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VI. the Arteries

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VI. the Arteries VI. The Arteries 1. Introduction THE DISTRIBUTION of the systematic arteries is like a highly ramified tree, the common trunk of which, formed by the aorta, commences at 1 the left ventricle, while the smallest ramifications extend to the peripheral parts of the body and the contained organs. Arteries are found in all parts of the body, except in the hairs, nails, epidermis, cartilages, and cornea; the larger trunks usually occupy the most protected situations, running, in the limbs, along the flexor surface, where they are less exposed to injury. There is considerable variation in the mode of division of the arteries: occasionally a short trunk subdivides into several branches at the same 2 point, as may be observed in the celiac artery and the thyrocervical trunk: the vessel may give off several branches in succession, and still continue as the main trunk, as is seen in the arteries of the limbs; or the division may be dichotomous, as, for instance, when the aorta divides into the two common iliacs. A branch of an artery is smaller than the trunk from which it arises; but if an artery divides into two branches, the combined sectional area of 3 the two vessels is, in nearly every instance, somewhat greater than that of the trunk; and the combined sectional area of all the arterial branches greatly exceeds that of the aorta; so that the arteries collectively may be regarded as a cone, the apex of which corresponds to the aorta, and the base to the capillary system. The arteries, in their distribution, communicate with one another, forming what are calledanastomoses, and these communications are very free 4 between the large as well as between the smaller branches. The anastomosis between trunks of equal size is found where great activity of the circulation is requisite, as in the brain; here the two vertebral arteries unite to form the basilar, and the two anterior cerebral arteries are connected by a short communicating trunk; it is also found in the abdomen, where the intestinal arteries have very ample anastomoses between their larger branches. In the limbs the anastomoses are most numerous and of largest size around the joints, the branches of an artery above uniting with branches from the vessels below. These anastomoses are of considerable interest to the surgeon, as it is by their enlargement that a collateral circulation is established after the application of a ligature to an artery. The smaller branches of arteries anastomose more frequently than the larger; and between the smallest twigs these anastomoses become so numerous as to constitute a close network that pervades nearly every tissue of the body. Throughout the body generally the larger arterial branches pursue a fairly straight course, but in certain situations they are tortuous. Thus the 5 external maxillary artery in its course over the face, and the arteries of the lips, are extremely tortuous to accommodate themselves to the movements of the parts. The uterine arteries are also tortuous, to accommodate themselves to the increase of size which the uterus undergoes during pregnancy. The Pulmonary Artery (A. Pulmonalis) (Figs. 503, 504) FIG. 503– Transverse section of thorax, showing relations of pulmonary artery. (See enlarged image) FIG. 504– Pulmonary vessels, seen in a dorsal view of the heart and lungs. The lungs have been pulled away from the median line, and a part of the right lung has been cut away to display the air-ducts and bloodvessels. (See enlarged image) The pulmonary artery conveys the venous blood from the right ventricle of the heart to the lungs. It is a short, wide vessel, about 5 cm. in 6 length and 3 cm. in diameter, arisingfrom the conus arteriosus of the right ventricle. It extends obliquely upward and backward, passing at first in front and then to the left of the ascending aorta, as far as the under surface of the aortic arch, where it divides, about the level of the fibrocartilage between the fifth and sixth thoracic vertebræ, into right and left branches of nearly equal size. Relations.—The whole of this vessel is contained within the pericardium. It is enclosed with the ascending aorta in a single tube of the visceral 7 layer of the serous pericardium, which is continued upward upon them from the base of the heart. The fibrous layer of the pericardium is gradually lost upon the external coats of the two branches of the artery. Infront, the pulmonary artery is separated from the anterior end of the second left intercostal space by the pleura and left lung, in addition to the pericardium; it rests at first upon the ascending aorta, and higher up lies in front of the left atrium on a plane posterior to the ascending aorta. On either side of its origin is the auricula of the corresponding atrium and a coronary artery, the left coronary artery passing, in the first part of its course, behind the vessel. The superficial part of the cardiac plexus lies above its bifurcation, between it and the arch of the aorta. The right branch of the pulmonary artery (ramus dexter a. pulmonalis), longer and larger than the left, runs horizontally to the right, behind 8 the ascending aorta and superior vena cava and in front of the right bronchus, to the root of the right lung, where it divides into two branches. The lower and larger of these goes to the middle and lower lobes of the lung; the upper and smaller is distributed to the upper lobe. The left branch of the pulmonary artery (ramus sinister a. pulmonalis), shorter and somewhat smaller than the right, passes horizontally in 9 front of the descending aorta and left bronchus to the root of the left lung, where it divides into two branches, one for each lobe of the lung. Above, it is connected to the concavity of the aortic arch by the ligamentum arteriosum, on the left of which is the left recurrent nerve, and on 10 the right the superficial part of the cardiac plexus. Below, it is joined to the upper left pulmonary vein by the ligament of the left vena cava. The terminal branches of the pulmonary arteries will be described with the anatomy of the lungs. 2. The Aorta The aorta is the main trunk of a series of vessels which convey the oxygenated blood to the tissues of the body for their nutrition. It commences 1 at the upper part of the left ventricle, where it is about 3 cm. in diameter, and after ascending for a short distance, arches backward and to the left side, over the root of the left lung; it then descends within the thorax on the left side of the vertebral column, passes into the abdominal cavity through the aortic hiatus in the diaphragm, and ends, considerably diminished in size (about 1.75 cm. in diameter), opposite the lower border of the fourth lumbar vertebra, by dividing into the right and left common iliac arteries. Hence it is described in several portions, viz., theascending aorta, the arch of the aorta, and the descending aorta, which last is again divided into the thoracic and abdominal aortæ. the Ascending Aorta (Aorta Ascendens) (Fig. 505).—The ascending aorta is about 5 cm. in length. It commences at the upper part of the base 2 of the left ventricle, on a level with the lower border of the third costal cartilage behind the left half of the sternum; it passes obliquely upward, forward, and to the right, in the direction of the heart’s axis, as high as the upper border of the second right costal cartilage, describing a slight curve in its course, and being situated, about 6 cm. behind the posterior surface of the sternum. At its origin it presents, opposite the segments of the aortic valve, three small dilatations called theaortic sinuses. At the union of the ascending aorta with the aortic arch the caliber of the vessel is increased, owing to a bulging of its right wall. This dilatation is termed the bulb of the aorta, and on transverse section presents a somewhat oval figure. The ascending aorta is contained within the pericardium, and is enclosed in a tube of the serous pericardium, common to it and the pulmonary artery. Relations.—The ascending aorta is covered at its commencement by the trunk of the pulmonary artery and the right auricula, and, higher up, is 3 separated from the sternum by the pericardium, the right pleura, the anterior margin of the right lung, some loose areolar tissue, and the remains of the thymus; posteriorly, it rests upon the left atrium and right pulmonary artery. On the right side, it is in relation with the superior vena cava and right atrium, the former lying partly behind it; on the left side, with the pulmonary artery. FIG. 505– The arch of the aorta, and its branches. (See enlarged image) FIG. 506– Plan of the branches. (See enlarged image) Branches.—The only branches of the ascending aorta are the two coronary arteries which supply the heart; they arise near the commencement 4 of the aorta immediately above the attached margins of the semilunar valves. The Coronary Arteries.—The Right Coronary Artery (a. coronaria [cordis] dextra)arises from the right anterior aortic sinus. It passes at first 5 between the conus arteriosus and the right auricula and then runs in the right portion of the coronary sulcus, coursing at first from the left to right and then on the diaphragmatic surface of the heart from right to left as far as the posterior longitudinal sulcus, down which it is continued to the apex of the heart as the posterior descending branch.
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