1. Radiological vascular anatomy of the upper and lower limbs.
Dr/ ABD ALLAH NAZEER. MD.

2. The arterial supply to the upper limb begins in the chest as
the subclavian artery. The right subclavian artery arises
from the brachiocephalic trunk, while the left subclavian
branches directly off the arch of aorta.
When the subclavian arteries cross the lateral edge of the
1st rib, they enter the axilla, and are called axillary
arteries.

3. The axillary artery passes through the axilla, just underneath
the pectoralis minor muscle, enclosed in the axillary sheath.
At the level of the humeral surgical neck, the posterior and anterior
circumflex humeral arteries arise. They circle posteriorly round the
humerus to supply the shoulder region. The largest branch of the
humerus also arises here; the subscapular artery.
The axillary artery becomes the brachial artery at the level of the
teres major muscle

4. In the Upper Arm
When the axillary artery reaches the lower border of the teres major, it becomes the
brachial artery. The brachial artery is the main source of blood for the arm.
Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii
– the deep artery of the arm. It travels along the posterior surface of the humerus, running
in the radial groove. It supplies structures in the posterior aspect of the arm (e.g the triceps
brachii, and terminates by contributing to a network of vessels at the elbow joint.
The brachial artery descends down the arm immediately posterior to the median nerve. As
it crosses the cubital fossa, underneath the brachialis muscle, the brachial artery
terminates by bifurcating into the radial and ulnar arteries.

5. In the Forearm
In the distal region of the cubital fossa, the brachial artery bifurcates
into the radial artery and the ulnar artery. The radial artery supplies
the posterior aspect of the forearm and the ulnar artery supplies the
anterior aspect. The two arteries anastamose in the hand, by forming
two arches, the superficial palmar arch, and the deep palmar arch.

6. In the Hand
The hand has a very good blood supply, with many anastomosing arteries, allowing the hand to
be perfused when grasping or applying pressure. A good majority of these arteries are
superficial, allowing for heat loss when needed. In the hand, the ulnar and radial arteries
interconnect to form two arches, from which branches to the digits emerge.
Radial artery – contributes mainly to supply of the thumb and the lateral side of the index finger
Ulnar artery – contributes mainly to the supply of the rest of the digits, and the medial side of
the index finger.

7. CTA of the left
upper limb – CPR
reconstruction. No
contrast
enhancement in the
distal part of the
brachial artery, for
approx. 40 mm.
Contrast
enhancement of
the forearm
arteries.

8. CT angiography
showing bones
and vessels of
the chest, neck
and upper
extremities.

9. MDCT angiography of
the upper right limb.
1. Axillary artery; 2.
Common trunk of
circumflex humeral
arteries; 3. Circumflex
scapular artery; 4.
Brachial artery; 5.
Superficial radial artery
(at the level of the
arm); 5. Superficial
radial artery (at the
level of the forearm); 6.
Profunda brachii
artery; 7. Inferior
recurrent radial artery;
8. Inferior recurrent
ulnar artery; 9.
Posterior interosseous
artery; 10. Anterior
interosseous artery.

10. Normal upper extremity CT angiogram.

11. MRA images of the upper limb arteries.

12. Upper extremity
CE-MRA: A)
Arterial
acquisition, and
B) Venous
acquisition

13. CE-MRA
acquisition in
arterial phase
(A) and venous
phase (B) with
corresponding
cross-sectional
reformations

15. Magnetic resonance angiography (MRA) of the hand.

17. Selective
angiogram
of right
upper
extremity.

18. Angiogra
m of the
radial
artery.

19. Superficial Veins
The major superficial veins of the upper limb are
the cephalic and basilic veins. As their name
suggests, they are located within the subcutaneous
tissue of the upper limb.
The basilic vein originates from the dorsal venous
network of the hand. It ascends the medial aspect
of the upper limb. At the border of the teres major,
the vein moves deep into the arm. Here, it
combines with the brachial veins to form the
axillary vein.
The cephalic vein arises from the dorsal venous
network of the hand. It ascends the antero-lateral
aspect of the upper limb, passing anteriorly at the
elbow. At the shoulder, the cephalic vein travels
between the deltoid and pectoralis major muscles
(known as the deltopectoral groove), and enters
the axilla region via the clavipectoral triangle.
Within the axilla, the cephalic vein terminates by
joining the axillary vein.
At the elbow, the cephalic and basilic veins are
connected by the median cubital vein.

20. Deep Veins
The deep veins of the upper limb
are situated underneath the deep
fascia.
They are paired veins that
accompany and lie either side of an
artery. The brachial veins are the
largest in size, and are situated
either side of the brachial artery.
The pulsations of the brachial
artery aids the venous return. Veins
that are structured in this way are
known as vena comitantes.
Perforating veins run between the
deep and superficial veins of the
upper limb, connecting the two
systems.

21. The superficial veins of the upper
extremity are shown in blue. The deep veins are shown in blue.

22. Basic deep venous anatomy of the arm. Basic superficial venous anatomy of the arm.

23. The red line shows the subclavian
vein origin scan plane. Doppler of the Subclavian vein origin.

29. lower limb vessels.
Femoral Artery.
The main artery of the lower limb is femoral artery. It is a continuation of
the external iliac artery (terminal branch of the abdominal aorta). The
external iliac becomes the femoral artery when it crosses under the
inguinal ligament and enters the femoral triangle.
In the femoral triangle, the profunda femoris artery arises from the
posterolateral aspect of the femoral artery. It travels posteriorly and
distally, giving off three main branches:
Perforating branches – Consists of three or four arteries that perforate
the adductor magnus, contributing to the supply of the muscles in the
medial and posterior thigh.
Lateral femoral circumflex artery – Wraps round the anterior, lateral side
of the femur, supplying some of the muscles in the lateral side of the thigh.
Medial femoral circumflex artery – Wraps round the posterior side of
the femur, supplying the neck and head of the femur. In a fracture of the
femoral neck, this artery can easily be damaged, and avascular necrosis of
the femur head can occur.

34. The course and branching of the common iliac artery into the external iliac artery
becoming femoral artery. Of particular interest is the course of the femoral artery
at the hip and knee joints. The sagittal maximum intensity projection (MIP) CT
image (middle) and coronal (right) better demonstrate its course

36. CTA of the lower limb arteries.

37. Computed tomography angiography curved multiplanar
reformat of the left lower extremity arterial vessels.

38. Axial images obtained at the level of abdominal aorta (a), aortic carrefour
(b), common iliac arteries (c), and external and internal iliac arteries (d)

39. Axial images obtained at the level of common femoral artery (e), femoral bifurcation (f-h).

40. Axial images obtained at the level of proximal popliteal artery (i), popliteal artery
(j), distal popliteal artery (k), and anterior tibial artery and tibio-peroneal trunk (l)

41. Axial images obtained at the level of anterior tibial, posterior tibial
and peroneal arteries (m, n) and pedideal artery and plantar arch (o)

42. MRA
images.

45. Magnetic resonance angiogram (MRA) obtained by using the bolus-chase
technique shows the normal anatomy of the lower extremity arterial
vasculature, including the aorta (a), the common iliac artery (b), the external
iliac artery (c), the internal iliac artery (d), and the common femoral artery (e).

47. Magnetic resonance angiogram (MRA) obtained by using the bolus-chase
technique shows the normal anatomy of the lower-extremity arterial vasculature,
including the deep femoral artery (a) and the superficial femoral artery (b).

48. Superficial and deep femoral arteries of the thigh.

50. Magnetic resonance angiogram (MRA) obtained by using the bolus-chase
technique shows the normal anatomy of the lower-extremity arterial
vasculature, including the popliteal artery (a), the anterior tibial artery (b), the
tibioperoneal trunk (c), the peroneal artery (d), and the posterior tibial artery (e).

51. Normal lower extremity CTA using maximum intensity projection (MIP) display and curved planar reformation
(CPR). (A) Complete topographic MIP display of aortoiliac inflow and femoropopliteal and tibioperoneal outflow
segments. (B) MIP display of normal aortoiliac inflow segment. (C) MIP display of femoral and above knee popliteal
segment. (D) MIP display of the distal popliteal and tibioperoneal segments. (E) CPR in lateral projection of the
right aortoiliac arterial inflow segment. (F) CPR in lateral projection of left aortoiliac arterial inflow segment.

52. The obturator artery arises from internal iliac artery in the
pelvic region. It descends via the obturator canal to enter the
medial thigh, bifurcating into two branches:
Anterior branch – This supplies the pectineus, obturator
externus, adductor muscles and gracilis.
Posterior branch – This supplies some of the deep gluteal
muscles.
The gluteal region is largely supplied by the superior and
inferior gluteal arteries. These arteries also arise from the
internal iliac artery, entering the gluteal region via the greater
sciatic foramen.
The superior gluteal artery leaves the foramen above the
piriformis muscle, the inferior below the muscle. In addition to
the gluteal muscles, the inferior gluteal artery also contributes
towards the vasculature of the posterior thigh.

54. The popliteal artery descends down the posterior thigh, giving off
genicular branches that supply the knee joint. It moves through the
popliteal fossa, exiting sandwiched between the gastrocnemius and
popliteus muscles. At the lower border of the popliteus, the popliteal
artery terminates by dividing into anterior and posterior tibial arteries.
The posterior tibial artery continues inferiorly, along the surface of the
deep muscles (such as tibialis posterior). It accompanies the tibial nerve
in entering the sole of the foot via the tarsal tunnel. During the descent
of the posterior tibial artery in the leg, the fibular artery arises. This
artery moves laterally, penetrating the lateral compartment of the leg.
It supplies muscles in the lateral compartment, and adjacent muscles in
the posterior compartment.
The other division of the popliteal artery, the anterior tibial artery,
passes anteriorly between the tibia and fibula, through a gap in the
interosseous membrane. It then moves inferiorly down the leg. It runs
down the entire length of the leg, and into the foot, where it becomes
the dorsalis pedis artery.

57. Dorsalis pedis (a continuation of the anterior tibial artery)
Posterior tibial
The dorsalis pedis artery begins as the anterior tibial artery
enters the foot. It passes over the dorsal aspect of the tarsal
bones, then moves inferiorly, towards the sole of the foot. It
then anastamoses with the lateral plantar artery to form the
deep plantar arch. The dorsalis pedis artery supplies the
tarsal bones and the dorsal aspect of the metatarsals. Via
the deep plantar arch, it also contributes to the supply of the
toes.
The posterior tibial artery enters the sole of the foot through
the tarsal tunnel. It then splits into the lateral and medial
plantar arteries. These arteries supply the plantar side of the
foot, and contributes to the supply of the toes via the deep
plantar arch.

61. Angiography with bilateral external iliac artery (EIA), common femoral artery
(CFA) and superficial femoral artery (SFA). Bilateral internal iliac artery (IIA)
continues as the inferior gluteal artery and persistent sciatic artery (PSA).

62. Angiogram of the superficial and deep femoral arteries.

63. Angiography of the popliteal artery (A) and posterior tibial artery .

66. The Deep Veins of the Lower Limb
The deep venous drainage system of the lower limb is located beneath
the deep fascia of the lower limb. As a general rule, the deep veins
accompany and share the name of the major arteries in the lower
limb. Often, the artery and vein are located within the same vascular
sheath – so that the arterial pulsations aid the venous return.
The Foot and Leg
The main venous structure of the foot is the dorsal venous arch, which
mostly drains into the superficial veins. Some veins from the arch
penetrate deep into the leg, forming the anterior tibial vein.
On the plantar aspect of the foot, medial and lateral plantar veins
arise. These veins combine to form the posterior tibial and fibular
veins. The posterior tibial vein accompanies the posterior tibial artery,
entering the leg posteriorly to the medial malleolus.
On the posterior surface of the knee, the anterior tibial, posterior tibial
and fibular veins unite to form the popliteal vein. The popliteal vein
enters the thigh via the adductor canal

67. The Thigh
Once the popliteal vein has entered the thigh, it is known
as the femoral vein. It is situated anteriorly,
accompanying the femoral artery.
The deep vein of the thigh is the other major venous
structure. Via perforating veins, it drains blood from the
thigh muscles. It then empties into the distal section of
the femoral vein.
The femoral vein leaves the thigh by running underneath
the inguinal ligament, at which point it is known as the
external iliac vein.
The Gluteal Region
The gluteal region is drained by inferior and superior
gluteal veins. These empty into the internal iliac vein

70. The Superficial Veins of the Lower Limb
The superficial veins of the lower limb run in the subcutaneous tissue. There
are two major superficial veins – the great saphenous vein, and the small
saphenous vein.
The Great Saphenous Vein
The great saphenous vein is formed by the dorsal venous arch of the foot, and
the dorsal vein of the great toe. It ascends up the medial side of the leg,
passing anteriorly to the medial malleolus at the ankle, and posteriorly to the
medial condyle at the knee.
As the vein moves up the leg, it receives tributaries from other small
superficial veins. The great saphenous vein terminates by draining into the
femoral vein immediately inferior to the inguinal ligament.
Surgically, the great saphenous vein can be harvested and used as a vessel in
coronary artery bypasses.
The Small Saphenous Vein
The small saphenous vein is formed by the dorsal venous arch of the foot, and
the dorsal vein of the little toe. It moves up the posterior side of the leg,
passing posteriorly to the lateral malleolus, along the lateral border of the
calcaneal tendon. It moves between the two heads of the gastrocnemius
muscle and empties into the popliteal vein in the popliteal fossa.

73. Basic deep venous anatomy of the leg Patient position

74. The blue line shows the CFV scan plane. The CFV, pre and post compression.

75. The blue line shows the distal FV scan plane. (Superficial) Femoral Vein.

76. The blue arrow shows the POPV scan direction. POPV.

77. Transverse mid calf.
Transverse view of the posterior tibial and
peroneal veins. Pre & Post compression.

78. A sagittal scan plane for the calf veins.
Longitudinal calf veins. Split screen,
color Doppler and B-mode.

79. Lymphatic drainage

80. Thank You.