Arterial Supply of the Upper Limb

1. Subclavian Artery

• Arises from the brachiocephalic trunk (right) and directly from the aortic arch (left)
• Becomes the axillary artery at the lateral border of the 1st rib

2. Axillary Artery

• Extends from the lateral border of rib 1 to the lower border of teres major
• Divided into 3 parts by pectoralis minor:

3. Brachial Artery

• Continuation of axillary artery from lower border of teres major
• Runs in the medial bicipital groove, accompanies the median nerve
• Key branch: Profunda brachii (deep brachial artery) — accompanies the radial nerve in the spiral groove; gives anterior and posterior descending branches that anastomose around the elbow

• Superior ulnar collateral artery
• Inferior ulnar collateral artery
• Nutrient artery to humerus

• Radial artery
• Ulnar artery

4. Radial Artery

• Runs laterally in the forearm (between brachioradialis and flexor carpi radialis)
• Passes over the anatomical snuffbox and enters the palm via the 1st dorsal interosseous muscle
• Forms the deep palmar arch (with the deep branch of ulnar artery)

5. Ulnar Artery

• Larger of the two terminal branches
• Passes deep to the pronator teres, then between flexor carpi ulnaris and flexor digitorum superficialis
• Enters the hand via Guyon's canal
• Forms the superficial palmar arch (with the superficial palmar branch of radial artery)

6. Palmar Arches

Periarticular Anastomoses (Elbow)

Venous Drainage of the Upper Limb

Superficial Veins

Cephalic Vein

• Begins at the radial side of the dorsal venous network of the hand
• Ascends along the lateral (radial) forearm and arm
• Runs in the deltopectoral groove
• Pierces the clavipectoral fascia and drains into the axillary vein
• Clinically important: often used for PICC lines and venipuncture

Basilic Vein

• Begins at the ulnar side of the dorsal venous network
• Ascends along the medial forearm
• Pierces the deep fascia at the mid-arm level
• Joins the brachial venae comitantes to form the axillary vein
• Often used as the graft vessel in forearm fistulas

Median Antebrachial (Median Cubital) Vein

• Drains the palmar venous plexus
• Ascends on the anterior forearm
• At the cubital fossa, the median cubital vein connects cephalic and basilic veins (the classic venipuncture site)
• Lies superficial to the bicipital aponeurosis (which protects the brachial artery beneath)

Deep Veins

• Run as venae comitantes (paired veins flanking each artery): radial veins, ulnar veins, brachial veins
• Radial and ulnar venae comitantes unite to form brachial veins
• Brachial veins + basilic vein → Axillary vein

Axillary Vein

• Formed at the lower border of teres major
• Receives the cephalic vein and thoracoepigastric veins
• Becomes the subclavian vein at the lateral border of rib 1

Summary Flow Chart

Subclavian A. → Axillary A. → Brachial A. → Radial A. → Deep palmar arch
                                           ↘ Ulnar A.  → Superficial palmar arch
                                                          ↓
                                               Digital arteries (fingers)

Hand venous plexus → Cephalic V. (lateral) ↘
                  → Basilic V. (medial)     → Axillary V. → Subclavian V.
Deep: Radial/Ulnar venae comitantes → Brachial V. ↗

• The median cubital vein is the preferred venipuncture site — it is broad, superficial, and the bicipital aponeurosis protects underlying vessels
• The brachial artery can be ligated below the profunda brachii origin — collateral circulation via the anastomotic network around the elbow maintains distal perfusion
• The cephalic vein terminates at an acute angle into the axillary vein, making it technically challenging for central catheter advancement
• The superficial palmar arch lies more distal than the deep arch; it is at the level of the outstretched thumb