Vessels of the Upper Limb

Summary:

• Arteries
• Veins
  • Superficial veins
  • Deep venous network
• Lymphatic drainage

Arterial Supply of the Upper Limb

• All supply of the upper limb originates from the subclavian artery (see neck anatomy)
  • The subclavian artery (SCA) becomes the axillary artery and then brachial artery, lastly branching into the radial and ulnar arteries

1. Subclavian artery
   • To the lateral border of 1st rib
   • Becomes axillary artery beyond this

2. Axillary artery
   • Lateral border of the 1st rib -> inferior border of teres major
   • Surrounded by brachial plexus at axilla
     • Posterolateral to axillary vein
     • There are three parts categorised by their relation to the Pec Minor 
       • First part medial to pec minor (1 branch) :
         • Superior thoracic artery – supplies upper ribs, pec major/minor and the medial axilla
       • Second part posterior to pec minor (2 branches) :
         • Thoraco-acromial artery – supplies via the clavicular, acromial, deltoid, pectoral branches
         • Lateral thoracic artery – supplies lateral breast, pec muscles, serratus anterior
       • Third part lateral to pec minor(3 branches):
         • Subscapular artery
         • Anterior circumflex humeral artery
         • Posterior circumflex humeral artery

     • 

       Note the location of teres major anterior to the artery and first rib posterior to it. The axillary artery is highlighted in pink in the above picture

3. Brachial artery
   • From teres major -> head of radius
   • Immediately below deep fascia
     • Relations with median, radial, and ulnar nerves
   • Bifurcates medial to the tendon of biceps at the head of the radius to form:
     1. Ulnar artery
        • Larger than radial – this is therefore the dominant artery
          • Lies between ulnar nerve and palmaris longus
        • Palmar arches contribution
        • Provides common interosseus artery => anterior and posterior branches
     2. Radial artery
        • Palpable
          • Close  to radial nerve
          • Palmar arches contribution

Veins of the upper limb

It is important to remember there are two venous networks

Deep veins of the upper limb

• These are known as vena comitantes and correspond with the arterial supply described above

Superficial veins of the upper limb

• These do not have arterial counterparts
• There are 3 key veins to know
  • Cephalic vein (laterally)
    • Comes up lateral bicep
    • Joins axillary vein
  • Basilic vein (medially)
    • Medial forearm (posterior then anterior)
    • Forms axillary vein at posterior axillary fold
  • Medial cubital vein
    • Crosses cubital fossa to link the two veins

Lymphatic drainage

• There are two parallel systems
  • Superficial system
    • Skin, and epithelial drainage
    • Drains parallel to superficial veins
  • Deep system
    • Muscle and organ drainage
    • Drains parallel to arteries/deep veins to pan-aortic nodes.