Median cubital vein : superficial vein of upper limb

Median cubital vein : superficial vein of upper limb 

Median cubital vein

It is the communicating venous channel between cephalic and basilica veins which shunts blood from cephalic vein to the basilic vein

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Course

·         It begins from the cephalic vein 2.5 cm below the elbow bend runs obliquely upwards and medially to end in the basilica vein 2.5 cm above the bend of elbow

·         The important features of median cubital vein are as follows

·         It is separated from brachial artery by bicipital apneurosis

·         It communicates with the deep veins through a perforating vein which pierce the bicipital aponeurosis

·         It receives median vein of the forearm

·         It shunts blood from cephalic vein to basilic vein

Clinical anatomy

·         It is routinely used for giving intravenous injections and for withdrawing blood from donors

·         The median cubital vein is most preferred due to the following reasons

·         It is the most superficial vein of the body hence access is easy

·         It is well supported by the underlying bicipital aponeurosis

·         It is well anchored to the deep vein by a perforating vein hence it does not slip during procedure

Superficial venous system of upper limb

Superficial venous system of upper limb 

General features of superficial veins of upper limb

1.    The superficial veins lie in the superficial fascia

2.    The superficial vein have a tendency to run away from the pressure sites , so they are absent in the palm along the ulnar border of forearm and back of the elbow

3.     There are two main superficial veins one along the pre-axial border and the other along the post-axial border of the upper limb.

4.    Cephalic vein is the pre-axial vein which is longer than the post-axial basilic vein but basilic vein drain more blood from superior extremity

5.    Most of the blood of cephalic vein drain into the basilic vein through the median cubital vein

6.    Superficial veins are accompanied by cutaneous nerves and superficial lymphatics

Name of superficial veins of upper limb

1.    Dorsal venous arch

2.    Pre-axial cephalic vein

3.    Post –axial basilic vein

4.    Median cubital vein

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Dorsal venous arch

The dorsal venous network of the hand is a network of veins in the superficial fascia on the dorsum of hand formed by the dorsal metacarpal veins. 

It is included in the superficial venous system.

 It is an irregular arrangement of veins with transverse element which lies 2-3 cm proximal to the heads of metatarsal bones

Tributaries : three dorsal metatarsal veins

1.    A dorsal digital vein from the medial side of little finger

2.    A dorsal digital vein from the lateral side of index  finger

3.    Two dorsal digital veins of the thumb

4.    Veins draining palm of hand

a) veins that pass around the margins of the hand and

b) perforating veins which pass dorsally through the interosseous spaces

Function

1.    Its main function is the venous drainage of the hand.

2.    It not only receives blood from the palm around the borders of the hand, but also from veins that go through the interosseous spaces.

3.    In practical terms, this means that even when there is pressure on the palm from a gripping action, venous return does not slow.

4.    In addition, the cephalic and basilic veins come up from the dorsal venous arch. These are responsible for joining the deep veins and the lymphatics.

Drainage:

It drains into cephalic and basilica veins – the efferent vessels of dorsal venous arch  but most of the blood from the entire hand drains into the arch of the hand.

Cephalic vein

It begins as the continuation of lateral end of the dorsal venous arch

Course:

·         It crosses the roof of anatomical snuff box

·         Then it ascends on the radial border of the forearm , continues upwards in front of the elbow along the lateral border of the biceps

·         It pierces the deep fascia at the lower border of the pectoralis major , the deltopectoral groove up to the infraclavicular fossa

·         In the infraclavicular fossa , it pierces the clavipectoral fascia and drains into the axillary vein (deep vein of upper limb)

Clinical anatomy

·         It is routinely used for giving intravenous injections and for withdrawing blood from donors

·         The cephalic vein is preferred for hemodialysis in patients with chronic renal failure to remove waste products from blood

·         The cut down of cephalic vein in the deltopectoral groove is preferred when superior vena caval infusion is necessary

·         Cephalic vein is not preferred for cardiac catheterization due to the following reasons

1.    Its diameter does not increase as it ascends

2.    It joins the axillary vein at a right angle hence it is difficult ot maneuver the catheter around sharp cephaloaxillary angle

3.    In deltopectoral groove it frequently divides into small branches

4.    One of the branches ascends over the clavicle and joins the external jugular vein

Basilic vein

It is begins as the continuation of the medial end of the dorsal venous arch of the hand

Course :

·         It runs upwards along the back of the medial border of the forearm winds round this border near the elbow to reach the anterior aspect of the forearm

·         Then it continues upwards in front of the elbow along the medial side of the biceps brachii up to middle of the arm

·         At the middle of the arm it pierces deep fascia unites with the brachial veins and runs along the medial side of the brachial artery

·         Then it continued with axillary vein at the lower border of the teres major

Clinical anatomy

·         It is routinely used for giving intravenous injections and for withdrawing blood from donors

·         The basilic vein is preferred for cardiac catheterization for the following reason

·         The diameter of basilic vein increases as it ascends from cubital fossa to the axillary vein

·         It is in direct line with the axillary vein . to enter the right atrium the catheter passes in succession as follows

·         Basilic vein > axillary vein > subclavian vein > brachiocephalic vein > superior vena cava > right atrium of heart

Median cubital vein

It is the communicating venous channel between cephalic and basilica veins which shunts blood from cephalic vein to the basilic vein

Course

·         It begins from the cephalic vein 2.5 cm below the elbow bend runs obliquely upwards and medially to end in the basilica vein 2.5 cm above the bend of elbow

·         The important features of median cubital vein are as follows

·         It is separated from brachial artery by bicipital apneurosis

·         It communicates with the deep veins through a perforating vein which pierce the bicipital aponeurosis

·         It receives median vein of the forearm

·         It shunts blood from cephalic vein to basilic vein

Clinical anatomy

·         It is routinely used for giving intravenous injections and for withdrawing blood from donors

·         The median cubital vein is most preferred due to the following reasons

·         It is the most superficial vein of the body hence access is easy

·         It is well supported by the underlying bicipital aponeurosis

·         It is well anchored to the deep vein by a perforating vein hence it does not slip during procedure

Median vein of the forearm

It begins from palmar venous networks runs upwards in the midline on the anterior aspect of forearm to end in any one of three veins in front of elbow

Sometimes upper end of median vein of forearm bifurcates into median cephalic and basilic veins respectively

In this situation the median cubital vein is absent

Common venous patterns in front of the elbow

The veins in front of the elbow commonly form two patterns

1.    H shaped pattern

2.    M shaped pattern

·         Clinical anatomy

·          It is routinely used for giving intravenous injections and for withdrawing blood from donors

·       

Post axial basilic vein o: the superficial vein of superior extremity

Basilic vein

It is begins as the continuation of the medial end of the dorsal venous arch of the hand

Course :

·         It runs upwards along the back of the medial border of the forearm winds round this border near the elbow to reach the anterior aspect of the forearm

·         Then it continues upwards in front of the elbow along the medial side of the biceps brachii up to middle of the arm

·         At the middle of the arm it pierces deep fascia unites with the brachial veins and runs along the medial side of the brachial artery

·         Then it continued with axillary vein at the lower border of the teres major

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Clinical anatomy

·         It is routinely used for giving intravenous injections and for withdrawing blood from donors

·         The basilic vein is preferred for cardiac catheterization for the following reason

·         The diameter of basilic vein increases as it ascends from cubital fossa to the axillary vein

·         It is in direct line with the axillary vein . to enter the right atrium the catheter passes in succession as follows

·         Basilic vein > axillary vein > subclavian vein > brachiocephalic vein > superior vena cava > right atrium of heart

The pre-axial vein cephalic vein of superior extremity

Cephalic vein

It begins as the continuation of lateral end of the dorsal venous arch

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Course:

·         It crosses the roof of anatomical snuff box

·         Then it ascends on the radial border of the forearm , continues upwards in front of the elbow along the lateral border of the biceps

·         It pierces the deep fascia at the lower border of the pectoralis major , the deltopectoral groove up to the infraclavicular fossa

·         In the infraclavicular fossa , it pierces the clavipectoral fascia and drains into the axillary vein (deep vein of upper limb)

Clinical anatomy

·         It is routinely used for giving intravenous injections and for withdrawing blood from donors

·         The cephalic vein is preferred for hemodialysis in patients with chronic renal failure to remove waste products from blood

•          The cut down of cephalic vein in the deltopectoral groove is preferred when superior vena caval infusion is necessary 

·         Cephalic vein is not preferred for cardiac catheterization due to the following reasons

1.    Its diameter does not increase as it ascends

2.    It joins the axillary vein at a right angle hence it is difficult ot maneuver the catheter around sharp cephaloaxillary angle

3.    In deltopectoral groove it frequently divides into small branches

4.    One of the branches ascends over the clavicle and joins the external jugular vein

Dorsal venous arch of hand : superficial vein of upper limb 

The dorsal venous network of the hand is a network of veins in the superficial fascia on the dorsum of hand formed by the dorsal metacarpal veins. 

It is included in the superficial venous system.

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 It is an irregular arrangement of veins with transverse element which lies 2-3 cm proximal to the heads of metatarsal bones

Tributaries : three dorsal metatarsal veins

1.    A dorsal digital vein from the medial side of little finger

2.    A dorsal digital vein from the lateral side of index  finger

3.    Two dorsal digital veins of the thumb

4.    Veins draining palm of hand

a) veins that pass around the margins of the hand and

b) perforating veins which pass dorsally through the interosseous spaces

Function

1.    Its main function is the venous drainage of the hand.

2.    It not only receives blood from the palm around the borders of the hand, but also from veins that go through the interosseous spaces.

3.    In practical terms, this means that even when there is pressure on the palm from a gripping action, venous return does not slow.

4.    In addition, the cephalic and basilic veins come up from the dorsal venous arch. These are responsible for joining the deep veins and the lymphatics.

Drainage:

It drains into cephalic and basilica veins – the efferent vessels of dorsal venous arch  but most of the blood from the entire hand drains into the arch of the hand.

Ilioinguinal nerve

The ilioinguinal nerve is a branch of lumbar plexus

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Root value: L1

Relations :  It separates from the first lumbar nerve along with the larger iliohypogastric nerve.

Course :

It emerges from the lateral border of the psoas major just inferior to the iliohypogastric, and passes obliquely across the quadratus lumborum and iliacus.

The ilioinguinal nerve then perforates the transversus abdominis near the anterior part of the iliac crest, and communicates with the iliohypogastric nerve between the transversus and the internal oblique muscle.

It then pierces the internal oblique muscle, distributing filaments to it, and then accompanies the spermatic cord (in males) or the round ligament of uterus (in females) through the superficial inguinal ring.

Sometimes the ilioinguinal nerve passes deep to the inguinal ligament .  

Distribution :

Its fibres are then distributed to the skin of the upper and medial part of the thigh, and to the following locations in the male and female:

·         In the male ("anterior scrotal nerve"): to the skin over the root of the penis and upper part of the scrotum.

·         In the female ("anterior labial nerve"): to the skin covering the mons pubis and labia majora.

The ilioinguinal nerve does not pass through the deep inguinal ring, and thus only travels through part of the inguinal canal. It mediates the cremasteric reflex.

Short note on left coronary artery

Short note on left coronary artery 

Aortic sinus :It arises from left posterior  aortic sinus of ascending aorta

Size: Bigger than the right coronary artery

Course

1.       It runs forwards and to the left between the pulmonary trunk and left auricle

2.       Then it  divides into anterior interventricular branch and circumflex branch

3.       The anterior inter-ventricular branches of left coronary artery descend downward along the anterior inter-ventricular groove and anastomosis with posterior inter-ventricular branch of left coronary artery

4.       The circumflex branch cross the left border of heart

5.       It then passes along the left posterior part of atrioventricular groove

6.       Then it anastomosis with branch of right coronary artery just left of the crux of heart
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Branches

1.       Anterior interventricular artery: it supplies anterior part of interventricular septum , greater part of the left ventricle and part of right ventricle and a part of left bundle branch of His  

2.       Circumflex artery : it gives a left marginal artery that supplies the left margin of the left ventricle up to the apex of the heart

3.       Diagonal artery: it may arise directly from the trunk of the left coronary artery  

4.       Conus artery : it supplies the pulmonary conus

5.       Atrial branches: they supply the left atrium

Distribution

It supplies :

1.       Most of the left atrium

2.       Most of the left ventricle except a strip along the posterior and inferior surfaces of the heart posterior and inferior surfaces of the heart

3.       Anterior superior 2/3 of the ventricular septum

Coronary dominance

10% individuals are left coronary dominance. It means ventricular septum is supply only by left coronary artery.

posterior inferior part of 1/3 of ventricular septum is  supply by circumflex branch of  branch of left coronary artery

anterior superior part of 2/3 of ventricular septum is supply by anterior interventricular branch of left coronary artery