DOCSLIB.ORG

Advantages and Disadvantages of Using the Internal Thoracic Artery Perforators As Recipient Vessels in Autologous Breast Reconstruction—A Narrative Review

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Advantages and Disadvantages of Using the Internal Thoracic Artery Perforators As Recipient Vessels in Autologous Breast Reconstruction—A Narrative Review 7 Review Article Page 1 of 7 Advantages and disadvantages of using the internal thoracic artery perforators as recipient vessels in autologous breast reconstruction—a narrative review Suzanne M. Beecher^ Department of Plastic & Reconstructive Surgery, Mater Misericordiae Hospital, Dublin, Ireland Correspondence to: Suzanne M. Beecher. Department of Plastic & Reconstructive Surgery, Mater Misericordiae Hospital, Dublin, Ireland. Email: [email protected]. Abstract: The rates of breast reconstruction after mastectomy are rising each year. Autologous breast reconstruction using free tissue transfer is considered the gold standard reconstruction, especially with recent controversy surrounding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). During free tissue transfer, the flap vessels must be anastomosed to recipient vessels on the chest wall. There are multiple options of recipient vessels during microvascular breast reconstruction. Most commonly, the thoracodorsal vessels or the internal thoracic vessels [also known as the internal mammary (IM) vessels] are used as the recipient vessels for microvascular anastomosis of the free tissue transfer. Other second-line options include the thoracoacromial axis and the lateral thoracic vessels. The use of perforators of the internal thoracic vessels for free flap anastomosis during autologous breast reconstruction has been in use for almost twenty years. They are generally favoured over use of thoracodorsal vessels as they result in medialisation of the flap. In recent years, the use of perforators of the internal thoracic vessels has become popular. Great debate surrounds whether or not they should be used as recipient vessels as opposed to the conventional main vessels. In this article, we discuss the advantages and disadvantages of both techniques to guide the choice of reconstructive microsurgeons. Keywords: Internal mammary perforators (IM perforators); internal thoracic artery (ITA); breast reconstruction; microvascular reconstruction Received: 20 April 2020; Accepted: 08 January 2021; Published: 30 June 2021. doi: 10.21037/abs-20-50 View this article at: http://dx.doi.org/10.21037/abs-20-50 Introduction the abdomen or the thigh. The vessels require anastomosis to native vessels in the region of the breast. The recipient The rates of breast reconstruction are rising internationally. vessels for anastomosis are usually the thoracodorsal or Breast reconstruction has been shown to have psychological benefits for patients. Autologous reconstruction is becoming the internal thoracic vessels [also known as the internal very popular as it uses the patient’s own tissue. It is also a mammary (IM) vessels]. Other secondary options, though better option compared to prosthetic implants if adjuvant rarely used, include the thoracoacromial and the lateral radiotherapy is required. thoracic vessels (1). In recent years, the use of perforators During autologous breast reconstruction, a flap of tissue of the internal thoracic vessels has become popular. Great is transferred from elsewhere in the body, from sites such as debate surrounds whether or not they should be used ^ ORCID: 0000-0001-6489-3424. © Annals of Breast Surgery. All rights reserved. Ann Breast Surg 2021;5:16 | http://dx.doi.org/10.21037/abs-20-50 Page 2 of 7 Annals of Breast Surgery, 2021 as recipient vessels as opposed to the conventional main use for a secondary latissimus dorsi flap in the case of flap vessels. In this article, we discuss the advantages and failure (10). The internal thoracic arteries bilaterally are disadvantages of the recipient vessels in microvascular breast good size matches for the deep inferior epigastric artery, as reconstruction. A review of the literature was performed, is the right internal thoracic vein. The left internal thoracic with relevant articles obtained from SCOPUS and Medline. vein however, is often much smaller than the deep inferior We present the following article in accordance with the epigastric vein, which may lead to vessel size mismatch Narrative Review reporting checklist (available at http:// during microsurgical anastomosis (3). The thoracodorsal dx.doi.org/10.21037/abs-20-50). and internal thoracic vessels when used as recipients for free flap anastomosis have a similar rate of complications, however, use of the internal thoracic vessels may be Thoracodorsal vessels associated with a higher rate of nipple necrosis in immediate The thoracodorsal were previously the vessels of choice. nipple-sparing reconstruction (11). The thoracodorsal vessels however are potentially damaged The ITA is a branch of the subclavian artery. It passes during axillary clearances. Even if still present, during inferiorly and 1–2 cm lateral to the sternal border, dividing delayed breast reconstruction, there is often a significant into its terminal branches at the level of the sixth rib. Its amount of scarring in the region of the axilla due to prior terminal branches are the superior epigastric artery and surgery or radiotherapy, which may make dissection of the the musculophrenic artery. In addition to these terminal thoracodorsal axis technically difficult (2). When using the branches, the ITA gives off medial and lateral branches. thoracodorsal vessels, a longer vascular pedicle is required The medial branches give supply to the area surrounding on the free flap. There may also be a reduction of tissue the sternum. The lateral branches include the anterior available to reconstruct volume in the medial aspect of the IC arteries, which supply the ribcage, with two branches breast due to the flap being placed laterally in the breast (2). to each IC space. The branches at the lower IC spaces With the advent of sentinel node biopsy, axillary node are larger, with the largest being in the 5th and 6th IC clearances are not always required. Because of this, there spaces (7). Laterally there are also branches to pectoralis has been a decline in the use of the thoracodorsal axis major. Also, arising from the lateral border of the ITA, as it is generally not exposed, as would’ve been the case the anterior ICs or the muscular branches are cutaneous when patients underwent node clearances (3). Also, if the perforators that supply the skin. The ITA gives blood thoracodorsal vessels are used at the time of sentinel node supply to approximately 60% of the breast parenchyma (12). biopsy, if a subsequent axillary node clearance is required, The cutaneous vascular territory of the ITA extends from the pedicle may be potentially compromised (4). the midline medially to the mid-clavicular line, two to three centimeters lateral to the nipple laterally. Cranially, it extends to the inferior border of the clavicle. The caudal Internal thoracic vessels border of the skin territory supplied can vary between the The use of the internal thoracic axis as the recipient vessel ninth rib to the umbilicus (7). was first described by Harashina et al. in 1980 (5). The There are however disadvantages to using internal internal thoracic vessels have the advantage of being a good thoracic vessels for free flap anastomosis. In order to size match to the flap pedicle, and also the site is more anastomose the free flap pedicle to the internal thoracic accessible for performing microsurgery (6). The average vessels, a section of cartilage is often removed in order diameter of the internal thoracic artery (ITA) is 3.6 mm to gain access to the vessels. There are multiple methods and the average size of the vein is also 3.6 mm (7). At the to remove the rib, but often the methods described by third intercostal (IC) space, the vessels are consistently of Haddock et al is employed, with removal of the cartilage adequate caliber for anastomosis (8). Using the internal piecemeal with a rongeur until the posterior perichondrium thoracic vessels also allows for easier positioning of the flap, is exposed (13). Rib resection can be quite painful, and and also there is a lower risk of avulsion injury and shoulder resection of cartilage and surgery in this area may result in stiffness due to shoulder immobilisation when using the chronic IC neuralgia (14). Pain can result in post-operative thoracodorsal axis for flap anastomosis. A shorter pedicle is atelectasis due to a reduction in deep breathing (15). required to optimally position the flap on the chest wall (9). Another potential disadvantage of cartilage or rib resection Its use may also preserve the thoracodorsal vessels for is that it may result in a contour deformity on the chest wall © Annals of Breast Surgery. All rights reserved. Ann Breast Surg 2021;5:16 | http://dx.doi.org/10.21037/abs-20-50 Annals of Breast Surgery, 2021 Page 3 of 7 A B C D Figure 1 Costal cartilage banking and use in nipple reconstruction. (10,16). This may require fat grafting to correct (17). One vessels a pneumothorax may also occur (22). Another, benefit to rib resection is that the cartilage can be banked more disadvantageous sequelae are that using the internal and subsequently used during nipple reconstruction to give thoracic vessels for free flap anastomosis would mean the the nipple support (Figure 1) (18). vessels would be removed as a potential donor for coronary Of note, there is however a rib sparing technique that artery bypass grafting. Radiotherapy is a common adjunct to can be performed that prevents a contour deformity and treatment of breast cancer. These patients are at higher risk results in less pain. This involves elevating an area of the for coronary artery disease due the effects of radiotherapy IC muscle in the second or third IC space (9,10). The on the cardiac vasculature. This may mean this cohort of second IC space is the largest IC space (19). This may patients may need coronary artery bypass grafting in the not be feasible in the presence of a bifid rib (20). In the future (23). The ITA is the vessel of choice for surgeons case of the patient who has had previous radiotherapy performing bypass grafting (24). Sacrifice of this vessel however, the segment of ITA that is behind the rib has may also lead to complications in sternal wound closure less damage due to the radiotherapy, which may be more during cardiothoracic surgery (25).
Load more

Recommended publications
  • Vessels and Circulation
    CARDIOVASCULAR SYSTEM OUTLINE 23.1 Anatomy of Blood Vessels 684 23.1a Blood Vessel Tunics 684 23.1b Arteries 685 23.1c Capillaries 688 23 23.1d Veins 689 23.2 Blood Pressure 691 23.3 Systemic Circulation 692 Vessels and 23.3a General Arterial Flow Out of the Heart 693 23.3b General Venous Return to the Heart 693 23.3c Blood Flow Through the Head and Neck 693 23.3d Blood Flow Through the Thoracic and Abdominal Walls 697 23.3e Blood Flow Through the Thoracic Organs 700 Circulation 23.3f Blood Flow Through the Gastrointestinal Tract 701 23.3g Blood Flow Through the Posterior Abdominal Organs, Pelvis, and Perineum 705 23.3h Blood Flow Through the Upper Limb 705 23.3i Blood Flow Through the Lower Limb 709 23.4 Pulmonary Circulation 712 23.5 Review of Heart, Systemic, and Pulmonary Circulation 714 23.6 Aging and the Cardiovascular System 715 23.7 Blood Vessel Development 716 23.7a Artery Development 716 23.7b Vein Development 717 23.7c Comparison of Fetal and Postnatal Circulation 718 MODULE 9: CARDIOVASCULAR SYSTEM mck78097_ch23_683-723.indd 683 2/14/11 4:31 PM 684 Chapter Twenty-Three Vessels and Circulation lood vessels are analogous to highways—they are an efficient larger as they merge and come closer to the heart. The site where B mode of transport for oxygen, carbon dioxide, nutrients, hor- two or more arteries (or two or more veins) converge to supply the mones, and waste products to and from body tissues. The heart is same body region is called an anastomosis (ă-nas ′tō -mō′ sis; pl., the mechanical pump that propels the blood through the vessels.
    [Show full text]
  • GROSS ANATOMY Lecture Syllabus 2008
    GROSS ANATOMY Lecture Syllabus 2008 ANAT 6010 - Gross Anatomy Department of Neurobiology and Anatomy University of Utah School of Medicine David A. Morton K. Bo Foreman Kurt H. Albertine Andrew S. Weyrich Kimberly Moyle 1 GROSS ANATOMY (ANAT 6010) ORIENTATION, FALL 2008 Welcome to Human Gross Anatomy! Course Director David A. Morton, Ph.D. Offi ce: 223 Health Professions Education Building; Phone: 581-3385; Email: [email protected] Faculty • Kurt H. Albertine, Ph.D., (Assistant Dean for Faculty Administration) ([email protected]) • K. Bo Foreman, PT, Ph.D, (Gross and Neuro Anatomy Course Director in Dept. of Physical Therapy) (bo. [email protected]) • David A. Morton, Ph.D. (Gross Anatomy Course Director, School of Medicine) ([email protected]. edu) • Andrew S. Weyrich, Ph.D. (Professor of Human Molecular Biology and Genetics) (andrew.weyrich@hmbg. utah.edu) • Kerry D. Peterson, L.F.P. (Body Donor Program Director) Cadaver Laboratory staff Jordan Barker, Blake Dowdle, Christine Eckel, MS (Ph.D.), Nick Gibbons, Richard Homer, Heather Homer, Nick Livdahl, Kim Moyle, Neal Tolley, MS, Rick Webster Course Objectives The study of anatomy is akin to the study of language. Literally thousands of new words will be taught through- out the course. Success in anatomy comes from knowing the terminology, the three-dimensional visualization of the structure(s) and using that knowledge in solving problems. The discipline of anatomy is usually studied in a dual approach: • Regional approach - description of structures regionally
    [Show full text]
  • Thymectomy with an Endoscopic Approach
    Review Article on Thoracic Surgery Page 1 of 6 Thymectomy with an endoscopic approach Takashi Suda Department of Thoracic Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan Correspondence to: Takashi Suda, MD. Department of Thoracic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi 470-1192, Japan. Email: [email protected]. Abstract: Various surgical approaches, including endoscopic surgery, are used when operating on tumors of the anterior mediastinum. Accordingly, surgical approaches for anterior mediastinal tumors include conventional median sternotomy, transcervical thymectomy from the cervical region, lateral thoracic intercostal approach, and the subxiphoid approach. Recently, robot-assisted surgery and single-port surgery are now performed as new forms of endoscopic surgery in the field of thoracic surgery and are now being adapted for anterior mediastinal tumors. We review current endoscopic surgical approaches for anterior mediastinal tumors and describe surgical techniques for thymectomy by a lateral thoracic intercostal approach, which is currently widely performed, as well as thymectomy by a subxiphoid approach. Keywords: Video-assisted thoracoscopic surgery (VATS); subxiphoid approach; thymectomy; robotic thymectomy; uniportal; single-port Received: 17 February 2019; Published: 07 March 2019; Published: 15 March 2019. doi: 10.21037/jovs.2019.03.09 View this article at: http://dx.doi.org/10.21037/jovs.2019.03.09 Introduction Median sternotomy Various surgical approaches, including endoscopic surgery, Median sternotomy is a classic method that was first reported are used when operating on tumors of the anterior by Milton et al. in 1897. This technique is still the standard mediastinum. Surgical methods involving an anterior surgical approach for anterior mediastinal tumors (8).
    [Show full text]
  • Anatomy of the Breast Doctors Notes Notes/Extra Explanation Please View Our Editing File Before Studying This Lecture to Check for Any Changes
    Color Code Important Anatomy of the Breast Doctors Notes Notes/Extra explanation Please view our Editing File before studying this lecture to check for any changes. Objectives By the end of the lecture, the student should be able to: ✓ Describe the shape and position of the female breast. ✓ Describe the structure of the mammary gland. ✓ List the blood supply of the female breast. ✓ Describe the lymphatic drainage of the female breast. ✓ Describe the applied anatomy in the female breast. Highly recommended Introduction 06:26 Overview of the breast: • The breast (consists of mammary glands + associated skin & Extra connective tissue) is a gland made up of lobes arranged radially .around the nipple (شعاعيا) • Each lobe is further divided into lobules. Between the lobes and lobules we have fat & ligaments called ligaments of cooper • These ligaments attach the skin to the muscle (beneath the breast) to give support to the breast. in shape (مخروطي) *o Shape: it is conical o Position: It lies in superficial fascia of the front of chest. * o Parts: It has a: 1. Base lies on muscles, (حلمة الثدي) Apex nipple .2 3. Tail extend into axilla Extra Position of Female Breast (حلقة ملونة) Base Nipple Areola o Extends from 2nd to 6th ribs. o It extends from the lateral margin of sternum medially to the midaxillary line laterally. o It has no capsule. o It lies on 3 muscles: • 2/3 of its base on (1) pectoralis major* Extra muscle, • inferolateral 1/3 on (2) Serratus anterior & (3) External oblique muscles (muscle of anterior abdominal wall). o Its superolateral part sends a process into the axilla called the axillary tail or axillary process.
    [Show full text]
  • Blood Vessels and Circulation
    19 Blood Vessels and Circulation Lecture Presentation by Lori Garrett © 2018 Pearson Education, Inc. Section 1: Functional Anatomy of Blood Vessels Learning Outcomes 19.1 Distinguish between the pulmonary and systemic circuits, and identify afferent and efferent blood vessels. 19.2 Distinguish among the types of blood vessels on the basis of their structure and function. 19.3 Describe the structures of capillaries and their functions in the exchange of dissolved materials between blood and interstitial fluid. 19.4 Describe the venous system, and indicate the distribution of blood within the cardiovascular system. © 2018 Pearson Education, Inc. Module 19.1: The heart pumps blood, in sequence, through the arteries, capillaries, and veins of the pulmonary and systemic circuits Blood vessels . Blood vessels conduct blood between the heart and peripheral tissues . Arteries (carry blood away from the heart) • Also called efferent vessels . Veins (carry blood to the heart) • Also called afferent vessels . Capillaries (exchange substances between blood and tissues) • Interconnect smallest arteries and smallest veins © 2018 Pearson Education, Inc. Module 19.1: Blood vessels and circuits Two circuits 1. Pulmonary circuit • To and from gas exchange surfaces in the lungs 2. Systemic circuit • To and from rest of body © 2018 Pearson Education, Inc. Module 19.1: Blood vessels and circuits Circulation pathway through circuits 1. Right atrium (entry chamber) • Collects blood from systemic circuit • To right ventricle to pulmonary circuit 2. Pulmonary circuit • Pulmonary arteries to pulmonary capillaries to pulmonary veins © 2018 Pearson Education, Inc. Module 19.1: Blood vessels and circuits Circulation pathway through circuits (continued) 3. Left atrium • Receives blood from pulmonary circuit • To left ventricle to systemic circuit 4.
    [Show full text]
  • A Case of the Bilateral Superior Venae Cavae with Some Other Anomalous Veins
    Okaiimas Fol. anat. jap., 48: 413-426, 1972 A Case of the Bilateral Superior Venae Cavae With Some Other Anomalous Veins By Yasumichi Fujimoto, Hitoshi Okuda and Mihoko Yamamoto Department of Anatomy, Osaka Dental University, Osaka (Director : Prof. Y. Ohta) With 8 Figures in 2 Plates and 2 Tables -Received for Publication, July 24, 1971- A case of the so-called bilateral superior venae cavae after the persistence of the left superior vena cava has appeared relatively frequent. The present authors would like to make a report on such a persistence of the left superior vena cava, which was found in a routine dissection cadaver of their school. This case is accompanied by other anomalies on the venous system ; a complete pair of the azygos veins, the double subclavian veins of the right side and the ring-formation in the left external iliac vein. Findings Cadaver : Mediiim nourished male (Japanese), about 157 cm in stature. No other anomaly in the heart as well as in the great arteries is recognized. The extracted heart is about 350 gm in weight and about 380 ml in volume. A. Bilateral superior venae cavae 1) Right superior vena cava (figs. 1, 2, 4) It measures about 23 mm in width at origin, about 25 mm at the pericardiac end, and about 31 mm at the opening to the right atrium ; about 55 mm in length up to the pericardium and about 80 mm to the opening. The vein is formed in the usual way by the union of the right This report was announced at the forty-sixth meeting of Kinki-district of the Japanese Association of Anatomists, February, 1971,Kyoto.
    [Show full text]
  • The Surgical Anatomy of the Mammary Gland. Vascularisation, Innervation, Lymphatic Drainage, the Structure of the Axillary Fossa (Part 2.)
    NOWOTWORY Journal of Oncology 2021, volume 71, number 1, 62–69 DOI: 10.5603/NJO.2021.0011 © Polskie Towarzystwo Onkologiczne ISSN 0029–540X Varia www.nowotwory.edu.pl The surgical anatomy of the mammary gland. Vascularisation, innervation, lymphatic drainage, the structure of the axillary fossa (part 2.) Sławomir Cieśla1, Mateusz Wichtowski1, 2, Róża Poźniak-Balicka3, 4, Dawid Murawa1, 2 1Department of General and Oncological Surgery, K. Marcinkowski University Hospital, Zielona Gora, Poland 2Department of Surgery and Oncology, Collegium Medicum, University of Zielona Gora, Poland 3Department of Radiotherapy, K. Marcinkowski University Hospital, Zielona Gora, Poland 4Department of Urology and Oncological Urology, Collegium Medicum, University of Zielona Gora, Poland Dynamically developing oncoplasty, i.e. the application of plastic surgery methods in oncological breast surgeries, requires excellent knowledge of mammary gland anatomy. This article presents the details of arterial blood supply and venous blood outflow as well as breast innervation with a special focus on the nipple-areolar complex, and the lymphatic system with lymphatic outflow routes. Additionally, it provides an extensive description of the axillary fossa anatomy. Key words: anatomy of the mammary gland The large-scale introduction of oncoplasty to everyday on- axillary artery subclavian artery cological surgery practice of partial mammary gland resec- internal thoracic artery thoracic-acromial artery tions, partial or total breast reconstructions with the use of branches to the mammary gland the patient’s own tissue as well as an artificial material such as implants has significantly changed the paradigm of surgi- cal procedures. A thorough knowledge of mammary gland lateral thoracic artery superficial anatomy has taken on a new meaning.
    [Show full text]
  • The Clinical Anatomy of the Internal Thoracic Veins
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE Foliaprovided Morphol. by Via Medica Journals Vol. 66, No. 1, pp. 25–32 Copyright © 2007 Via Medica O R I G I N A L A R T I C L E ISSN 0015–5659 www.fm.viamedica.pl The clinical anatomy of the internal thoracic veins M. Loukas1, 2, M.S. Tobola1, R.S. Tubbs3, R.G. Louis Jr.1, M. Karapidis1, I. Khan1, G. Spentzouris1, S. Linganna1, B. Curry1 1Department of Anatomical Sciences, St. George’s University, Grenada, West Indies 2Harvard Medical School, Department of Education and Development, Boston, MA, USA 3Department of Cell Biology and Section of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA [Received 17 October 2006; Accepted 25 January 2007] The branching pattern and adequacy of the internal thoracic veins (ITV) are impor- tant factors, providing useful information on the availability of vessels and their appropriateness as an option for anastomoses in plastic and reconstructive surgery. During 100 cadaveric examinations of the anterior thoracic wall it was observed that ITVs were formed by the venae commitantes of ITAs, which united to form a single vein (one for the right side and one for the left) draining into the right and left brachiocephalic veins. The tributaries of ITVs corresponded to the branches of ITA. The right internal thoracic vein bifurcated at the 2nd rib in 36% of the specimens, at the 3rd rib in 30% of the specimens, at the 4th rib in 10% of the specimens and in 24% of the specimens it remained a single vein.
    [Show full text]
  • Redalyc.Internal Thoracic Vein Draining Into the Extrapericardial Part of The
    Jornal Vascular Brasileiro ISSN: 1677-5449 [email protected] Sociedade Brasileira de Angiologia e de Cirurgia Vascular Brasil Vollala, Venkata Ramana; Pamidi, Narendra; Potu, Bhagath Kumar Internal thoracic vein draining into the extrapericardial part of the superior vena cava: a case report Jornal Vascular Brasileiro, vol. 7, núm. 1, marzo, 2008, pp. 80-83 Sociedade Brasileira de Angiologia e de Cirurgia Vascular São Paulo, Brasil Available in: http://www.redalyc.org/articulo.oa?id=245016527015 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative CASE REPORT Internal thoracic vein draining into the extrapericardial part of the superior vena cava: a case report Drenagem da veia torácica interna para a parte extrapericárdica da veia cava superior: relato de caso Venkata Ramana Vollala,1 Narendra Pamidi,1 Bhagath Kumar Potu2 Abstract Resumo The internal thoracic veins are venae comitantes of each internal As veias torácicas internas são veias comitantes de cada artéria thoracic artery draining the territory supplied by it and usually unite torácica interna drenando o território suprido por ela e geralmente se opposite the third costal cartilage. This single vein enters the unem em frente à terceira cartilagem costal. Esta única veia entra na corresponding brachiocephalic vein. We present a variation of right veia braquicefálica correspondente. Apresentamos uma variação da internal mammary vein draining into superior vena cava in a veia mamária interna direita drenando para a veia cava superior em 45-year-old male cadaver.
    [Show full text]
  • Blood Vessels and Circulation
    C h a p t e r 21 Blood Vessels and Circulation PowerPoint® Lecture Slides prepared by Jason LaPres Lone Star College - North Harris Copyright © 2009 Pearson Education, Inc., Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings publishing as Pearson Benjamin Cummings Classes of Blood Vessels . Arteries . Carry blood away from heart . Arterioles . Are smallest branches of arteries . Capillaries . Are smallest blood vessels . Location of exchange between blood and interstitial fluid . Venules . Collect blood from capillaries . Veins . Return blood to heart Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Blood Vessels . The Largest Blood Vessels . Attach to heart . Pulmonary trunk . Carries blood from right ventricle . To pulmonary circulation . Aorta . Carries blood from left ventricle . To systemic circulation Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Blood Vessels . The Smallest Blood Vessels . Capillaries . Have small diameter and thin walls . Chemicals and gases diffuse across walls Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Blood Vessels . The Structure of Vessel Walls . Walls have three layers: . Tunica intima . Tunica media . Tunica externa Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Blood Vessels . The Tunica Intima . Is the innermost layer . Includes . The endothelial lining . Connective tissue layer . Internal elastic membrane: – in arteries, is a layer of elastic fibers in outer margin of tunica intima Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Blood Vessels . The Tunica Media . Is the middle layer . Contains concentric sheets of smooth muscle in loose connective tissue . Binds to inner and outer layers . External elastic membrane of the tunica media .
    [Show full text]
  • Human Anatomy: Thoracic Wall
    Thoracic wall - structure, blood supply and innervation Ingrid Hodorová UPJŠ LF, Dept. of Anatomy MediTec training for students 1.-15.9.2019, Kosice, Slovakia Thoracic borders external - Upper: jugular notch, clavicule, acromion scapulae, spine of C7 (vertebra prominens) Lower: xiphoid process, costal arches (right and left), Th12 internal - Upper: superior thoracic aperture: jugular notch, 1. pair of ribs, Th1 Lower: inferior thoracic aperture: diaphragm (right side - to 4. ICS left side - to 5. ICS) Lines of orientation Anterior axillary l. Anterior median line (midsternal) Scapular l. Sternal line Middle axillary l. Paravertebral l. Parasternal l. Posterior median line Midclavicular l. Posterior axillary l. Layers of thoracic wall ► Deep layer - osteothorax, muscles of proper thoracic wall + intrinsic muscles of the back, deep structures, endothoracic fascia ► Middle layer - thoracohumeral mm., spinohumeral mm., spinocostal mm., (fascie, vessels, nerves) ► Superficial layer - skin, subcutaneous tissue, superficial structures, mammary gland ►Deep layer Osteothorax - ribs - sternum - thoracic vertebrae Osteothorax Ribs Types of ribs: Sternum - manunbrium of sternum - body of sternum - xiphoid process - manunbriosternal and xiphisternal synchondrosis(synostosis) Movement of the ribs and sternum during breathing Thoracic vertebrae - body - arch (lamina+pedicles) - spinous process - transverse processes - superior and inferior articular processes Joints of the ribs anteriorly ►sternocostal joints (2nd-5th ribs) posteriorly ►costovertebral
    [Show full text]
  • 1. Brachiocephalic Vein 2. External Jugular Vein 3. Internal Jugular Vein 4
    Veins 1 Head and Thoracic Veins 1. Given the following veins: 1. brachiocephalic vein 2. external jugular vein 3. internal jugular vein 4. subclavian vein 5. superior vena cava 6. venous sinus Select and arrange the veins in the order blood passes through going. From the brain to the heart From the right (or left) side of the face to the heart. 2. Given the following veins: 1. azygos vein 2. brachiocephalic vein 3. inferior vena cava 4. subclavian vein 5. superior vena cava Select and arrange the veins in the order blood passes through them going. From the RIGHT upper limb to the heart. From the LEFT upper limb to the heart. 1 3. Given the following veins: 1. azygos vein 2. brachiocephalic vein 3. hemiazygos and accessory hemiazygos veins 4. internal thoracic vein 5. subclavian vein 6. superior vena cava Select and arrange the veins in the order blood passes through them going. From the ANTERIOR thoracic wall to the heart. From the LEFT, POSTERIOR thoracic wall to the heart. From the RIGHT, POSTERIOR thoracic wall to the heart. 4. Given the following veins: 1. azygos vein 2. brachiocephalic vein 3. intercostal vein 3. inferior vena cava 5. superior vena cava Select and arrange the veins in the order blood passes through them going from the esophagus to the heart. 5. In one type of heart failure, the RIGHT side of the heart does not pump out enough blood. As a result, blood tends to "backup" in the blood vessels that carry blood to the right side of the heart.
    [Show full text]