Vascular Anatomy cont'd

Arteries used by Anesthesia Providers to monitor arterial blood pressure

 

 Left: outline of upper extremity anatomy; 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

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  • 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 (http://www.ctisus.org), 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 & left iliac arteries
    • Inguinal Ligament level: iliac bifurcation into superior & deep femoral arteries
      •  Cannulation: femoral artery cannulation site: just below inguinal ligament
    • Femoral artery bifurcation into anterior & 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 (http://www.ctisus.org), 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 & 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