Vascular Anatomy of The Lower Limb : Vascular Anatomy of The Lower Limb Mr. MOHAMED OMAR EL-FDROK M.Sc, FRCS What is the cardiovascular system? : What is the cardiovascular system? Includes the heart and blood vessels
Brings nutrients to cells and helps get rid of wastes
Blood is refreshed in the lung, kidneys, intestine and liver
Lymphatic vessels help this system by collecting excess fluid surrounding tissues and return it to the cardiovascular system 5.1 Overview of the cardiovascular system What are the functions of the cardiovascular system? : What are the functions of the cardiovascular system? Generate blood pressure
Exchange of nutrients and wastes at the capillaries
Regulate blood flow as needed 5.1 Overview of the cardiovascular system What is the main pathway of blood in the body? : What is the main pathway of blood in the body? Heart – arteries – arterioles – capillaries - venules – veins – back to the heart… 5.2 The types of blood vessels Capillaries: : Capillaries: Microscopic vessels with endothelium wall
Where O2 and CO2 and nutrients-wastes exchange takes place 5.2 The types of blood vessels and
5.6 Exchange at the capillaries Exchange at the capillary beds is primarily a result of osmotic and blood pressure : Exchange at the capillary beds is primarily a result of osmotic and blood pressure 5.6 Exchange at the capillaries Bones of Lower Limb : Bones of Lower Limb Function
Support & locomotion
Phalanges (14) pg 195 Arteries and arterioles: : Arteries and arterioles: Carry blood away from the heart
Their walls have 3 layers:
Tunic interna: endothelium
Tunic media: elastic fibers and smooth muscle
Tunic externa: elastic and collagen fibers 5.2 The types of blood vessels Arteries of Lower Limb : Arteries of Lower Limb Pg 562 Common Iliac (split from aorta)
Internal Iliac (branches from common iliac)
Cranial + Caudal Gluteals= gluteals
Internal Pudendal = perineum, external genitalia
Obturator = adductor muscles
Other branches supply rectum, bladder, uterus, vagina, male repro glands
External Iliac (branches from common iliac)
Femoral = lower limb
Deep femoral = adductors, hamstrings, quadriceps
Medial/lateral femoral circumflex = head and neck of femur
Popliteal (continuation of femoral)
Geniculars = knee
Anterior Tibial = ant. leg muscles, further branches to feet
Posterior Tibial = flexor muscles, plantar arch, branches to toes (Figure on pg 541) Veins of Lower Limb : Veins of Lower Limb Deep Veins: Mostly share names of arteries
Ultimately empty into Inferior Vena Cava
Dorsal venous arch (foot)
Great saphenous (empties into femoral)
small saphenous (empties into popliteal) “May I please be excused? My brain is full!” : “May I please be excused? My brain is full!” Circulatory System : Circulatory System Major Role: The main role of the circulatory system is to transport nutrients, gases (such as oxygen and CO2), hormones and wastes through the body.
Major Organs: Heart, blood vessels and blood. Circulatory System : Circulatory System Red blood cells carry oxygen from the lungs to all the cells of the body.
White blood cells are like soldiers protecting the body.
ARTERIES are vessels that carry blood away from the heart.
VEINS are vessels that carry blood back to the heart.
Blood CIRCULATES--circles--all around your body in about one or two minutes. 5 liters
Inside the heart are four hollow chambers. Each chamber is a little pump. The pumping pushes blood all around your body. Anatomy of the Circulatory System : Anatomy of the Circulatory System The Main Features
Two pumps (in a single heart)
one to pump deoxygenated blood to the lungs;
the other to pump oxygenated blood to all the other organs and tissues of the body.
A system of blood vessels to distribute blood throughout the body
Specialized organs for exchange of materials between the blood and the external environment; for example
organs like the lungs and intestine that add materials to the blood and
organs like the lungs and kidneys that remove materials from the blood and deposit them back in the external environment. Circulatory System : Circulatory System It's small, a little larger than a clenched fist. Relatively simple in function, your heart's primary purpose is to pump...24 hours a day, 70 to 80 times a minute. With each beat, the heart pumps blood that delivers life-sustaining oxygen and nutrients to 300 trillion cells. Each day the average heart "beats" (or expands and contracts) 100,000 times and pumps about 2,000 gallons of blood. In a 70-year lifetime, an average human heart beats more than 2.5 billion times, pumping approximately 55 million gallons of blood. Anatomy of the Circulatory System : Anatomy of the Circulatory System The Coronary System
From the left atrium,
Blood flows through the mitral valve (also known as the bicuspid valve) into the left ventricle.
Contraction of the ventricle closes the mitral valve and opens the aortic valve at the entrance to the aorta.
The first branches from the aorta occur just beyond the aortic valve still within the heart.
Two openings lead to the right and left coronary arteries, which supply blood to the heart itself. Although the coronary arteries arise within the heart, they pass directly out to the surface of the heart and extend down across it. They supply blood to the network of capillaries that penetrate every portion of the heart.
The capillaries drain into two coronary veins that empty into the right atrium. Anatomy of the Circulatory System : Anatomy of the Circulatory System Deoxygenated blood from the body enters the right atrium.
It flows through the tricuspid valve into the right ventricle. The term tricuspid refers to the three flaps of tissue that make up the valve.
Contraction of the ventricle then closes the tricuspid valve and forces open the pulmonary valve. Circulatory System Disease : Circulatory System Disease The single major cause of artery disease is the thickening and hardening of arterial walls by deposits of fatty materials, known as arteriosclerosis. Arteriosclerosis : Arteriosclerosis Vascular disease, which affects the brain, heart, kidneys, other vital organs, and extremities, is the leading cause of morbidity and mortality in the USA and in most Western countries.
There were almost 1 million deaths due to vascular disease in the USA in 1994 (twice as many as from cancer and 10 times as many as from accidents).
CAD and ischemic stroke combined are the number one killer in industrialized Western countries and are of increasing prevalence in the rest of the world.
The death rate from CAD among white men aged 25 to 34 is about 1/10,000; at age 55 to 64, it is nearly 1/100.
The death rate from CAD among white men aged 35 to 44 is 6.1 times that among age-matched white women. Arteriosclerosis : Arteriosclerosis Atherosclerosis is a disease of the arteries in which fatty material is deposited in the vessel wall, resulting in narrowing and eventual impairment of blood flow. Severely restricted blood flow in the arteries to the heart muscle leads to symptoms such as chest pain. Atherosclerosis shows no symptoms until a complication occurs. Arteriosclerosis : Arteriosclerosis Carotid Stenosis : Carotid Stenosis Carotid artery stenosis is the narrowing of the carotid arteries. These are the main arteries in the neck that supply blood to the brain.
This is an angiogram of the right carotid artery showing a severe narrowing (stenosis) of the internal carotid artery just past the carotid fork. There is enlargement of the vein or ulceration in the area after the stenosis in this close-up film. Note the narrowed segment toward the bottom of the picture. Angina : Angina Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion.
Stable angina and Unstable
Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheeks and gum is used to relieve an angina episode. Nitroglycerin in the form of pills and skin patches is used to prevent attacks of angina. (Nitroglycerin in these forms acts too slowly to relieve pain during an angina attack.) Coronary artery balloon angioplasty : Coronary artery balloon angioplasty Coronary artery balloon angioplasty : Coronary artery balloon angioplasty Fat and cholesterol accumulates on the inside of arteries (atherosclerosis). The small arteries of the heart muscle (the coronary arteries) can be narrowed or blocked by this accumulation. If the narrowing is small, percutaneous transluminal coronary angioplasty, or PTCA for short, may be the course for treatment. PCTA is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle.
The indications for PCTA are:
persistent chest pain (angina)
blockage of only one or two coronary arteries Coronary artery balloon angioplasty : Coronary artery balloon angioplasty The patient is awake and pain-free (local anesthesia), a catheter is inserted into an artery at the top of the leg (the femoral artery). The procedure begins with the doctor injecting some local anesthesia into the groin area and putting a needle into the femoral artery (the blood vessel that runs from the heart down the leg). Once the needle is inserted, a guide wire is placed through the needle, into the blood vessel. Following this step, the guide wire is left in the blood vessel and the needle is removed. A large needle called an introducer is then placed over the guide wire and the guide wire is removed. Coronary artery balloon angioplasty : Coronary artery balloon angioplasty Next, a diagnostic catheter, which is a long narrow tube, is advanced through the introducer over a .035"guidewire, into the blood vessel. This catheter is then guided to the aorta and the guidewire is removed. Once the catheter is placed in the opening or ostium of one of the coronary arteries, the doctor injects dye and takes a series of X-rays (film of the images). Coronary artery balloon angioplasty : Coronary artery balloon angioplasty The first catheter is exchanged out over the guidewire for a guiding catheter and the guidewire is removed. A smaller guidewire is advanced across the blocked section of the coronary artery and a balloon -tipped tube is positioned so the balloon part of the tube is beside the blockage. The balloon is then inflated for a few seconds to compress the blockage against the artery wall. Then the balloon is deflated. The doctor may repeat this a few times, each time pumping up the balloon a little more to widen the passage for the blood to flow through. This treatment may be repeated at each blocked site in the coronary arteries. Coronary artery balloon angioplasty : Coronary artery balloon angioplasty A device called a stent may be placed. A stent is a latticed, metal scaffold that is placed within the coronary artery to keep the vessel open. Coronary Bypass Surgery : Coronary Bypass Surgery Thrombophlebitis : Thrombophlebitis Deep venous thrombosis (DVT) affects mainly the veins in the lower leg and the thigh. It involves the formation of a clot (thrombus) in the larger veins of the area. Thrombophlebitis : Thrombophlebitis This picture shows a red and swollen thigh and leg caused by a blood clot (thrombus) in the deep veins in the groin (ileofemoral veins) which prevents normal return of blood from the leg to the heart. Slide 33: The main arteries to the shoulder and upper limb. Slide 34: Major vessels of the arterial system. Slide 35: Femoral artery: arises from external iliac artery and supplies muscles and tissues of thigh, skin of groin, and lower abdominal wall
Popliteal artery supplies knee joint, muscles of thigh and calf
Anterior tibial artery supplies skin and muscles in anterior and lateral regions of leg. Continues to foot as dorsalis pedis artery which supplies foot and toes
Posterior tibial artery supplies skin, muscles and other tissues of posterior lower leg. Venous System : Venous System Difficult to follow pathway because they connect in irregular networks. Many unnamed tributaries may join to form a large vein
Larger veins typically parallel courses of names arteries and often have same names as arterial counterparts
Ex. Renal vein parallels renal artery
Veins converge into 2 major pathways: superior and inferior venae cava and enter right atrium Slide 37: The main veins of the upper limb and shoulder. v=vein Anastomosis : Anastomosis Connection between two blood vessels, sometimes produced surgically Arteriography : Arteriography Injection of radiopaque solution into the vascular system for X-ray examination of arteries Embolectomy : Embolectomy Removal of an embolus through an incision in a blood vessel Endarterectomy : Endarterectomy Removal of the inner wall of an artery to reduce an arterial occlusion Phlebitis : Phlebitis Inflammation of a vein, usually in the lower limbs Blood flows more slowly through the veins and especially in varicose veins where they become dilated and more torturous. When added pressure is put on the veins by a lot of standing and squatting, by crossing the legs and by getting bumped, an inflammation takes place. This causes the area to become swollen, painful, red, and tender to touch. Once it begins, it can extend up and down the leg and may cause fever. At this point, it becomes urgent to be checked by the doctor and start immediate treatment. It is at this time that blood clots can develop and, if dislodged, circulate into the heart or lungs with fatal results. Phlebotomy : Phlebotomy Incision or puncture of a vein to withdraw blood Thrombophlebitis : Thrombophlebitis Formation of a blood clot in a vein in response to inflammation of the venous wall They can result from many different things, but many times, the common theme is the blood not moving the way it should. You could be sitting down for a long time in a place where you can't stretch out your legs, such as on a long car ride. Blood sits, too, and it is more likely to form clots. This is where sitting elbow-to-elbow with your fellow airline travelers on a long flight (dubbed economy class syndrome) can be a problem.
But other things can cause this condition as well, such as varicose veins. The vessels are stretched out too much, allowing blood to swish back and forth instead of streaming in one direction. That swishing of the blood can lead to blood clots.
People also could develop thrombophlebitis as a complication of intravenous tubes, or IVs. The hospital staff will try to lower the risk of this happening by changing the spots where the lines are injected into the body and by checking for problems, but thrombophlebitis still is possible. Also, pregnant women may develop thrombophlebitis before or shortly after the baby is born. Venography : Venography Injection of radiopaque solution into the vascular system for X-ray examination of veins. Slide 46: Here is an example of an atherosclerotic aneurysm of the aorta in which a large "bulge" appears just above the aortic bifurcation.Such aneurysms are prone to rupture when they reach about 6 to 7 cm in size. They may be felt on physical examination as a pulsatile mass in the abdomen.Most such aneurysms are conveniently located below the renal arteries so that surgical resection can be performed with placement of a dacron graft. Slide 47: Thank you