UPPER EXTREMITY ARTERIAL ANATOMY AND DISEASE

Subclavian arteries, travel how to the what bone and muscle

Travel posterior to clavicle and scalene muscle

Right subclavian branches off what artery?

Right subclavian branches off brachiocephalic artery

Left subclavian arises directly from what artery?

Left subclavian arises directly from aortic arch

Subclavian arteries, Give off branches that do what for the upper limb?

Give off branches that do not supply upper limb

what’s the first branch of the Subclavian arteries?

Vertebral artery- 1 st branch

what’s the 2nd branch of the Subclavian arteries?

Thyrocervical trunk- 2 nd branch

name two other arteries of the Subclavian arteries?

Internal thoracic arteries

Costocervical arteries

After the Subclavian arteries passing beneath the clavicle, it becomes the what artery?

After passing beneath the clavicle, it becomes the axillary artery

Name the Seven branches of the Axillary artery?

Superior artery

Subscapular artery

Thoracic artery

Thoracodorsal artery

Thoracoacromial artery

Lateral thoracic artery

Anterior and posterior humeral artery

The Axillary artery becomes the what artery?

Becomes the brachial artery

How does the Brachial artery courses and what does it supply?

Courses down upper arm

Supplies the muscles of the arm

The Brachial artery end about what (number and units please!) beyond the what?

Ends about 1 cm beyond the bend of the elbow

The Brachial artery divides into what arteries ?

Radial and ulnar arteries

How does the Radial artery course ?

Travels down lateral side of forearm into the hand

The Radial artery gives off branch in where forming the what?

Gives off branch in hand forming the superficial palmar arch

where does the Radial artery terminates, by joining what?

Terminates in deep palmar arch by joining the deep branch of the ulnar artery

Where does the Ulnar artery course?

Travels down the medial side of the forearm into the hand

The Ulnar artery gives off what branch?

Gives off a deep palmar branch

Where does the Ulnar artery terminates

Terminates in the superficial palmar arch

whats the Superficial palmar arch, what portion of the what artery termination and branch of what artery?

Distal portion of ulnar artery (termination); Branch of radial artery

Whats the Deep palmar arch, what portion of the what artery termination and branch of what artery?

Distal portion of radial artery (termination); Branch of ulnar artery

Where does the Digital arteries arise from?

Arise from palmar arches

Digital arteries, extend into where and divide into what branches

Extend into the fingers

Divide into lateral and medial branches

For UEA anatomy how common are Anatomic variants, and familiarity with variants can prevent what during duplex sonography?

Many can occur

Familiarity with variants can prevent confusion and error during duplex sonography

Tunica Intima what layer is this and consists of what?

Innermost layer: consists of smooth endothelium and connective tissue.

Tunica Media what layer is this, describe it and composed of what?

intermediate layer, thicker and composed of smooth muscle and connective tissue.

Tunica Externa (adventitia), what layer is this, describe it and what type of tissue is this?

Tunica Externa (adventitia): Outer layer; thinner; fibrous connective tissue.

Collateral Pathways • Obstruction of proximal subclavian

flow from where to subclavian artery where to the obstruction?

Flow from cranial and/or neck arteries to subclavian artery distal to obstruction

Collateral Pathways • Obstruction of proximal subclavian

flow from what arteries to subclavian artery where to the obstruction?

Flow from pelvic, abdominal wall, & thoracic wall arteries to subclavian artery distal to obstruction

Collateral Pathways • Obstruction of distal subclavian or axillary arteries

flow from what wall of what region to what artery how to the obstruction

Flow from thoracic wall or shoulder region to axillary artery distal to obstruction

Collateral Pathways • Obstruction of the brachial artery, describe flow on the arm, and how does the flow look and filling the what

Flow from the distal arm to the proximal forearm 

Flow from the mid-arm to the distal arm and/or forearm 

Retrograde flow filling the palmar arches of the hand

name 6 of UEA Disease

Subclavian Steal Syndrome •

Thoracic Outlet Syndrome (TOS) •

Quadrilateral Space Syndrome •

Thromboangitis Obliterans •

Raynaud’s Phenomenon •

Hypothenar Hammer Syndrome

Subclavian Steal results from what?

Results from stenosis/occlusion in proximal subclavian or innominate artery

Subclavian Steal there is a Increased incidence on on what side? (right or left?)

Describe the flow and occurs in what artery on what side?

describe what Subclavian Steal is / does ?

Increased incidence on left

Retrograde flow occurs in the vertebral artery on the same side as occlusion

Stealing blood flow from contralateral vertebral artery which was destined to basilar artery and brain

what is Thoracic Outlet Syndrome (TOS)?

Condition caused by muscular or bony compression of the subclavian or axillary artery

TOS, Condition caused by muscular or bony compression of the subclavian or axillary artery

Describe where can these compression happen? (name 3)

Compression between 1st rib and scalene muscle 

Compression between 1st rib and clavicle 

Compression between coracoid process and pectoralis muscle

what are the TOS Symptoms

Pain or numbness and loss of sensation when upper extremity is in a predictable and reproducible position

TOS Symptoms are what related and found in patients who perform what task?

Syndrome may be job related, found in patients who perform repetitive tasks

Quadrilateral Space Syndrome, describe what this?

Impingement of the axillary nerve and posterior humeral circumflex artery

Quadrilateral Space Syndrome, the impingement due to what? and this syndrom is similar to what?

Impingement due to trauma or muscle hypertrophy

Similar to TOS

what are the Signs and symptoms Quadrilateral Space Syndrome (name 3)

Pain, paresthesia and atrophy

Quadrilateral Space Syndrome, compression of what?

Compression of either nerve, artery or both

Quadrilateral Space Syndrome, what age group does this happen and due to what motion?

Young, <40 years old, repetitive overhead motion

Thromboangitis Obliterans is also known as what disease?

Also known as Buerger’s Disease

Thromboangitis Obliterans is the most common form of what?

Most common form of arteritis

what arteries does Thromboangitis Obliterans effects? Leadings to what?

Effects small/medium distal extremity arteries

Leading to rest pain & ischemic ulceration

Thromboangitis Obliterans is associated with heavy with which controllable risk factor?

Associated with heavy cigarette smoking

Thromboangitis Obliterans is most common in what sex and age?

 Primarily men < 40 years of age

Thromboangitis Obliterans begins where and spreads where?

Begins at palmar arch, spreads centrally up arm

Thromboangitis Obliterans, has little opportunity for what development?

Little opportunity for collateral development

name 3 treatment options for Thromboangitis Obliterans

Eliminate smoking 

Avoid vasoconstriction 

Disease progresses if untreated

UEA Disease • Raynaud’s Phenomenon, what are the different types?

Primary Raynaud’s , Raynaud’s Disease

Secondary Raynaud’s

Primary Raynaud’s Phenomenon is also known as what disease?

Also known as Raynaud’s Disease

Primary Raynaud’s Phenomenon, is what disorder?

Innocuous vasospastic disorder , No underlying disease

Primary Raynaud’s Phenomenon - explain what this is?

Intermittent digital ischemia is caused by digital arterial spasm

Primary Raynaud’s Phenomenon is common in what sex and age?

Common in young women (under 40)

Primary Raynaud’s Phenomenon is what type of prognosis?

Good prognosis- lack of disease progression

What are the symptoms for Primary Raynaud’s Phenomenon ? what does it represent? what does testing include?

Digits display bilateral intermittent pallor, cyanosis, and rubor that is caused solely by digital arterial spasm

Represents an overreaction of vasomotor responses to cold or stress stimuli

Testing includes pre and post cold water challenge

Secondary Raynaud’s Phenomenon, is also known as what?

Also known as Secondary Raynaud’s

Secondary Raynaud’s Phenomenon- explain what this is? and give 3 example?

Vasospasm secondary to underlying systemic or vascular abnormality Arteriosclerosis

Connective tissue disorders

Thromboangitis obliterans

what is Secondary Raynaud’s?

Normal vasoconstrictive response of arterioles superimposed on a fixed arterial obstruction

Secondary Raynaud’s is more common in what sex and age?

More common in men over 40

Secondary Raynaud’s, what arms can it affect? and what does it constant of?

Bilateral or unilateral

Ischemia is constant

Secondary Raynaud’s may be first manifestation of what?

May be first manifestation of a collagen disorder or other abnormality

Hypothenar Hammer Syndrome- what is this syndrome?

Hypothenar – group of muscles that control movement of the little finger

Hypothenar Hammer Syndrome, makes up what?

Make up fleshy edge of palm

Hypothenar Hammer Syndrome, how does this happen (also explains what it damages?)

Repeated use of palm as a hammer to grind, push, and twist objects damages blood vessels of the hand especially the ulnar artery

Hypothenar Hammer Syndrome; Damage to ulnar artery results in what?

Damage to ulnar artery results in reduction of blood flow to fingers

Hypothenar Hammer Syndrome, what sex is this common in and age?

Men mean age of 40

Hypothenar Hammer Syndrome, is most common in what workers? (name 8)

Auto mechanics, metal workers, miners, machinists, butchers, bakers, carpenters, and brick layers

Hypothenar Hammer Syndrome

Symptoms include: (name 5)

Pain 

Pins and needles 

Loss of sensation 

Difficulty holding heavy objects 

Cold sensitivity