AXILLARY ARTERY.ppt
- 1. AXILLARY ARTERY Lt Col Supeeti Gupta Demonstrator DEPT OF ANATOMY 1 SUPEETI
- 2. Competencies • Branch / continuation • Relations • Branches • Applied SUPEETI 2
- 5. AXILLARY ARTERY – Continuation • of 3rd part of Subclavian Art – Extends from • outer border of 1st Rib to • lower border of Teres Maj, then continue as Brachial art. 5 SUPEETI
- 6. AXILLARY ARTERY COURSE • At outer border of 1st rib --- • enter axilla --- • run from apex to base of axilla. – Close to • medial wall at apex, • lat wall at base. – Acccompanied with • axillary vein, cords of BP along with branches. – Enclosed within Axillary sheath. 6 SUPEETI
- 7. AXILLARY ARTERY PARTS 1.proximal to Pect minor 2.Behind Pect minor 3.Distal to Pect minor 7 SUPEETI
- 8. AXILLARY ARTERY Relation of Pectoralis Minor to the Artery 8 SUPEETI
- 9. AXILLARY ARTERY Relation of Axillary Artery 9 SUPEETI
- 10. PART ANTERIOR POSTERIOR MEDIAL LATERAL First skin, SF, platysma 1,2nd ribs with IC msl Axillary V Lat and Post cord Suprclavicular N SA (1-2 dig) (ant med) Deep fascia, P maj Long thoracic N Clavipect fascia Medial cord BP (Art crossed anteriorly by Thoraco acromial art, Lat pect N, loop of commn bt medial and lat Pectoral N) MEDIAL AXILLARY ARTERY FIRST PART 10 SUPEETI
- 11. PART ANTERIOR POSTERIOR MEDIAL LATERAL Second as above + Subscapularis Medial cord BP Lat cord BP P minor Post cord BP Axillary V (antmed) Coracobrachialis (In between Pect maj and minor are Pect branches of Thoracoacromial art, medial Pect N and Rotter’s LN) AXILLARY ARTERY SECOND PART MEDIAL PART 11 SUPEETI
- 12. ANTERIOR POSTERIOR MEDIAL LATERAL Third Pect maj (upperpart) LD & T Maj (lat) Axillary V Coracobrachialis skin & fascia (lower) Subscapularis Medial Cut N Musculocutaneous Axillary N of arm /forarm Median N Radial N AXILLARY ARTERY THIRD PART UPPER PART LOWER PART 12 SUPEETI
- 13. AXILLARY ARTERY- RELATIONS PART ANTERIOR POSTERIOR MEDIAL LATERAL First skin, SF, platysma 1,2nd ribs with IC msl, Axillary V Lat and Post cord Suprclavicular N SA(1-2 dig (ant med) Deep fascia, P maj Long thoracic N Clavipect fascia Medial cord BP (Art crossed anteriorly by Thoraco acromial art, Lat pect N, loop of commn bt medial and lat Pectoral N) Second as above + P minor Subscapularis Medial cord BP Lat cord BP Post cord BP Axillary V (antmed) Coracobrachialis (In between Pect maj and minor are Pect branches of Thoracoacromial art, medial Pect N and Rotter’s LN) Third Pect maj (upperpart) LD & T Maj Axillary V Coracobrachialis skin & fascia (lower) Subscapularis Medial Cut N Musculocutaneous N of arm/forearm Median N Axillary N & Radial N 13 SUPEETI
- 14. AXILLARY ARTERY- BRANCHES FIRST PART Superior thoracic SECOND PART Thoracoacromial Lateral thoracic THIRD PART Anterior circumflex humeral Posterior circumflex humeral subscapular 14 SUPEETI
- 16. AXILLARY ARTERY- BRANCHES FIRST PART 1. Superior thoracic Art – Smallest br – Arise above Pect minor – Supply : • 1,2nd IC space • Seratus ant upper part 16 SUPEETI
- 17. AXILLARY ARTERY- BRANCHES SECOND PART 1. Thoracoacromial artery • Largest br • Pierce clavipectoral fascia just above Pect minor and divides 1. clavicular – • supply sternoclavicular jt and subclavius 2. Acromial – • shoulder 3. Deltoid – • accompany cephalic vein in delto pectoral groove and • supply both msl. 4. Pectoral – • supply both pectorals and breast. 17 SUPEETI
- 19. AXILLARY ARTERY- BRANCHES 2. Lateral thoracic – Arise deep to P minor, – come out at inferior border of P minor. – Supply Pect msl and Breast • through Lateral mammary branches – Anastomose with • pectoral br of Thoraco acromial art 19 SUPEETI
- 20. AXILLARY ARTERY- BRANCHES THIRD PART 1. Anterior circumflex humeral artery – Small br – Run infront of surgical neck of humerus and winds around it. – Anastomoses with • post circumflex humeral art – Gives ascending branch • goes through Intertubercular groove and supply shoulder jt. H 20 SUPEETI
- 21. AXILLARY ARTERY- BRANCHES 2. Post circumflex humeral art – Larger br – Winds around posterior aspect of surgical neck of humerus, leaves axilla with axillary N in the quadrangular space. – Anastomose with • anterior circumflex art. – Give descending br which anastomose with deltoid br of Profunda brachii 21 SUPEETI
- 22. Post circumflex passes thro post axillary wall bt subscapularis and T maj 22 SUPEETI
- 23. AXILLARY ARTERY- BRANCHES 3. Subscapular artery – Largest br – Run along post axillary wall, give off circumflex scapular br – Main artery continue down as • Thoracodorsal art • upto Inferior angle of scapula. Supply LD. – Circumflex scapular br – • winds around lateral border of scapula after piercing T minor and reach infraspinatus fossa. 23 SUPEETI
- 24. AXILLARY ARTERY- BRANCHES Circumflex art passes through post wall of axilla bt subscapularis and T Maj 24 SUPEETI
- 25. AXILLARY ARTERY- SCAPULAR ANASTOMOSIS Collateral anastomosis : between branches of – 1st part of Subclavian and – 3rd part of Axillary artery. Sites of scapular anastomosis 1. In subscapular, 2. supraspinous and 3. infraspinous fossae Other small anas • Over acromial process 26 SUPEETI
- 26. AXILLARY ARTERY- SCAPULAR ANASTOMOSIS 1. In subscapular, supraspinous and infraspinous fossae – 1st part of Subclavian (thyrocervical trunk): • Suprascapular art • Deep branch of transverse cervical artery – 3rd part of Axillary • Circumflex scapular art 27 SUPEETI
- 27. AXILLARY ARTERY- SCAPULAR ANASTOMOSIS 2. Other small anas : Over acromial process – 1st part of Subclavian (thyrocervical trunk) • Acromial branch of suprascapular artery – Branches of axillary • Thoracoacromial • Post circumflex humeral artery 28 SUPEETI
- 28. AXILLARY ARTERY- SCAPULAR ANASTOMOSIS 29 SUPEETI
- 30. AXILLARY ARTERY- APPLIED 1. most susceptible to laceration/ trauma 2. To arrest bleeding : compressed against the shaft of humerus (upper part) 3. Aneurysms : can compress cords of BP due to axillary aneurysms and thin axillary sheath. 4. Axillary vein • Bleeding and air embolism in injuries to proximal part • Subclavian vein puncture 5. Scapular anastomosis 31 SUPEETI
- 31. Subclavian puncture Needle passed in the axillary vein uptil the junc of IJV and subclavian vein Axillary vein is Anterior to artery and excessive posterior push may penetrate artery 32 SUPEETI
- 32. 5. Axillofemoral graft • Used for salvaging pregangrenous limb with bilateral iliac obstruction • PFTE 8mm graft tunneled subcutaneously from axillary art proximally to femoral art distally grafts 33 SUPEETI
- 33. 6. Axillary vein thrombosis 1. May occur following • Excessive exercise • Complication of thoracic outlet syn • Associated with cervical rib 2. Presentation • Swollen arm with collateral circulation • Treatment with anticoagulants, fibrinolytic therapy 34 SUPEETI
- 34. ASSESSMENT • Which of the following is most correct? (A) subscapular artery arises from third part of axillary artery & contributes to blood supply of muscles near the scapula & humerus (B) second part of axillary artery typically gives two branches—thoracoacromial artery & superior thoracic artery (C) first part of axillary artery lies posterior to pectoralis minor (D) thoracoacromial artery supplies pectoral muscles, axillary lymph nodes, & most importantly lateral part of mammary gland in women (E) lateral thoracic artery divides into acromial, deltoid, pectoral, & clavicular branches SUPEETI 35
- 35. ASSESSMENT Which among the following is a branch from the trunk of brachial plexus? a. Suprascapular nerve b. Long thoracic nerve c. Anterior thoracic nerve d. Nerve to subclavius SUPEETI 36
- 36. ASSESSMENT • Axillary vein is ---------- to Axillary artery • Scapular anastomosis is between ----- part of subclavian and ----- part of axillary artery SUPEETI 37