To supply oxygen to the torso, 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 anteriorly at the level of the first rib. The left one is longer than the right one and starts from the aortic arch. Right - directly from the brachiocephalic trunk.
Crossing the region of the sternum muscles, the vessels pass into the shoulder, branching in the area of the elbow joint in two directions. They supply blood 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 runs in the deepening of the armpit and is surrounded by a plexus of the shoulder muscles. The axillary artery flows into the brachial artery in the lower part of the tendon related to the latissimus dorsi muscle. Depending on the conditional division of the anterior wall of the cavity, there are three sections of the axillary aorta.
Shoulder artery
A. brachialis is also referred to as a type of artery in 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 anterior part of the brachialis muscle and branches into the radial and ulnar sections.
Radial artery
A. radialis originates near the slit-like opening at the junction of the radial and ulnar joints and successively continues the previous artery, passing between the muscles and the pronator. The pulsation inside the vessel is easily heard in the third lower part of the forearm, where it passes close to the surface and is separated only by the skin. Further, the artery goes around the styloid section of the radial process and is located from the rear of the hand, on the palm it passes through a gap in the bones.
Elbow section of the artery
A. ulnaris, as traced by the anatomy of the arteries of the upper extremities, departs from the shoulder region in the region of the elbow joint in the cavity of the coronoid bone process. Further, the vessel passes under the round pronator, simultaneously supplying it with blood using two branches. The direction that feeds 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 section of the radial vessel. Together theyform a superficial 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 there is a sharp stenosis or occlusion in the initial section of the artery, before it passes into the vertebral one. This condition is called subclavian-vertebral steal 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 dorsal and shoulder systems.
Such replacement types include anastomoses:
- Between the transverse scapular branch of the artery under the clavicle from the thyrocervical gap system and the thoracic acromial vessel from the axillary area system.
- Between the transverse cervical artery in the last region of the subclavian system and the circumflex scapular vessel.
When the brachial artery is damaged, the deep vessel of the shoulder is activated. Its branches extend to the elbow area with the lower and upper collateral systems and form a dense network of anastomoses.
When the artery and vein of the upper limb is affected, multiple anastomoses are formed at the site of the forearm. Along the path of blood in the radial and ulnar vessels, the nutrition of the periarticular regions is organized with the help of branching processes. They interact with the network diverging from the brachial artery. With the help of palmar arches, damage to the vessels of the hand is compensated by numerous branchesanastomoses between 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 replacement of the 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 up to the place of origin of the deep vessel. From the point of view of restoring blood supply, a violation of the integrity of the superficial palmar arch is considered dangerous. All other injuries and diseases that disrupt the passage of blood, with the help of 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 the axillary and brachial aortas is done using wave devices with a frequency of 4 MHz, and the condition of the ulnar and radial vessels is checked by a device with an operating power of 8 MHz. The arteries are palpated: 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 area of depressions;
- The brachial vessel of the system is palpated in the long section between the biceps muscle and the bone of the shoulder, in the fossa of the elbow joint, blood pulsation is also detected in the wrist area from the side of the palm.
Determine the level of defeatarteries of the upper limb can be listening to the location along the branching tree. In the normal state, the supply of hands occurs according to the main type, the transition to collateral blood supply is carried out in case of vascular stenosis or occlusion.
Indications for surgery
Reconstruction of vessels in case of significant deviations in work is carried out strictly in accordance with the recommendations. The arteries of the upper extremities are much less susceptible to ischemia, this is due to the impact of a lower load on them, compared to body weight and extra pounds acting on the legs. In addition, the collateral blood supply is better developed in the upper body, shoulders and arms compared to the same system in the legs and lumbar.
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 life of the patient. Based on arterial, hemodynamic, clinical symptoms, a number of indications for surgery have been identified.
The arteries of the upper limb undergo 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 adversely affects the work activity, reduces the quality of life of the patient. Indications take into account the individual characteristics of the body, work style and the presence of concomitant diseases.
If the patient's pain does not go away at rest, is poorly stopped 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 fingers and hands. Before surgery, in any case, medical 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 advanced age of the patient.
Types of transactions
The anatomy of the arteries of the upper limbs allows you to reduce the results of vascular damage in various ways:
- the main majority is shunting, which creates bypass channels between he althy parts of the aorta, bypassing the altered part of the vessel;
- with proximal changes in the axillary aorta and brachycephalic trunk, balloon plasty procedures are performed;
- revascularization operations using microsurgical devices are performed less often.
Vascular Bypass Technology
The operation is done under general or local anesthesia. The most commonly used material for a shunt is the saphenous femoral vein. Depriving the patient of this vessel has practically no effect on the blood supply to the lower limb. The choice is made on the basis offemoral veins are usually rarely affected by atherosclerosis and their large diameter is well suited for creating a bypass.
For coronary aortic bypass surgery, the internal radial and thoracic arteries are most often taken on the left side. After an incision in the area of the affected vessel, incisions are made at the sites of the proposed shunt installation. It is sutured to aortic incisions to restore blood flow. After a certain time after the operation, repeated examinations are carried out.
Using x-rays to determine the condition of blood vessels
At the border of the union of surgery and medical radiology, a new discipline is growing and developing, manifesting itself as radiation-based vascular surgery. All arteries of the free upper limb, veins and their branches, and lymphatic tracts become available for examination by X-ray waves. All radiation exposures are becoming methods for studying the vascular system:
- radionuclide;
- ultrasonic;
- magnetic resonance;
- X-ray.
These violation detection methods 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 extremity is studied by radiation methods, such use of waves is especially effective for determining blood flow. Under the control of X-ray observation, therapeutic micro-operations on the vessels, the so-called endovascular corrections, are carried out.which represent an alternative to surgery for some changes in the veins.
Research of the pulse in the hematopoietic system
The heart is one with the vascular system, so the malfunction of the aortas and veins is largely determined by the pathology of this organ. The main arteries of the upper limb are examined for the value of the peripheral pulse and pressure. Small vessels are usually first examined visually, using the method of palpation, 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 radial, brachial, axillary, femoral, popliteal and arteries in the feet. The total value of the pulse is considered to be the frequency on the arteries of the carpal joint.
Blood pressure measurement
If we talk about the magnitude of pressure in various vessels, then 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. The pressure is subdivided into systolic (at the time of the rise in 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 the power and voltage of the pulse. The higher these numbers, the higher the blood pressure.
Determination of venous pulse and pressure
Increased blood flow moving through the veins to the right atrium, respectively,increases central pressure. In a disorder called heart failure, the peripheral vessels dilate and swell, primarily in the neck. Pressure increases with right ventricular failure, valve defects, pericarditis, and many other cardiac pathologies. A specialist in swelling of the veins in the hand assesses the amount of central pressure in the veins.
Visually swelling of the veins in the hand can be determined if you lower it below the level of the left atrium. Raising the hand to a height of more than 10 cm above the indicated mark will show sluggish filling of the vessels and a decrease in blood supply.
Examination of arteries
Disorders of the peripheral system of arterial tissue nutrition allows us to speak of partial occlusion against the background of the presence of atherosclerosis. Usually disorders of such circulation of blood are associated with age due to the deterioration of the collateral supply. The arteries of the upper limb show 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 cramps do not disturb the person. Over time, the duration of the load decreases, which passes without pain.
Such symptoms are characteristic of damage to the internal femoral and iliac vessels, if the process progresses, then spasms appear even at rest. Lowering the arm or leg to a vertical position slightly reduces the manifestations of pain, although an increase in venous pressure will provokelocal swelling.
Vein diagnostics
Allows you to identify a violation in the passage of blood flow associated with blockage after thrombosis, external pressure or phlebitis. The 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, press on the anastomosis of the vein and, after releasing, trace the further picture of the restoration of movement.
Vascular Doppler Ultrasound
The Doppler effect, known in physics, is the basis of the operation of the device and the method of examination. Its action is to change the frequency of the emitted ultrasonic signals when the position of the medium chosen for their reflection changes. The second option is to move the frequency sound source itself.
If the arteries of the upper and lower extremities are examined, then the reflection of the sent signals occurs 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 reflected wave catcher. Laboratory studies are based on the indicator of the velocity vector of movement along the observed line.
Procedure for examination
The procedure does not require special preliminary preparation, but it is impossible to examine the patient in the presence of purulent diseases and inflammatory foci on the skin. The procedure takes up to 40 minutes.
The person is laid on his back, the skin areas where the arteries of the upper limbs of the blood supply area are located, are smeared with a thick layer of gel soluble in the aquatic environment. This is required to improve the conductivity of ultrasound signals and creates an obstacle for the entry of excess air into the study area. By pressing the sensor to the study area, the specialist makes translational and circular movements over 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 for ultrasound examination of the arteries of the upper lower extremities is absolutely painless and does not cause any other discomfort to the patient. Traces of the gel are removed with a napkin after finishing.
Reasons for vascular examination
There are a number of indications for a detailed examination of the circulatory system of the body:
- appearance of pain in the hands for no known and visible reasons, impaired skin sensitivity;
- previously diagnosed with atherosclerosis of the leading pathways;
- various rheumatic pathologies, due to which parts of the vessels are affected;
- thrombosis of the leading aortas of the upper body, forearms and hands;
- squeezing the arteries of the upper limbs (photos of problem areas can be seen in the picture);
- suspicion of benign and malignant neoplasms in the veins;
- congenital malformations of the circulatory system;
- previously bridging the main and branch sections.
Research results
If the movement of the studied blood flow is directed towards the sensor, then the frequency of the signals becomes greater, and the movement in the opposite direction reduces 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.
Ultrasound, duplex and triplex scanning, examining the arteries and veins of the upper limbs, the anatomy of which has been damaged, allows us to assess their internal structure and the size of the throughput diameter. With the help of the method, reliable information about the hemodynamics of the circulatory system is obtained, it allows you to see the vessels on the screen. The study helps to 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, allowing you to visually trace the entire structure under study. The second option uses blind Doppler in spectral mode.
If a triplex survey is used, then a third method of color mapping is added to the two above modes. The method visualizes the blood flow in the area of observation. 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 for the detection of anomalies and damage to arteries and veins have significant advantages over those previously usedsurvey methods. The design of ultrasound preparations allows them to be used right at the patient's bedside, there is no harmful radiation for the patient.
