint of the radial and ulnar joints and sequentially continues the previous artery, passing between the muscles and the pronator. Ripple inside the vessel is easily audible in the third lower portion of the forearm, where it passes close to the surface and is separated only by the skin. Next, the artery goes around the styloid region of the radial process and is located from the rear of the hand; in the palm of its hand, it passes through the gap in the bones.
Ulnar portion of the artery
A. ulnaris, as traces the anatomy of the arteries of the upper extremities, departs from the shoulder area in the elbow joint in the cavity of the coronary bone process. Further, the vessel passes under the round pronator, simultaneously supplying it with blood using two branches. The direction that nourishes the deep and superficial flexors of the fingers runs 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 the union with the lower part of the beam vessel. Together they form the surface arc of the brush.
Collateral blood supply to the arteries of the trunk and upper limbs when they are affected
A type of collateral circulation develops when in the initial section of the artery, before it passes into the vertebral, there is a sharp stenosis or occlusion. This condition is called subclavian-vertebral robbery syndrome. Full blood supply to the arm with defects in the axillary vessel is possible if there are anastomoses of the arteries of the upper limb in the spinal and brachial system.
These replacement species include anastomoses:
- Between the transverse scapular branch of the artery under the collarbone from the thyroid cervical system 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 scapula of the vessel.
When the brachial artery is affected, the deep vessel of the shoulder is included in the work. Its branches extend to the region of the elbow with the lower and upper collateral systems and form a dense network of anastomoses.
With damage to the arteries and veins of the upper limb, multiple anastomoses form at the site of the forearm. Along the route of blood in the radial and ulnar vessels, nutrition of the periarticular regions is organized using branching processes. They interact with the network diverging from the brachial artery. With the help of the palmar arches, the damage to the vessels of the hand is compensated by numerous branches of the 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 impaired. By nature, the collateral substitution of circulation has considerable perfection. The most vulnerable in this regard are the areas of the lower part of the axillary and upper region of the brachial arteries to the place of discharge of the deep vessel. A violation of the integrity of the superficial palmar arch is considered dangerous from the point of view of restoration of blood nutrition. All other injuries and diseases that disrupt the passage of blood, using collateral nutrition exclude the development of ischemia of the hand.
Survey Methods
To study the condition of patients, ultrasound dopplerography of the arteries of the upper extremities is performed. Examination of axillary and shoulder aorta is done using wave instruments with a frequency of 4 MHz, and the condition of the elbow and beam vessels is checked by a device with a working power of 8 MHz. Palpation of the arteries is performed: unlike the vessels of the legs, the circulatory system of the upper section can be traced in almost all areas:
- axillary arteries of the trunk and upper limbs are easily accessible in the region of the hollows;
- the humeral vessel of the system is felt on a long section between the biceps and the bone of the shoulder, in the fossa of the elbow joint, pulsation of the blood is detected on the wrist region of the palm.
You can determine the level of damage to the artery of the upper limb by listening to the location along the branch tree. In the normal state, the nutrition of the hands occurs according to the main type, the transition to collateral blood supply is carried out in case of stenosis of the vessels or occlusion.
Indications for surgery
Reconstruction of vessels with significant deviations in operation is carried out strictly in accordance with the recommendations. Arteries of the upper extremities are much less prone to ischemia, this is due to the impact of less load on them, compared with body weight and extra pounds acting on the legs. In addition, collateral blood supply is better developed in the upper body, shoulders and arms relative to the same system in the leg and lumbar regions.
The main and most important indication for surgical intervention in the work of the arteries is chronic persistent ischemia and a pronounced danger to the normal functioning of the upper body. Sometimes the condition is accompanied by a threat to the patient's life. On the basis of arterial, hemodynamic, clinical symptoms, a number of indications for surgery have been identified.
Arteries of the upper limb undergo a forced reconstruction if, as a result of the work of the hands, periods of prolonged fatigue are observed in a person leading an active lifestyle. This symptom negatively affects labor activity, reduces the patient's quality of life. Indications take into account the individual characteristics of the body, work style and the presence of concomitant diseases.
If the patient does not have pain at rest, they are poorly stopped by local exposure 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 fingers and hand. Before surgery, in any case, drug treatment is performed, reconstruction is prescribed only according to its final results.
Pain from coronary disease, tissue necrosis and the appearance of ulcers indicate the need for surgery, while the doctor takes into account individual anatomical parameters. Often a contraindication to reconstruction is the elderly patient.
Types of operations
Anatomy of the arteries of the upper extremities can reduce the results of vascular lesions in various ways:
- the main majority is bypass surgery, which creates bypass channels between healthy sections of the aorta bypassing the altered part of the vessel;
- with proximal changes in the axillary aorta and the brachycephalic trunk, balloon plastic surgery is done;
- revascularization operations using microsurgical instruments are less common.
Vascular bypass technology
The operation is performed under general or local anesthesia. For the shunt, the saphenous femoral vein material is most often used. Depriving a patient of this vessel has practically no effect on the blood supply to 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 to create a bypass area.
For coronary-aortic bypass surgery, the internal radial and thoracic arteries on the left side are most often taken. After an incision in the area of the affected vessel, incisions are made at the sites of the proposed shunt installation. It is hemmed to the aortic incisions to restore blood flow. After a certain time after the operation, repeated examinations are performed.
The use of x-rays to determine the state of blood vessels
At 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 paths become accessible to X-ray waves. Methods for studying the vascular system are all radiation exposure:
- radionuclide;
- ultrasonic;
- magnetic resonance;
- radiological.
These methods for detecting violations make it possible, when used together, to compare data that complement each other, which makes it possible to obtain more stable results. The morphology of the arteries of the upper limb is studied by radiation methods, such an application of waves to determine blood flow is especially effective. Under the supervision of X-ray observation, therapeutic microoperations are performed on the vessels, the so-called endovascular corrections, which represent an alternative to surgical intervention with some changes in the veins.
The study of the pulse in the hematopoietic system
The heart is one with the vascular system, therefore, the incorrect functioning of the aorta and veins is largely determined by the pathology of this organ. The main arteries of the upper limb are examined for the value of peripheral pulse and pressure. Small vessels are usually first examined visually, using the palpation method, as a result, areas of visible pulsation are found, for example, in the region of the carotid artery on the neck. However, the main thing in the examination is to determine the value of the pulse in the peripheral vessels. This indicator is determined in the beam, shoulder, axillary, femoral, popliteal and arteries in the feet. The total pulse value is considered to be the frequency on the arteries of the carpal joint.
Blood pressure measurement
If we talk about the magnitude of the pressure in various vessels, the highest values give 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 raising the pulse load) and diastolic (during the decline of the wave). The difference between them is a significant indicator in the survey. Experts approximately estimate the result by power and pulse voltage. The higher these rates, the higher the blood pressure.
Determination of venous pulse rate and pressure
Increased blood flow moving through the veins to the right atrium, respectively, increases central pressure. In a disorder called heart failure, peripheral vessels expand and swell, primarily in the neck. Pressure increases with right ventricular failure, valve defects, pericarditis, and many other cardiac pathologies. The vein swelling specialist on the wrist evaluates the magnitude of the central pressure in the veins.
Visually, the swelling of the veins on the hands can be determined by lowering it below the level of the left atrium. Raising the brush to a height of more than 10 cm above the indicated mark will show a sluggish filling of the vessels and a decrease in blood supply.
Artery examination
Disorders of the peripheral system of arterial nutrition of tissues suggests a partial occlusion in the presence of atherosclerosis. Typically, disorders of such blood circulation are associated with age due to a deterioration in collateral supply. Arteries of the upper limb manifest their disorders in the symptoms of intermittent claudication, which is the first messenger of the disease. The patient notes the appearance of pain during walking in the calves, at rest, these spasms of a person do not bother. Over time, the duration of the load decreases, which passes without pain.
Such symptoms are characteristic of lesions of the internal femoral and iliac vessels, if the process progresses, then cramps occur even at rest. Slightly reduces the manifestations of pain lowering the arm or leg into an upright position, although an increase in venous pressure will provoke local edema.
Vein diagnostics
Allows you to identify a violation in them of the passage of blood flow associated with blockage after thrombosis, pressure from the outside or phlebitis. An initial examination is carried out by palpation. Collateral vessels, replacing the movement of blood, become visible under the skin, depending on the site of the primary violation. At the same time, to determine the direction of blood flow, anastomosis of the veins is pressed and, after release, a further picture of the restoration of movement is traced.
Doppler ultrasonography of blood vessels
The device and the examination method are based on the Doppler effect known in physics. Its action is to change the frequency of the emitted ultrasonic signals when the position of the medium chosen to reflect them changes. The second option is to move the source of the frequency sound itself.
If the arteries of the upper and lower extremities are examined, then the reflection of the sent signals comes from the blood particles and the change in the response waves indicates the speed of the fluid flow in the vessels. Modern Doppler devices use only one sound emitter, combined with a trap of reflected waves. The basis of laboratory research is the indicator of the velocity vector along the observed line.
Examination Procedure
For the procedure, special preliminary preparation is not required, but the patient cannot be examined if there are purulent diseases and inflammatory foci on the skin. The procedure takes up to 40 minutes of time.
A person is laid on his back, areas of the skin where the arteries of the upper extremities of the blood supply are located, smeared with a thick layer of gel, soluble in the aquatic environment. This is required to improve the conductivity of ultrasonic signals and creates an obstacle to excess air entering the study area. By pressing the sensor to the study area, the specialist makes translational and circular movements on the skin.
The patient lies still so as not to smear the picture of the results, sometimes the doctor may require you to stop breathing for seconds to get a clearer picture. The procedure of UZDG of the arteries of the upper lower extremities is absolutely painless and does not cause the patient any other discomfort. Traces of the gel after the end are removed with a napkin.
Reasons for vascular examination
For a detailed examination of the circulatory system of the body, there are a number of indications:
- the appearance in the hands of pain without known and visible reasons, a violation of the sensitivity of the skin;
- previously diagnosed atherosclerosis of the leading ways;
- various rheumatic pathologies, due to which areas of the vessels are affected;
- thrombosis of the leading aorta of the upper body, forearms and hands;
- compression of the arteries of the upper extremities (photos of problem areas can be seen in the picture);
- suspected benign and malignant neoplasms in the veins;
- congenital malformations of the circulatory system;
- previously performed shunting of sections of the main direction and branches.
Research results
If the movement of the studied blood flow is directed to the sensor, then the frequency of the signals becomes larger, and 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 on the screen for review.
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If triplex examination is applied, then the third method of color mapping is added to the two above-mentioned modes. The method visualizes blood flow in the observation area. In fact, this is an ultrasound picture, colored depending on the density of the passing fluid and its speed indicators.
In conclusion, it should be noted that modern methods of examining patients to identify abnormalities and damage to arteries and veins have significant advantages over previously used examination methods. The design of ultrasound preparations allows them to be used right at the patient’s bedside; there is a lack of harmful radiation for the patient.