Medical Pharmacology Chapter 43:  Adult Cardiac Procedures

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  Vascular Anatomy Continued

  • Upper extremity arteries

    • Subclavian artery gives rise to:

      • Axillary 

      • Brachial

      • Radial

      • Ulnar arteries

       

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    • Above Left: outline of upper extremity anatomy

    • Above Right: Arteriogram illustrating the aortic arch, brachial cephalic vessel, right subclavian, right carotid, left carotid, and left subclavian (normal study)

      • Images courtesy of emedicine (http://emedicine.com), used  with permission

  • Special Considerations:

    •  Brachial artery -- located below the basilic vein. 

      •  The brachial artery might be punctured inadvertently during attempted basilic vein cannulation in the antecubital  fossa

    •  Aberrant radial arteries:

      • May enter the the webbed space after traversing the radial styloid process; vein cannulation over the anatomic "snuffbox" may  inadvertently resulted in aberrant radial artery cannulation.

  • Intra-Abdominal and Lower Extremity Arteries

    • Posterior Abdominal Wall

      • Posterior Abdominal Wall:  courtesy of Elliot Fishman, MD,(c) 2000, Department of Radiology, Johns Hopkins University, used with permission, art by Frank Corl, MS.

  • Aortic abdominal branches:

    • Gastrointestinal blood supply

      •  Superior mesenteric

      •  Inferior mesenteric

      •  Celiac arteries

    • Renal blood supply (20% of cardiac output through  single renal artery)

    • Lower torso: aortic bifurcation into right and left iliac arteries

    • Inguinal Ligament level: iliac bifurcation into superior and deep femoral arteries

      •  Cannulation: femoral artery cannulation site: just below inguinal ligament

    • Femoral artery bifurcation into anterior and posterior tibial arteries.

     

  • Abdominal aorta

    • Abdominal aorta from 3D vascular atlas image using volume rendering techniques (3D CT)

    • Courtesy of Elliot Fishman, MD,(c) 2000, Department of Radiology, Johns Hopkins University, used with permission

  • Foot arteries:

    • Superficial: 

      • Dorsalis pedis-- just lateral to the extensor hallucis longus tendon

      • Posterior tibial artery --behind the medial ankle malleolus

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  • Primary Reference: Lake, C.L. Cardiovascular Anatomy and Physiology, Third edition  (Barash, PG, Cullen, BF, Stoelting, R.K, eds), Lippincott-Raven Publishers, Philadelphia, pp. 805-835, 1997

  • Primary Reference:  Ross, AF, Gomez, MN. and Tinker, JH Anesthesia for Adult Cardiac Procedures in  Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 1659-1698, 1998.

  • Primary Reference: Shanewise, JS and Hug, Jr., CC, Anesthesia for Adult Cardiac Surgery, in Anesthesia, 5th edition,vol 2, (Miller, R.D, editor; consulting editors, Cucchiara, RF, Miller, Jr.,ED, Reves, JG, Roizen, MF and Savarese, JJ) Churchill Livingston, a Division of Harcourt Brace and Company, Philadelphia, pp. 1753-1799, 2000.

  • Primary Reference: Wray Roth, DL, Rothstein, P and Thomas, SJ Anesthesia for Cardiac Surgery, in Clinical Anesthesia, third edition  (Barash, PG, Cullen, BF, Stoelting, R.K, eds), Lippincott-Raven Publishers, Philadelphia, pp. 835-865, 1997
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