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Arteries of the Upper Limb and Lower Limb - Complete Notes

Sources: THIEME Atlas of Anatomy - General Anatomy & Musculoskeletal System; Color Atlas of Human Anatomy Vol. 2

PART I: ARTERIES OF THE UPPER LIMB

Overview - Arterial Segments

The arterial supply of the upper limb is a continuous chain: Aorta → Subclavian artery → Axillary artery → Brachial artery → Radial + Ulnar arteries → Palmar arches → Digital arteries

Course of arteries supplying the shoulder and arm - Subclavian, Axillary, Brachial, Radial and Ulnar arteries labeled

1. SUBCLAVIAN ARTERY

Origin:

Right side: from the brachiocephalic trunk
Left side: directly from the aortic arch

Course: Runs over the 1st rib between the anterior and middle scalene muscles (interscalene space), then continues as the axillary artery at the lateral border of the 1st rib.

Note: Unlike other upper limb arteries, the subclavian also supplies the neck, cerebral circulation, and anterior chest wall.

Branches of the Subclavian Artery

Branch	Supply/Notes
Vertebral artery	Ascends through transverse foramina, supplies brain and spinal cord
Internal thoracic artery (internal mammary a.)	Anterior chest wall, breast
Thyrocervical trunk	Divides into 4 branches (see below)
- Inferior thyroid artery	Thyroid gland
- Ascending cervical artery	Neck muscles
- Suprascapular artery	Supraspinatus, infraspinatus; anastomoses with circumflex scapular a.
- Transverse cervical artery	Trapezius, posterior neck
Costocervical trunk	Divides into:
- Deep cervical artery	Deep posterior neck muscles
- Supreme intercostal artery	1st and 2nd intercostal spaces

2. AXILLARY ARTERY

Origin: Continuation of the subclavian artery from the lateral border of the 1st rib.

Termination: Becomes the brachial artery at the inferior border of the teres major (or pectoralis major tendon).

Relation: Covered anteriorly by pectoralis minor, which divides it into three parts.

Branches of the Axillary Artery

Part	Branch	Supply/Notes
1st part (medial to pec. minor)	Superior thoracic artery	1st and 2nd intercostal spaces, upper serratus anterior
2nd part (behind pec. minor)	Thoracoacromial artery	Divides into 4 branches:
	- Acromial branch	Acromial anastomosis
	- Clavicular branch	Clavicular region
	- Deltoid branch	Deltoid + pectoralis major
	- Pectoral branch	Pectoralis major and minor
2nd part	Lateral thoracic artery	Serratus anterior, mammary glands (thicker in females)
3rd part (lateral to pec. minor)	Subscapular artery	Largest branch; divides into:
	- Circumflex scapular artery	Through triangular space; anastomoses with suprascapular a. in infraspinous fossa
	- Thoracodorsal artery	Latissimus dorsi, teres major, subscapularis, serratus anterior
3rd part	Anterior circumflex humeral artery	Passes anterior to surgical neck of humerus; supplies shoulder joint
3rd part	Posterior circumflex humeral artery	Passes posterior through quadrangular space; supplies shoulder joint and deltoid

Comprehensive diagram showing all branches of upper limb arteries including subclavian, axillary, brachial, radial and ulnar with their branches to the hand

3. BRACHIAL ARTERY

Origin: Continuation of the axillary artery from the inferior border of teres major.

Course: Runs along the medial bicipital groove, where its pulse is palpable (can be compressed against the humerus in emergency).

Termination: Divides into radial and ulnar arteries at the elbow (neck of radius level).

Branches of the Brachial Artery

Branch	Supply/Notes
Deep artery of the arm (profunda brachii / deep brachial artery)	Originates at lower border of teres major; passes posteriorly with radial nerve in the spiral groove
- Medial collateral artery	Part of cubital anastomosis (elbow arterial network)
- Radial collateral artery	Part of cubital anastomosis; anastomoses with radial recurrent a.
Superior ulnar collateral artery	Runs with ulnar nerve; part of cubital anastomosis
Inferior ulnar collateral artery	Above medial epicondyle; part of cubital anastomosis
Nutrient artery of humerus	Enters humeral shaft
Muscular branches	Supply biceps, brachialis, coracobrachialis

Cubital Anastomosis (elbow arterial network): Formed by descending branches from the deep brachial and brachial arteries (superior ulnar collateral, inferior ulnar collateral, radial collateral, medial collateral) and ascending branches from the radial and ulnar arteries (radial recurrent, ulnar recurrent, interosseous recurrent). Allows collateral circulation if brachial artery is occluded above the elbow.

4. RADIAL ARTERY

Origin: Lateral terminal branch of brachial artery, at level of neck of radius.

Course: Runs between brachioradialis and flexor carpi radialis, then crosses the "anatomical snuffbox" to reach the dorsum of the hand, then plunges through 1st dorsal interosseous to form the deep palmar arch.

Clinical note: Radial pulse is palpable at the wrist just lateral to the flexor carpi radialis tendon.

Branches of the Radial Artery

Branch	Notes
Radial recurrent artery	Ascending branch; part of cubital anastomosis
Palmar carpal branch	Contributes to palmar carpal network
Superficial palmar branch	Contributes to superficial palmar arch (with ulnar artery)
Dorsal carpal branch	Contributes to dorsal carpal network
- Dorsal metacarpal arteries	From dorsal carpal network
- Dorsal digital arteries	From dorsal metacarpal arteries
Princeps pollicis artery	Main supply to thumb
Radialis indicis artery	Radial side of index finger
Deep palmar arch	Main terminal branch; lies on metacarpal bases
- Palmar metacarpal arteries	Deep arch gives 3-4 palmar metacarpal arteries
- Perforating branches	Connect deep and superficial arches

5. ULNAR ARTERY

Origin: Medial terminal branch of brachial artery.

Course: Passes under pronator teres, runs on the ulnar side of the forearm under flexor carpi ulnaris, then crosses the wrist through Guyon's canal to form the superficial palmar arch.

Branches of the Ulnar Artery

Branch	Notes
Ulnar recurrent artery	Ascending branch; part of cubital anastomosis
Common interosseous artery	Short trunk that quickly divides into:
- Anterior interosseous artery	Runs on anterior surface of interosseous membrane; supplies deep flexors
- Posterior interosseous artery	Passes through interosseous membrane; supplies extensor compartment
- Recurrent interosseous artery	Part of cubital anastomosis
Palmar carpal branch	Contributes to palmar carpal network
Dorsal carpal branch	Contributes to dorsal carpal network
Deep palmar branch	Contributes to deep palmar arch
Superficial palmar arch	Main terminal branch; lies deep to palmar aponeurosis
- Common palmar digital arteries	3 vessels running along web spaces
- Proper palmar digital arteries	Supply individual fingers on each side

Palmar Arches Summary:

Arch	Formed by	Depth
Superficial palmar arch	Mainly ulnar artery + superficial palmar branch of radial	Superficial (deep to palmar aponeurosis)
Deep palmar arch	Mainly radial artery (deep palmar arch) + deep palmar branch of ulnar	Deep (on metacarpal bases)

PART II: ARTERIES OF THE LOWER LIMB

Overview - Arterial Segments

Abdominal aorta → Common iliac → External iliac → Femoral → Popliteal → Anterior tibial + Posterior tibial → Foot arteries → Plantar arch → Digital arteries

Abdominal aorta dividing into common iliac arteries, external iliac, femoral artery and branches of the thigh

1. EXTERNAL ILIAC ARTERY

Origin: From common iliac artery (at bifurcation of abdominal aorta in front of L4).

Course: Descends along the medial border of psoas major, passes through the lacuna vasorum (deep to inguinal ligament), then becomes the femoral artery.

Branches of the External Iliac Artery

Branch	Notes
Inferior epigastric artery	Ascends to posterior rectus sheath; anastomoses with superior epigastric a.
- Cremasteric artery	Supplies cremaster muscle and testis
- Artery of the round ligament of uterus	Female equivalent of cremasteric a.
- Pubic branch	Anastomoses with obturator artery's pubic branch
Deep circumflex iliac artery	Runs laterally along inguinal ligament to iliac crest

2. FEMORAL ARTERY

Origin: Continuation of external iliac artery, begins at the inguinal ligament.

Course: Enters the femoral triangle (lateral to femoral vein and nerve), passes through the adductor canal (Hunter's canal) via the adductor hiatus, then becomes the popliteal artery behind the knee.

Clinical note: Femoral pulse palpable at the mid-inguinal point (midpoint between ASIS and pubic symphysis).

Branches of the Femoral Artery

Branch	Notes
Superficial epigastric artery	Ascends toward umbilicus; supplies lower abdominal skin
Superficial circumflex iliac artery	Runs toward ASIS; supplies overlying skin
Superficial external pudendal artery	Supplies scrotum/labia majora
Deep external pudendal artery	Supplies perineal skin
Deep artery of the thigh (profunda femoris)	Largest branch; main supply to thigh muscles
- Medial circumflex femoral artery	Passes posteriorly; main blood supply to femoral head; enters joint via ligament of femoral head
- Lateral circumflex femoral artery	Passes laterally between rectus femoris and vastus lateralis; divides into ascending, descending, and transverse branches
- Perforating branches (1st-4th)	Pierce adductor magnus; supply posterior thigh and hamstrings
Descending genicular artery	Descends to knee; contributes to genicular anastomosis

Clinical note: The medial circumflex femoral artery is the primary blood supply to the femoral head. Femoral neck fractures can disrupt this vessel, causing avascular necrosis of the femoral head.

3. POPLITEAL ARTERY

Origin: Continuation of femoral artery after it passes through the adductor hiatus.

Course: Runs through the popliteal fossa (the deepest structure in the fossa), ends at the inferior border of popliteus by dividing into anterior and posterior tibial arteries.

Clinical note: The popliteal artery must not be ligated - collateral circulation through genicular arteries is insufficient.

Popliteal artery and genicular anastomosis around the knee joint - lateral and medial genicular arteries labeled

Branches of the Popliteal Artery

Branch	Notes
Posterior tibial recurrent artery	Inconstant; passes to popliteal fossa (part of genicular anastomosis)
Medial superior genicular artery	Passes above medial femoral condyle; genicular anastomosis
Lateral superior genicular artery	Passes above lateral femoral condyle; genicular anastomosis
Sural arteries (2)	Supply gastrocnemius and soleus
Middle genicular artery	Pierces posterior capsule; supplies cruciate ligaments and synovial membrane
Medial inferior genicular artery	Passes below medial tibial condyle; genicular anastomosis
Lateral inferior genicular artery	Passes below lateral tibial condyle; genicular anastomosis

Genicular Anastomosis: Forms an arterial network around the knee. Receives descending contributions from the femoral artery (descending genicular a.) and ascending contributions from the tibial arteries (anterior tibial recurrent a., circumflex fibular branch). Allows limited collateral flow if popliteal is slowly occluded.

4. ANTERIOR TIBIAL ARTERY

Origin: Terminal branch of popliteal artery at inferior border of popliteus.

Course: Pierces the interosseous membrane at its upper border, enters the extensor (anterior) compartment of the leg, runs between tibialis anterior and extensor hallucis longus, then crosses the ankle to become the dorsal pedal (dorsalis pedis) artery.

Clinical note: Compression from blunt trauma can cause extensor compartment syndrome with muscle necrosis.

Anterior tibial artery running down the leg to the dorsum of the foot, with malleolar arteries, lateral tarsal artery, arcuate artery, and dorsal metatarsal arteries labeled

Branches of the Anterior Tibial Artery

Branch	Notes
Posterior tibial recurrent artery	Inconstant; passes to popliteal fossa
Anterior tibial recurrent artery	Ascending; contributes to genicular anastomosis
Anterior lateral malleolar artery	Lateral malleolar network
Anterior medial malleolar artery	Medial malleolar network
Dorsal pedal artery (dorsalis pedis)	Continuation on dorsum of foot (from ankle joint level)
- Lateral tarsal artery	Posterolateral tarsus
- Medial tarsal arteries	Posteromedial tarsus
- Arcuate artery (inconstant)	Runs along metatarsal bases
-- Dorsal metatarsal arteries	From arcuate artery; run in intermetatarsal spaces
-- Dorsal digital arteries	From dorsal metatarsal arteries; to toes
- Deep plantar artery	Passes through 1st intermetatarsal space to plantar deep arch

Clinical note: Dorsal pedal pulse is palpable between tendons of extensor hallucis longus and extensor digitorum longus on the dorsum of the foot.

5. POSTERIOR TIBIAL ARTERY

Origin: Direct continuation of popliteal artery at inferior border of popliteus.

Course: Enters the flexor (posterior) compartment deep to the soleus, passes behind the medial malleolus (where pulse is palpable), then divides into medial and lateral plantar arteries.

Clinical note: Posterior tibial pulse palpated 2 cm anterior to medial border of Achilles tendon, behind medial malleolus.

Branches of the Posterior Tibial Artery

Branch	Notes
Fibular (peroneal) artery	Largest branch; runs along the medial border of fibula
- Perforating branch	Pierces interosseous membrane to join anterior tibial territory
- Communicating branch	Connects with posterior tibial artery
- Lateral malleolar branches	Lateral malleolar network
- Calcaneal branches	To the heel
Medial malleolar branch	Medial malleolar network
Calcaneal branches (direct)	To heel from posterior tibial
Medial plantar artery	Runs along medial side of sole
- Superficial branch	Superficial sole structures
- Deep branch	Contributes to deep plantar arch
Lateral plantar artery	Runs across sole to form deep plantar arch

Sole of the foot showing medial plantar artery, lateral plantar artery, deep plantar arch, plantar metatarsal arteries, common and proper plantar digital arteries

Plantar Arch: The lateral plantar artery curves medially across the sole to form the deep plantar arch, which is completed by the deep plantar branch of the dorsalis pedis artery. From the arch arise:

Plantar metatarsal arteries (4 vessels)
Common plantar digital arteries - divide into proper plantar digital arteries to each toe

Anterior tibial artery, popliteal artery and branches - dorsal artery of foot with full labeling

Quick Reference Tables

Upper Limb - Artery Sequence

Subclavian
  └── Axillary (lateral border of 1st rib)
        └── Brachial (inferior border of teres major)
              ├── Radial artery (lateral)
              │     └── Deep palmar arch
              └── Ulnar artery (medial)
                    └── Superficial palmar arch
                          └── Common palmar digital arteries
                                └── Proper palmar digital arteries

Lower Limb - Artery Sequence

Abdominal aorta (L4)
  └── Common iliac
        ├── Internal iliac (pelvic viscera + gluteal muscles)
        └── External iliac
              └── Femoral (at inguinal ligament)
                    ├── Profunda femoris (deep artery of thigh)
                    └── Popliteal (at adductor hiatus)
                          ├── Anterior tibial
                          │     └── Dorsalis pedis
                          │           └── Deep plantar artery → Deep plantar arch
                          └── Posterior tibial
                                ├── Fibular (peroneal) artery
                                ├── Medial plantar artery
                                └── Lateral plantar artery → Deep plantar arch
                                      └── Plantar metatarsal arteries
                                            └── Plantar digital arteries

Clinically Important Pulse Points

Pulse	Artery	Location
Radial pulse	Radial artery	Lateral to flexor carpi radialis, at wrist
Ulnar pulse	Ulnar artery	Medial wrist, lateral to FCU tendon
Brachial pulse	Brachial artery	Medial bicipital groove, used for BP measurement
Femoral pulse	Femoral artery	Mid-inguinal point (between ASIS and pubic symphysis)
Popliteal pulse	Popliteal artery	Deep in popliteal fossa, knee flexed
Posterior tibial pulse	Posterior tibial artery	Behind medial malleolus
Dorsalis pedis pulse	Dorsalis pedis artery	Between EHL and EDL tendons on dorsum of foot

Key Anastomoses

Anastomosis	Arteries Involved	Clinical Significance
Cubital (elbow) anastomosis	Radial/medial collateral, ulnar collateral, radial recurrent, ulnar recurrent, interosseous recurrent	Collateral flow if brachial artery ligated above elbow
Scapular anastomosis	Suprascapular + circumflex scapular (subscapular)	Collateral flow in subclavian/axillary occlusion
Genicular anastomosis	Descending genicular, all 4 genicular arteries, anterior tibial recurrent	Some collateral at knee; insufficient if popliteal ligated acutely
Plantar arch	Lateral plantar (dominant) + deep plantar branch of dorsalis pedis	Complete arch ensures foot perfusion from both tibial sources

Sources: THIEME Atlas of Anatomy - General Anatomy and Musculoskeletal System (ISBN 9781626237186); Color Atlas of Human Anatomy Vol. 2 - Internal Organs (ISBN 9783132424487)

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