Anatomical Considerations Chapter 8

Linear Guide - Common Carotid Artery

A point from the sternoclavicular articulation to the anterior surface of the lobe of the ear.

Facial Artery (place of incision)

Along the inferior border of the mandible just anterior to the angle of the mandible

Place of Incision for Anterior Tibial Artery

Along the lateral margin of the inferior third of the crest of the tibia.

Rising the Dorsalis Pedis Artery

An incision made from a point midway between the medial and lateral malleoli to the interosseous space will provide access to the artery

A method of locating a structure by reference to an adjacent, known, or prominent structure.

Anatomical Guide

External Iliac Artery

Anatomical Guide Along the medial border of the psoas major muscle

Drawing an imaginary line along the midline of the neck between the tip of the mandible and the sternum. Extend this line superiorly along the anterior border of the Sternocleidomastoid muscle (SCM) and them anteriorly along the lower margin of the body of the mandible. These three lines are called

Anterior Triangle

Branches of the Right and Left External Carotid Arteries

Ascending pharyngeal, superior thyroid, lingual, facial, occipital, posterior auricular, maxillary, superficial temporal

Arteries of the Upper Extremity

Axillary Artery Brachial Artery Radial Artery Ulnar Artery

Accompanying Vein for Brachial Artery

Basilic Vein

Right Subclavian Artery

Begins at the sternoclavicular articulation and extends to the lateral border of the first rib (right)

The anatomical guides for veins and arteries

Blood flows the same

the anatomical limit and the linear guide for veins

Blood in the veins flows in the direction opposite of the respective of those arteries

Branches of the Right and Left Internal Carotid Arteries

Branches arising within the carotid canal, in addition to ophthalmic, anterior cerebral, middle cerebral, posterior communication, and choroidal branches

Arteries of the Lower Extermity

Femoral Artery Popliteal Artery Anterior Tibial Artery Posterior Tibial Artery

Accompanying Vein for the Femoral Artery

Femoral Vein

Accompanying Vein

Internal Jugular Vein

Contents of the Carotid Sheath

Internal jugular vein (lateral to artery), vagus nerve (between and posterior to artery and vein), common carotid artery (medial to vein)

Relative Location to Common Carotid Artery

Lateral and superficial to the common carotid artery.

An imaginary line drawn on the surface of the skin to represent the approximate location of some deeper lying structure

Linear Guide

Axillary Artery

Linear Guide - A point over or through the center of the base of the axillary space to a point over or through the center of the lateral border of the base of the axillary space. This line is parallel to the long axis of the upper extremity when abducted. Anatomical Guide- Just behind the medial border of the coraco-brachialis muscle Anatomical Limits - Begins at the lateral border of the first rib and extends to the inferior border of the tendon of the teres major muscle.

Brachial Artery

Linear Guide - From the center of the base of the axillary space to the center of the forearm just below the bend in the elbow. Anatomical Guide - Lies Posterior to the medial border of the belly of the biceps brachii muscle. Anatomical Limits- Begins at the inferior border of the tendon of the teres major muscle and extends to a point inferior to the anticubital fossa.

Posterior Tibial Artery

Linear Guide - From the center of the popliteal space to a point midway between the medial malleolus and calcaneous bone

Radial Artery

Linear Guide - On the surface of the forearm from the center of the antecubital fossa to the center of the base of the index finger Anatomical Guide- Lies lateral to the tendon of the flexor carpi radialis muscle and just medial to the tendon of the brachioradialis muscle Anatomical Limit The radial artery extends from a point approximately 1 inch below and in front of the bend of the elbow to a point over he base of the thumb (thenar eminence)

Underlying the skin is a thin, delicate cutaneous muscle (a muscle of facial expression) called

Platysma

Anatomical Limit

Points of origin and points of termination in relation to adjacent structures

Anatomical Limit- - Common Carotid Artery

RCC -begins at the level of the sternoclavicular articulation and extends to the level of the superior border of the thyroid cartilage. LCC- begins at the level of the second costal cartilage and extends to the superior border of the thyroid cartilage

Subclavian Artery Anatomical Limits

Right Subclavian Artery-Begins at the sternoclavicular articulation and extends to the lateral border of the first rib (right) Left Subclavian Artery-Begins at the level of the second costal cartilage and extends to the lateral border of the first rib (left)

Accompanying Veins for Arteries of the Trunk

Subclavian Artery - Subclavian Vein Brachiocephalic Artery - Brachiocephalic Vein Aorta Artery - Superior and Inferior Vena Cava Common Iliac Artery - Common IliacVein External Iliac Artery - External Iliac Vein Internal Iliac Artery - Internal Iliac Vein

Relationship of the Brachial Artery and the Basilic Vein?

The accompanying basilica vein is located medial and superficial to the brachial artery.

The distal forearm is the area in which the radial and ulnar arteries can be approached

The radial artery lies on the lateral side of the forearm and the ulnar artery on the medial side.

Anatomical Guide of Common Carotid Artery

The right and left common carotid arteries are located posterior to the medial border of the SCM

Anatomical Guide - Common Carotid Artery

The right and left common carotid arteries are located posterior to the medial border of the sternocleidomastoid muscle (SCM)

Origins of Common Carotid Artery

The right carotid is a terminal branch of the brachiocephalic artery. The left common carotid is a branch off the arch of the aorta

Axillary Artery -Origins

The axillary artery is a continuation of the subclavialn artery.

What is the relationship of the Axillary Artery to the Axillary Vein?

The axillary artery is located lateral and deep to the axillary vein.

Incision for Rising Brachial Artery

The brachial artery is usually raised by an incision along the upper one third of the linear guide (center of lateral border of the base of the axillary space to a point approximately 1 inch below and in front of the elbow joint

Anatomical Limit of Common Carotid Artery

The common carotid begins at the level of the right sternoclavicular articulation and extends to the superior border of the thyroid cartilage. The left common carotid begins at the level of the second costal cartilage and extends to the superior border of the thyroid cartilage

Located in the anterior triangle

The external carotid artery and several of its branches

Relationship of the Femoral Artery to the Femoral Vein?

The femoral artery lies lateral and superficial to the femoral vein.

Incision for Raising the Axillary Vessels

The incision is made along the anterior margin of the hairline of the axilla with the arm abducted

Femoral Triangle

The inguinal ligament serves as the base for this triangle whose two sides consist of the medial border of the sartorius and the lateral border of the adductor longus muscles. The roof consist of a dense sheet of fascia, the fascia lata, which attaches firmly to the inguinal ligament and encircles the thigh.

Relationship of the Common Carotid to the internal Jugular Vein?

The internal jugular vein lies lateral and superficial to the common carotid artery. The artery lies medial to the vein

Relationshp to the Popliteal Artery and Vein

The vein lies posterior and medial to the artery. Because of the location of these vessels the vein can also be described as lying superficial to the artery.

Branches of Common Carotid Artery

There are no branches of the right common carotid, except the terminal bifurcation into the right internal and external carotid arteries. No branches of the left common carotid, except the terminal bifurcation into the left internal and external carotid arteries.

Relationship of the Radial Artery to the Vena Comitantes?

Two small veins (venae comitantes) lie on either side of the artery. They may be helpful in locating the artery, for they generally contain some blood.

Relationship of the Ulnar Artery to the Venae Comitantes?

Two small veins (venae comitantes) lie on either side of the artery. They may be helpful in locating the artery, for they generally contain some blood.

Linear Guide of Common Carotid Artery

a point over the respective sternoclavicular articulation to a point over the anterior surface of the base of the respective earlobes.

Carotid sheath

is an investment of fascia that extends up into the neck and contains within it the common carotid (medial) artery, the internal jugular vein (lateral), and the vagus nerve (between the artery and the vein)

Three large nerve cords of the brachial plexus

medial lateral posterior

The common iliac is one of the terminal branches of

the abdominal aorta

If the carotid sheath in incised

the upper position of the internal jugular vein and the common carotid artery be comes visible

Tendons passing onto the dorsum of the foot from the leg pass posterior to and are restrained by

two thickening of facia, the superior and inferior extensor retinacula, which lies anterior to the ankle

The vagus nerve (cranial nerve X) can be identified

between and posterior to the vessels within the sheath

Lying posterior and roughly parallel with the SCM muscles are the

Carotid sheath and its contents.

Anterior and Posterior tibial Arteries

Linear Guide- Anterior Tibial Artery. Draw or visualize a line from the lateral border of the patella to the anterior surface of the ankle joint. Posterior Tibial Artery. The posterior tibial vessels are located between the posterior border of the tibia and the calcaneus tendon Anatomical Guide- Anterior Tibial Artery. The anterior tibial vessels are located in a groove between the tibialis anterior muscle and the tendon of the extensor hallucis longus muscle. Posterior Tibial Artery. The posterior tibial vessels are located between the posterior border of the tibia and the calcaneus tendon Anatomical Limit - Anterior Tibial Artery. the anterior tibial artery extends from a point beginning at the inferior border of the poplitieus muscle to the point in from of the middle of the ankle joint on the respective sides. . Posterior Tibial Artery. The posterior tibial artery extends from a point beginning at the inferior border of the poplitieus muscle to a point over and between the medial malleolus and the calcaneus of the respective foot.

Femoral Artery

Linear Guide- On the surface of the thigh from the center of the inguinal (femoral) ligament to a center point on the medial condyle of the femur bone. Anatomical Guide- Through the center of the femoral triangle, bounded laterally by the sartorius muscle and medially by the adductor longus muscle. Anatomical Limits- Begins at a point behind the center of the inguinal ligament and terminates at the opening in the adductor magnus muscle.

Popliteal Artery

Linear Guide- from the center of the superior border of the popliteal space and parallel to the long axis of the lower extremity to the center of the inferior border of popliteal space Anatomical Guide- The popliteal vessels are located between the popliteal surface of the femur and the oblique popliteal ligament Anatomical Limits- The popliteal artery extends from a point that Begins at the opening of the adductor magnus muscle and terminates at the inferior border of the popliteous muscle

Dorsalis Pedis Artery

Linear Guide-From the center of the anterior surface of the ankle joint to a point between the first and second toes.

Anterior Tibial Artery

Linear Guide-From the lateral border of the patella to the anterior surface of the ankle joint.

Ulnar Artery

Linear Guide-One the surface of the forearm from the center of the antecubital fossa to a point between the fourth and fifth fingers Anatomical Guide-Lies lateral to the tendon of the flexor carpi ulnaris muscle (lies between the tendons of the flexor carpi ulnaris and flexor digitorum superficialis muscles.) Anatomical Limit- The ulnar artery extends from a point approximately 1 inch below and in front of the bend of the elbow to a point over the pisiform bone (hypothenar eminence)

Relative Position of Femoral Vein

Medial and deep to the femoral artery.

Relative Location of Axillary Vein

Medial and superficial to the axillary artery.

Relative Location for Basilic Vein

Medial and superficial to the brachial artery

The apex of the axilla is an opening called

cervicoaxillary canal