BLOOD SUPPLY AND

ANASTOMOSIS OF UPPER
LIMB; LYMPHATIC AND
VENOUS DRAINAGE
 Axillary Artery
 Begins at the lateral border of 1st rib as a continuation
of subclavian artery.

 Ends at the lower border of teres major muscle by

continuing as brachial artery.

 Pectoralis minor muscle crosses in front of the artery

and divides it into 3 parts.
Axillary
Artery
 Axillary Artery
 1st part of Axillary artery:
Relations:
Anteriorly: Pectoralis Major
Posteriorly: Long thoracic nerve
Laterally: Three cords of brachial plexus
Medially: Axillary vein
Branches:
Superior thoracic artery
 Axillary Artery
 2nd part of Axillary artery:
Relations:
Anteriorly: Pectoralis Minor & Pectoralis Major
Posteriorly: Posterior cord of Brachial Plexus (BP)
Laterally: Lateral cord of Brachial Plexus
Medially: Medial Lateral cord of BP & Axillary vein

Branches:
Thoracoacromial artery
 Axillary Artery
 3rd part of Axillary artery:
Relations:
Anteriorly: Pectoralis Major
Posteriorly: Subscapularis, Latissimus dorsi & Teres Major
Laterally: Lateral cord of Brachial Plexus
Medially: Medial Lateral cord of BP & Axillary vein
Branches:
Subscapular artery
Anterior & Posterior circumflex humeral arteries
Branches of Axillary Artery
• Superior thoracic artery:
– Supplies posterior aspects of intercostal
spaces 1 and 2 and part of serratus anterior
• Thoracoacromial artery (trunk):
– Pectoral branch
– Deltoid branch
– Acromial branch
– Clavicular branch
• Lateral thoracic artery:
– Supplies part of pectoral muscles, lymph
nodes and breast (esp. important in women)
• Posterior circumflex humeral:
– Passes around posterior aspect of surgical
neck of humerus.
– Anastomoses with the anterior circumflex
humeral.
– Supplies deltoid and triceps muscles
– Part of contents of quadrilateral space.
• Anterior circumflex humeral:
• Subscapular:
– Thoracodorsal:
• Latissimus muscle
– Circumflex scapular:
 Brachial Artery
 Begins at the inferior border of teres major muscle as a
continuation of Axillary artery.

 Terminates opposite the neck of the radius by dividing

into Radial and Ulnar arteries.
 Relations of Brachial Artery
Relations:

Anteriorly: Coracobrachialis & Biceps

Posteriorly: Brachialis & Triceps
Laterally: Median nerve & Coracobrachialis
Medially: Ulnar nerve & Basilic vein
 Branches of Brachial Artery
 Nutrient humeral artery
 Profunda Brachii artery
 Superior ulnar collateral artery
 Inferior ulnar collateral artery
Brachial
Artery
Anastomosis around the Elbow
• Deep brachial (profunda brachii):
– Wraps around posterior surface of humerus.
– Runs in radial groove with radial nerve.
– Supplies posterior compartment of brachium.

– Branches:
• Ascending branch to posterior circumflex
humeral artery.
• Descending branch becomes radial collateral.
– Anastomoses with radial recurrent.
• Superior ulnar collateral:
– Runs with ulnar nerve.
– Passes posterior to medial epicondyle.
– Anastomoses with posterior ulnar recurrent
artery.
• Inferior ulnar collateral:
– Passes anterior to medial epicondyle.
– Anastomoses with anterior ulnar recurrent
artery.
 Radial Artery
 Smaller terminal branch of Brachial artery.

 Begins in the cubital fossa & passes below

Brachioradialis muscle.

 Rest on deep muscles of forearm.

 In the distal part of forearm it lies on anterior surface of

the Radius.
 Radial Artery
 At wrist it winds backward and passes anteriorly into the
palm between two heads of 1st dorsal interossei muscle.

 Then it joins deep branch of ulnar artery to form Deep

Palmar Arch.
Radial
Artery
 Branches of Radial Artery
 Muscular branches
 Recurrent branch
 Superficial Palmar branch
 Joins ulnar artery to form Superficial
Palmar Arch
 Radialis Indicis artery
 Princeps Pollicis
 Ulnar Artery
 Larger terminal branch of Brachial artery.

 Begins in the cubital fossa & descends through anterior

compartment of forearm.

 It enters the palm in front of flexor retinaculum.

 It ends by forming Superficial Palmar Arch with

Superficial Palmar branch of Radial artery.
 Branches of Ulnar Artery
 Muscular branches
 Recurrent branches
 Deep Palmar branch
 Joins radial artery to form Deep Palmar
Arch
 Common Interosseous artery
 Anterior Interosseous artery
 Posterior Interosseous artery
Ulnar
Artery
Ulnar
Artery
Branches
Areas of
Ulnar
&
Radial
Arteries
Supply
 Deep Palmar Arch
 Direct continuation of Radial artery.

 Deeply placed in palm in front of the metacarpal bones &

Interosseous muscles.

 The Arch on medial side is completed by deep branch of

the ulnar artery.
 Branches: Palmar, Metacarpal, Perforating & Recurrent
Deep
Palmar
Arch
 Superficial Palmar Arch
 Direct continuation of Ulnar artery.

 Superficially placed in palm in front of the long flexor

tendons.

 The Arch on lateral side is completed by superficial

palmar branch of the radial artery.
 Branches: Four digital arteries
Superficial
Palmar
Arch
 Veins of the Upper Limb

 Superficial veins

 Deep veins
 Superficial Veins of the Upper Limb
 Dorsal venous arch

 Veins of the Palm

 Cephalic vein

 Basilic vein

 Median vein of the forearm

 Dorsal venous arch
 Lies in the subcutaneous tissue proximal to
Metacarpophalangeal joints

 Drains on the lateral side into the Cephalic vein

 Drains on the medial side into the Basilic vein

 Communicates with the deep veins of the palm freely

Dorsal
Venous
Arch
Dorsal venous arch
 Veins of the Palm

 Superficial palmar venous Arch

 Deep palmar venous Arch

 Cephalic Vein
 Arises from the lateral side of the dorsal venous arch on
the back of hand.

 Winds round the lateral border of forearm

 Ascends in the superficial fascia into the cubital fossa

and up the front of the arm on the lateral side of Biceps
 Cephalic Vein
 On reaching the interval between deltoid & Pectoralis
major muscles, it pierces deep fascia & joins the Axillary
vein.

 Drains the lateral and posterior surfaces of the limb.

 Median Cubital Vein, a branch of cephalic vein, joins the

Basilic vein in the cubital fossa.
Cephalic Vein
Cephalic
Vein
 Basilic Vein
 Arises from the medial side of the dorsal venous arch on
the back of hand

 Winds round the medial border of forearm

 Ascends in the superficial fascia on the posterior surface

of the forearm
 Below elbow it inclines to reach the cubital fossa
 Basilic Vein
 Ascends on the medial side of Biceps

 It pierces deep fascia at the middle of the arm

 It joins the vena comitantes of the brachial artery to form

the Axillary vein.

 Drains the medial and posterior surfaces of the limb.

 Receives Median Cubital Vein at cubital fossa.
Basilic
Vein
Median Cubital Vein
 Median Vein of the Forearm
 Arises in the palm

 Ascends on the front of forearm

 Drains into Basilic vein or Median cubital vein or divides

into two branches:
 Median Basilic vein: (Drain into basilic vein)
 Median cephalic vein: (Drain into cephalic vein)
Median Vein of the Forearm
 Deep Veins of the Upper Limb
 Venae Comitantes

 Axillary vein
 Vena Comitantes
 Deep veins accompany the respective arteries as vena
comitantes

 Two vena comitantes of brachial artery join the basilic

vein at the lower border of teres major to form Axillary
vein
Cephalic Vein
 Axillary Vein
 Formed by the union of the vena comitantes of brachial
artery with basilic vein

 It becomes Subclavian Vein at the outer border of 1st rib

 Tributaries correspond to the branches of the axillary

artery and also receive Cephalic Vein
Axillary
Vein
Superficial and Deep veins of the Limb
LYMPHATICS OF THE UPPER LIMB
• Lymphatics from the fingers accompany the
cephalic and basilic veins and enter the lateral
axillary and deltopectoral nodes.
• Axillary nodes:
– they are divided into five groups:
– lateral nodes
– pectoral nodes
– subscapular nodes
– central nodes
– apical nodes.
• Lateral:
Lie behind the axillary vein and drain
upper limb.
• Pectoral:
Lie behind pectoralis minor with lateral
thoracic artery.
Drain mammary gland.
• Subscapular:
Lie along lower border of scapula with
subscapular artery.
Drain the posterior shoulder.
• Central nodes:
In axillary fat.
Receive lymph from all the above nodes.

• Apical nodes lie medial to the axillary vein and

superior to the pectoralis minor. They receive the
lymph from all the other groups and sometimes
directly from the breast.
Thank You