 The largest artery of body

 Main arterial trunk delivering oxygenated blood from left ventricle to tissues of body
 Course:
 Arise from left ventricle of heart as ascending aorta.
 It arches to the left as arch of aorta.
 Then descends in the thorax as descending or thoracic aorta.
 It passes through diaphragm to enters the abdominopelvic cavity & becomes abdominal aorta.

 Ascending Aorta:
 Begins at the base of left ventricle & runs upward & forward to come to lie behind the right half of
sternum.
 At the level of sternal angle, it becomes continuous with the arch of aorta
 Has three bulges (sinuses of aorta)
 Branches: Lt & Rt coronary artery

 Arch of Aorta:
 Beginning: continuation of ascending aorta at right 2nd sternocostal junction.
 End of aortic arch: continues as descending thoracic aorta at left side of lower
border of T4.
 Course & relations of arch of aorta:
o Lies behind manubrium sterni
o Arches upward, backward & to left in front of trachea
o Then, passes downward to left of trachea

 Branches:
1. Brachiocephalic artery:
o Arises from convex surface of aortic arch
o Passes upward & to right of trachea
o Behind right sternoclavicular joint divides into: Right subclavian artery &
Right common carotid artery

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 2. Left common carotid artery:
o Arises from convex surface of aortic arch on left side of brachiocephalic artery
o Runs upward & to left of trachea
o Enters neck behind left sternoclavicular Joint

3. Left subclavian artery:

o Arises from aortic arch behind left CCA
o Runs upward along left side of trachea & esophagus to enter root of neck
o Arches over apex of left lung.

 Descending Thoracic Aorta:

 Beginning: continuation of arch of aorta at left side of lower border of T4 (opposite
sternal angle)
 Course & relations: runs downward in posterior mediastinum inclining forward &
medially to reach anterior surface of vertebral column
 End: continues as abdominal aorta at level of T12, passes behind diaphragm through
aortic opening
 Branches of descending thoracic aorta:
o Lower 9 posterior intercostal arteries: from 3-11 intercostal spaces (9 pairs)
o Subcostal arteries (one pair): are given off on each side & run along the lower
border of 12th rib to enter the abdominal wall
o Pericardial, esophageal, mediastinal & bronchial arteries: small branches.

 Conveys deoxygenated blood from right ventricle of heart to the lungs.

 It is about 2 in. (5 cm) long
 Beginning: at pulmonary orifice, upper part of right ventricle
 Course & Relations: runs upward, backward & to the left.
 Divides into:
 Right pulmonary artery: runs to the right behind ascending aorta & SVC to enter root of
right lung
 Left pulmonary artery: runs to left in front of descending aorta to enter root of left lung

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 Ligamentum Arteriosum:
 Fibrous band that connects bifurcation of pulmonary trunk to lower concave
surface of aortic arch
 Remains of ductus arteriosus, which in the fetus conducts blood from pulmonary
trunk to aorta, bypassing the lungs
 Left recurrent laryngeal nerve hooks around its lower border
 Following birth, the ductus closes. If it remains patent, surgical ligation of ductus is
necessary.

 Right CCA arises from brachiocephalic artery behind the right sternoclavicular joint.
 Left CCA arises from aortic arch in superior mediastinum.
 It runs upward through the neck under cover of anterior border of sternocleidomastoid muscle, from the
sternoclavicular joint to the upper border of thyroid cartilage.
 It is embedded in a connective tissue sheath (carotid sheath)
throughout its course,
 At the upper border of thyroid cartilage, it divides into:
 External carotid artery
 Internal carotid artery

 Carotid sheath: local condensation of prevertebral, pretracheal &

investing layers of the fascia that surround the:
 Common & internal carotid arteries.
 Internal jugular vein
 Vagus nerve
 Deep cervical lymph nodes

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 Carotid Sinus:
 Localized dilatation at the point of CCA division (terminal part of CCA or beginning of internal
carotid artery).
 Tunica media of the sinus is thinner than elsewhere, but adventitia is relatively thick & contains
numerous nerve endings derived from glossopharyngeal nerve.
 It serves as a reflex pressoreceptor, mechanism: ↑BP slowing of heart rate & vasodilatation of
arterioles.

 Carotid Body:
 Small structure that lies posterior to the point of bifurcation of CCA.
 It is innervated by glossopharyngeal nerve.
 A chemoreceptor, sensitive to ↑carbon dioxide & ↓oxygen tension in the blood ↑BP & heart rate &
↑respiratory movements.

 One of the terminal branches of common carotid artery, Supplies structures in the neck, face & scalp
 Course & Relation:
 Begins at the level of upper border of thyroid cartilage & terminates in the substance of
parotid gland behind the neck of mandible by dividing into: Superficial temporal &
Maxillary arteries.
 Close to its origin, the artery emerges from undercover of sternocleidomastoid muscle,
where its pulsations can be felt.
 At first, it lies medial to the internal carotid artery, but as it ascends in the neck, it passes
backward & lateral to it.

 Branches: (Some Anatomists Like Freaking Out Poor Medical Students)

 Superior thyroid artery
 Ascending pharyngeal artery
 Lingual artery
 Facial artery
 Occipital artery
 Posterior auricular artery
 Maxillary artery & Superficial temporal artery.

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 Begins at the bifurcation of CCA at the level of upper border
of thyroid cartilage.
 Supplies the brain, eye, forehead & part of nose.
 Course:
 It ascends in the neck embedded in the carotid sheath with
internal jugular vein & vagus nerve.
 It leaves the neck by passing into cranial cavity through the
carotid canal in the petrous part of temporal bone.
 It then passes upward & forward in the cavernous venous
sinus (without communicating with it).
 It then leaves the sinus & passes upward
 It then inclines backward, lateral to the optic chiasma &
terminates by dividing into anterior & middle cerebral arteries.

 Branches:
 No branches in the neck & Many important branches are given off in the skull:
 Ophthalmic Artery
 Posterior Communicating Artery
 Anterior Cerebral Artery
 Middle Cerebral Artery

 Lies in the subarachnoid space at the base of brain.

 Formed by anastomosis between branches of the 2 internal
carotid arteries & the 2 vertebral arteries:
 From anterior to posterior:
 Anterior communicating artery (from anterior cerebral artery)
 Anterior cerebral arteries (from internal carotid artery)
 Internal carotid arteries (from common carotid artery)
 Posterior communicating arteries (from internal carotid artery)
 Posterior cerebral arteries (branch of basilar artery)

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 Right Subclavian Artery:
 Arises from brachiocephalic artery, behind the right sternoclavicular joint
 Arches upward & laterally over the pleura & between scalenus anterior & medius muscles.
 At the outer border of 1st rib, it becomes the axillary artery.

 Left Subclavian Artery:

 Arises from the arch of aorta in the thorax.
 Ascends to the root of neck & then arches laterally in a manner similar to that of the right
subclavian artery

 Scalenus anterior muscle passes anterior to the artery on each side & divides it into 3 parts.
 Phrenic nerve passes anterior to this muscle

 First part of Subclavian artery:

 From the origin of subclavian artery to the medial border of scalenus anterior muscle.
 This part gives off the: vertebral artery, thyrocervical trunk & internal thoracic artery

I. vertebral artery Branches:

o Ascends in the neck through the foramina in transverse processes of the
upper 6 cervical vertebrae
o Ascends through the foramen magnum into the skull.
o On the anterior surface of medulla oblongata of brain at the level of the
lower border of pons, it joins the vessel of the opposite side to form the
basilar artery.
o It finally divides into 2 posterior cerebral arteries
o Branches in the neck: Spinal & muscular arteries
o Branches in the skull: Meningeal, anterior & posterior spinal, posterior
inferior cerebellar & medullary arteries

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 II. Thyrocervical Trunk: Short trunk that gives off 3 terminal branches:
o Inferior thyroid artery: Ascends to the posterior surface of thyroid
gland, it is closely related to recurrent laryngeal nerve, supplies thyroid
& inferior parathyroid glands.
o Transverse cervical artery
o Suprascapular artery

III. Internal Thoracic Artery (internal mammary)

o Descends into the thorax behind 1st costal cartilage & in front of pleura.
o Descends vertically one fingerbreadth lateral to sternum; in 6th
intercostal space, it divides into: superior epigastric & musculophrenic
arteries.
o Branches:
- 2 anterior intercostal arteries for the upper 6 intercostal spaces
- Perforating arteries: accompany the terminal branches of corresponding intercostal nerves
- Pericardiacophrenic artery: accompanies the phrenic nerve & supplies the pericardium
- Mediastinal arteries: to the contents of anterior mediastinum (e.g., the thymus)
- Superior epigastric artery: enters the rectus sheath of anterior abdominal wall & supplies
the rectus muscle as far as the umbilicus.
- Musculophrenic artery: runs around the costal margin of diaphragm & supplies the lower
intercostal spaces & the diaphragm

 Second Part of Subclavian Artery:

 Lies behind the scalenus anterior muscle
 Branches: Costocervical trunk: runs backward over the dome of pleura & divides into:
o Superior intercostal artery: supplies 1st & 2nd intercostal spaces (posterior intercostal arteries)
o Deep cervical artery: supplies the deep muscles of neck

 Third Part of Subclavian Artery:

 Extends from the lateral border of scalenus anterior muscle to the lateral border of 1st rib where it
becomes the axillary artery.
 In the root of the neck, it is closely related to the nerves of brachial plexus.
 Branches: Usually has no branches.
o Occasionally, transverse cervical arteries, suprascapular arteries, or both arise from this part.

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 Begins at the lateral border of 1st rib as a continuation of subclavian &
ends at the lower border of teres major muscle where it continues as
brachial artery.
 Throughout its course, the artery is closely related to the cords of brachial
plexus & their branches
 Enclosed with brachial plexus branches in a connective tissue sheath (axillary sheath)

 The pectoralis minor muscle crosses in front of the axillary artery & divides it into 3 parts

 First Part of Axillary Artery:

 Extends from the lateral border of 1st rib to the upper border of pectoralis minor
 Branch: highest thoracic artery (superior thoracic artery): small & runs along the upper border of
pectoralis minor.

 Second Part of Axillary Artery:

 Behind the pectoralis minor muscle
 Branches:
o Thoracoacromial artery: immediately divides into: Clavicular- acromial- deltoid- pectoral
o Lateral thoracic artery: runs along the lower border of pectoralis minor

 Third Part of Axillary Artery:

 Extends from the lower border of pectoralis minor to the lower border of teres major.
 Branches:
o Subscapular artery: runs along the lower border of subscapularis muscle.
o Anterior & posterior circumflex humeral arteries: wind around the front & back of the surgical
neck of humerus, respectively

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 readingonly
 The extreme mobility of shoulder joint may result in kinking of axillary artery & temporary
occlusion of its lumen.
 An important arterial anastomosis exists between the branches of subclavian artery & axillary
artery.
 Branches from Subclavian Artery:
 Suprascapular artery, which is distributed to the supraspinous & infraspinous fossae of scapula.
 Superficial cervical artery, which gives off a deep branch that runs down the medial border of
scapula.

 Branches from Axillary Artery

 Subscapular artery & its circumflex scapular branch supply the subscapular & infraspinous
fossae of scapula, respectively.
 Anterior circumflex humeral artery.
 Posterior circumflex humeral artery.

 Begins at the lower border of teres major muscle as a continuation of

axillary artery.
 Provides the main arterial supply to the arm.
 Terminates opposite the neck of radius by dividing into: radial artery &
ulnar artery.

 The larger of 2 terminal branches of brachial artery

 Begins in the cubital fossa at the level of neck of radius.
 Descends through the anterior compartment of forearm & enters the palm
in front of flexor retinaculum in company with the ulnar nerve.
 The deep branch of ulnar artery arises in front of the flexor retinaculum &
joins the radial artery to complete the deep palmar arch
 Ends by forming superficial palmar arch, often anastomosing with
superficial palmar branch of radial artery.

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 In front of flexor retinaculum, it lies just lateral to pisiform bone
& is covered only by skin & fascia.

 The ulnar artery gives off a deep branch & then continues into the
palm as superficial palmar arch.
 It is a direct continuation of ulnar artery
 It is completed on the lateral side by one of the branches of radial
artery
 Four digital arteries arise from the convexity of arch & pass to the
fingers.

 Begins in the cubital fossa at the level of neck of radius

 Passes downward & laterally
 In the distal part of forearm, the radial artery lies on the anterior surface of radius &
is covered only by skin & fascia.
 It has the tendon of brachioradialis on its lateral side & the tendon of flexor carpi
radialis on its medial side.
 It leaves the forearm by winding around the lateral aspect of wrist to reach the
posterior surface of hand.

 Direct continuation of radial artery

 It is completed on the medial side by deep branch of ulnar artery.
 It sends branches superiorly, which take part in the anastomosis around the wrist
joint, & inferiorly, to join the digital branches of superficial palmar arch.

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 Aorta enters the abdomen through aortic opening of diaphragm in
front of T12.
 Course & Relations:
 It descends behind the peritoneum on the anterior surface of bodies
of lumbar vertebrae.
 At the level of 4th lumbar vertebra, it divides into 2 common iliac
arteries.
 On its right side lie the IVC, cisterna chyli & the beginning of azygos
vein
 On its left side lies the left sympathetic trunk

 Branches:
 3 anterior visceral branches: celiac artery, superior mesenteric artery & inferior mesenteric artery
 3 lateral visceral branches: suprarenal artery, renal artery & testicular or ovarian artery
 5 lateral abdominal wall branches: 1 inferior phrenic artery & 4 lumbar arteries
 3 terminal branches: right common iliac artery, left common iliac artery & median sacral artery

 Right & left common iliac arteries are the terminal branches of aorta.
 Arise at the level of the 4th lumbar vertebra
 Run downward & laterally along the medial border of psoas muscle.
 Each artery ends in front of sacroiliac joint by dividing into:
 External iliac artery
 Internal iliac arteries

 At the bifurcation, common iliac artery on each side is crossed anteriorly by the ureter

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 Runs along the medial border of psoas following the pelvic brim
 It gives off:
 Inferior epigastric artery:
o Arises just above the inguinal ligament
o Passes upward & medially
o Enters the rectus sheath behind the rectus abdominis muscle

 Deep circumflex iliac artery:

o Arises close to inferior epigastric artery
o Ascends laterally to the anterior superior iliac spine & iliac crest
o Supplying the muscles of anterior abdominal wall

 The artery enters the thigh by passing under the inguinal ligament to become the femoral artery.

 Internal iliac artery passes down into the pelvis to the upper margin of greater sciatic foramen.
 It divides into anterior & posterior divisions.
 Supply the pelvic viscera, perineum, pelvic walls & buttocks.
 Branches of Anterior Division:
 Umbilical artery:
o From the proximal patent part of umbilical artery arises the superior vesical artery:
o Superior vesical artery supplies the upper portion of bladder.

 Obturator artery:
o Runs forward along the lateral wall of pelvis with the obturator nerve & leaves the pelvis
through the obturator canal.

 Inferior vesical artery:

o Supplies the base of bladder, prostate & seminal vesicles in male; it also gives off the artery
to vas deferens.

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  Middle rectal artery:
o Arises with the inferior vesical artery.
o Supplies the muscle of lower rectum & anastomoses with the superior & inferior rectal
arteries.

 Internal pudendal artery:

o Leaves the pelvis through the greater sciatic foramen
o Enters the perineum by passing through the lesser sciatic foramen
o Its branches supply the musculature of anal canal (Inferior rectal artery) & the skin &
muscles of perineum.

 Inferior gluteal artery:

o Leaves the pelvis through greater sciatic foramen below the piriformis muscle
o Passes between the first & second or second & third sacral nerves

 Uterine artery: anastomoses with ovarian artery. It gives off a vaginal branch
 Vaginal artery: usually takes the place of inferior vesical artery present in male. It supplies
the vagina & the base of bladder.

 Branches of Posterior Division: Justknowtheirnames

 Iliolumbar artery: ascends across the pelvic inlet posterior to external iliac vessels, psoas &
iliacus muscles
 Lateral sacral arteries: descend in front of sacral plexus, giving off branches to neighboring
structures.
 Superior gluteal artery: leaves the pelvis through greater sciatic foramen above piriformis
muscle. It supplies the gluteal region.

 Direct continuation of inferior mesenteric artery as it artery crosses the common iliac artery.
 Supplies the mucous membrane of rectum & the upper half of anal canal.

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 Testicular artery enters the inguinal canal & does not enter the pelvis.
 Ovarian artery arises from the abdominal part of aorta at the level of L1.
 The artery is long & slender and passes downward & laterally behind the peritoneum.
 It crosses the external iliac artery at the pelvic inlet & enters the suspensory ligament of ovary.
 It then passes into the broad ligament & enters the ovary through mesovarium.

 Small artery that arises at the bifurcation of aorta.

 Descends over the anterior surface of sacrum & coccyx.

 Enters the thigh from behind the inguinal ligament, as a continuation of external iliac artery.
 It lies midway between anterior superior iliac spine & symphysis pubis.
 It descends almost vertically & ends by entering the popliteal space as popliteal artery
 Branches:
 Superficial circumflex iliac artery: runs up laterally to the region of ASIS.
 Superficial epigastric artery: arise below the inguinal ligament & runs up to the abdominal wall
 Superficial external pudendal artery & deep external pudendal artery: Both runs medially &
supplies the skin of scrotum (or labium majus).
 Profunda femoris artery:
o Large & important branch that arises from femoral artery about 1.5 in. (4 cm) below the
inguinal ligament.
o It gives off: Medial femoral circumflex artery, Lateral femoral circumflex artery & Four
perforating arteries.

 Deeply placed & enters the popliteal fossa as continuation of femoral artery.
 Ends at the level of lower border of popliteus muscle by dividing into:
 Anterior tibial artery & Posterior tibial artery

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 The smaller of terminal branches of popliteal artery.
 Arises at the level of lower border of popliteus muscle
 Passes forward into the anterior compartment of leg.
 Descends on the anterior surface of interosseous membrane, accompanied by deep
peroneal nerve
 In front of the ankle joint, it becomes the dorsalis pedis artery
 Tendon of the extensor hallucis longus on its medial side
 Deep peroneal nerve & the tendons of extensor digitorum longus on its lateral side.
 It is here that its pulsations can easily be felt in the living subject
 It terminates by passing downward into the sole where it joins the
lateral plantar artery & completes the plantar arch.

 One of the terminal branches of popliteal artery.

 Begins at the level of lower border of popliteus muscle.
 It descends in posterior compartment of the leg accompanied by tibial nerve.
 It passes behind the medial malleolus & terminates by dividing into:
 Medial plantar artery
 Lateral plantar artery:
o Curves medially to form the plantar arch through anastomosis with the dorsalis pedis
artery.
o The plantar arch gives off plantar digital arteries to the toes.

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