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Here is a complete MBBS-level overview of the major arteries and veins of the body, region by region, with their supplies and key clinical points.
Major Arteries and Veins of the Body - MBBS Overview
Key concept: Arteries = high-pressure supply system. Veins = low-pressure reservoir/drainage system. The microcirculation (arterioles → capillaries → venules) is the exchange zone. - THIEME Atlas of Anatomy
ARTERIES
1. AORTA - The Main Trunk
| Segment | Vertebral Level | Key Branches |
|---|---|---|
| Ascending Aorta | T4 | Right & Left coronary arteries |
| Arch of Aorta | T4 | Brachiocephalic trunk, L. Common Carotid, L. Subclavian |
| Thoracic (Descending) Aorta | T4-T12 | Bronchial, Esophageal, Posterior intercostal (9 pairs), Subcostal, Superior phrenic |
| Abdominal Aorta | T12-L4 | See table below |
| Terminal | L4 | Right & Left Common Iliac arteries |
Branches of the Abdominal Aorta (T12-L4)
| Branch | Type | Level | Supply |
|---|---|---|---|
| Inferior phrenic | Parietal (paired) | T12 | Diaphragm (inferior) |
| Celiac trunk | Visceral (unpaired) | T12 | L. gastric, Splenic, Common hepatic → stomach, liver, spleen, pancreas, duodenum |
| Middle suprarenal | Visceral (paired) | L1 | Adrenal glands |
| Superior mesenteric | Visceral (unpaired) | L1 | Small intestine, cecum, ascending + transverse colon |
| Renal arteries | Visceral (paired) | L2 | Kidneys |
| Gonadal (testicular/ovarian) | Visceral (paired) | L2 | Testes/Ovaries |
| Inferior mesenteric | Visceral (unpaired) | L3 | Descending colon, sigmoid, rectum |
| Lumbar arteries | Parietal (paired) | L1-L4 | Posterior abdominal wall |
| Median sacral | Parietal (unpaired) | L4 | Sacrum and coccyx |
| Common iliac arteries | Terminal | L4 | Divide into internal + external iliac |
Clinical - Fischer's Mastery of Surgery: Abdominal aortic aneurysms (AAA) most commonly occur just inferior to the renal arteries and may extend into the common iliac arteries. Supernumerary renal arteries are end-arteries; occlusion causes renal segment necrosis.
2. HEAD & NECK ARTERIES
| Artery | Origin | Supply |
|---|---|---|
| Common Carotid | Brachiocephalic (R), Arch (L) | Bifurcates at C4 into internal + external |
| Internal Carotid | Common Carotid | Brain (anterior circulation), eye, forehead |
| External Carotid | Common Carotid | Face, scalp, tongue, thyroid, pharynx |
| Vertebral | Subclavian | Brainstem, cerebellum, posterior brain (posterior circulation) |
| Subclavian | Brachiocephalic (R), Arch (L) | Upper limb, brain (vertebral), anterior chest |
| Costocervical trunk | Subclavian | 1st & 2nd intercostal spaces, deep neck |
| Internal thoracic | Subclavian | Anterior chest wall, breast; gives musculophrenic + pericardiacophrenic |
Clinical: Carotid endarterectomy is done for >70% stenosis causing TIA/stroke. The carotid sinus (at bifurcation) contains baroreceptors - pressure on it can cause syncope (carotid sinus hypersensitivity). Vertebral artery stenosis causes vertebrobasilar insufficiency (dizziness, drop attacks).
3. UPPER LIMB ARTERIES
| Artery | Region | Supply / Key Branches |
|---|---|---|
| Subclavian | Root of neck | Continues as axillary at lateral border of 1st rib |
| Axillary | Axilla | Superior thoracic, thoracoacromial, lateral thoracic, anterior/posterior circumflex humeral, subscapular |
| Brachial | Arm | Profunda brachii (deep brachial - radial nerve companion), anterior/posterior circumflex humeral |
| Radial | Forearm lateral | Thenar muscles, superficial palmar arch (lateral part), dorsal carpal arch |
| Ulnar | Forearm medial | Superficial palmar arch (main), deep palmar arch (lateral part), common interosseous |
| Superficial Palmar Arch | Palm | Digital arteries to fingers |
| Deep Palmar Arch | Deep palm | Palmar metacarpal arteries |
Clinical: The radial artery is used for arterial BP monitoring and cardiac catheterization (radial access). Allen's test assesses dual supply before radial artery cannulation. Brachial artery injury in supracondylar fracture of humerus (common in children) → ischemic contracture (Volkmann's). Radial pulse is absent in Takayasu's arteritis (aortoarteritis).
4. THORAX ARTERIES (other than aorta)
| Artery | Origin | Supply |
|---|---|---|
| Coronary arteries (R & L) | Ascending aorta (sinuses of Valsalva) | Myocardium |
| LAD (Left Anterior Descending) | Left main → LAD | Anterior LV, anterior IVS, apex |
| LCx (Left Circumflex) | Left main → LCx | Lateral LV wall, posterior LV (in 15%) |
| RCA (Right Coronary Artery) | Right coronary sinus | SA node (60%), AV node (90%), inferior LV, posterior IVS |
| Internal thoracic | Subclavian | Anterior chest; used as CABG graft |
| Posterior intercostal | Thoracic aorta | Intercostal muscles, overlying skin |
Clinical: LAD ("widow-maker") occlusion → anterior MI. RCA occlusion → inferior MI + AV block. The left internal thoracic artery (LIMA) is the gold-standard graft for CABG. Coarctation of aorta causes rib notching on CXR from enlarged posterior intercostal arteries.
5. LOWER LIMB ARTERIES
| Artery | Region | Supply |
|---|---|---|
| Common Iliac | Aorta bifurcation L4 | Divides into external + internal iliac |
| Internal Iliac | Pelvis | Bladder, rectum, uterus/prostate, gluteal muscles |
| External Iliac | Becomes femoral at inguinal ligament | Lower limb |
| Femoral | Anterior thigh | Profunda femoris (main thigh supply), descending genicular |
| Profunda Femoris | Femoral | Medial + lateral circumflex femoral (hip supply), perforating arteries |
| Popliteal | Posterior knee | Genicular branches, divides into anterior + posterior tibial |
| Anterior Tibial | Popliteal | Anterior compartment leg → continues as Dorsalis Pedis |
| Posterior Tibial | Popliteal | Posterior + lateral leg → divides into medial + lateral plantar arteries |
| Peroneal (Fibular) | Posterior tibial | Lateral compartment of leg |
Clinical: Femoral artery is used for cardiac catheterization. Leriche syndrome = aortoiliac occlusion → absent femoral pulses + buttock claudication + impotence. Critical ischemia = rest pain + gangrene (ankle-brachial index <0.4). Posterior tibial pulse is palpated behind the medial malleolus; Dorsalis pedis is on the dorsum of the foot (absent in 8% normally). Profunda femoris injury in femoral fracture → massive thigh hemorrhage.
VEINS
Blood Vessel Classification
| System | Pressure | Function |
|---|---|---|
| Arteries | High | Supply (O₂, nutrients) |
| Capillaries | Very low | Exchange (gases, fluids) |
| Veins | Low | Reservoir + drainage |
1. SYSTEMIC VEINS - SUPERIOR & INFERIOR VENA CAVA
| Vein | Drains | Formed By |
|---|---|---|
| Superior Vena Cava (SVC) | Head, neck, upper limbs, thorax | Union of R + L brachiocephalic veins |
| Brachiocephalic veins | Head + upper limb | Subclavian + internal jugular |
| Azygos system | Thoracic + abdominal wall | Connects SVC to IVC (collateral) |
| Inferior Vena Cava (IVC) | Lower limbs, abdomen, pelvis | Union of two common iliac veins at L5 |
Clinical: SVC syndrome (from mediastinal mass/lung cancer) → facial puffing, arm edema, dilated neck veins. IVC thrombosis (rare, from tumor or DVT extension) → bilateral leg edema.
2. HEAD & NECK VEINS
| Vein | Drains | Notes |
|---|---|---|
| Internal Jugular | Brain (via sigmoid sinus), face, neck | Main venous outflow from brain; runs with carotid artery in carotid sheath |
| External Jugular | Scalp, face, superficial neck | Visible at neck surface |
| Vertebral vein | Cervical muscles, deep neck | Accompanies vertebral artery |
| Facial vein | Face | Communicates with cavernous sinus via ophthalmic veins |
Clinical: Cavernous sinus thrombosis can arise from facial infections spreading via the facial vein (dangerous area of face = upper lip to nose). IJV catheterization is done for CVP monitoring. Elevated JVP is a bedside sign of right heart failure.
3. UPPER LIMB VEINS
| Vein | Course | Clinical Use |
|---|---|---|
| Cephalic vein | Lateral forearm → arm → deltopectoral groove → axillary vein | IV access, PICC lines |
| Basilic vein | Medial forearm → medial arm → axillary vein | Median cubital communicates with cephalic |
| Median cubital vein | Connects cephalic + basilic in cubital fossa | Most common site for venepuncture |
| Axillary vein | Continues as subclavian | Becomes subclavian at 1st rib |
| Subclavian vein | Joins IJV to form brachiocephalic | Central venous access site |
Clinical: The median cubital vein is the standard site for blood collection and IV drips. The brachial artery lies medial to the biceps tendon in the cubital fossa - must be avoided during venepuncture. Paget-Schroetter syndrome = effort thrombosis of axillary-subclavian vein.
4. LOWER LIMB VEINS
| Vein | Course | Notes |
|---|---|---|
| Great Saphenous Vein (GSV) | Medial malleolus → medial leg → thigh → saphenofemoral junction (4 cm below inguinal ligament) → femoral vein | Longest vein in body |
| Small Saphenous Vein (SSV) | Lateral malleolus → posterior leg → popliteal fossa → popliteal vein | |
| Femoral vein | Adductor canal to femoral triangle | Becomes external iliac at inguinal ligament |
| Popliteal vein | Behind knee | Receives SSV |
| Anterior/Posterior tibial veins | Leg (deep) | Accompany arteries |
Clinical: Varicose veins = dilated, tortuous superficial veins (GSV most common) from incompetent valves. DVT most commonly affects deep calf veins and propagates to popliteal/femoral veins → pulmonary embolism risk. The GSV is used as a bypass graft in CABG and peripheral vascular surgery. Saphenous vein cutdown at the medial malleolus is emergency vascular access. Trendelenburg test assesses saphenofemoral valve competence.
5. PORTAL VENOUS SYSTEM
| Vein | Formed By | Drains |
|---|---|---|
| Portal vein | Superior mesenteric + splenic veins (behind neck of pancreas) | All GI tract (stomach to rectum), spleen, pancreas |
| Splenic vein | Splenic tributaries + inferior mesenteric vein | Spleen, stomach, pancreas, left colon |
| Superior mesenteric vein | Jejunal/ileal veins | Small intestine, right colon |
| Inferior mesenteric vein | Drains into splenic vein | Left colon, sigmoid, rectum |
Clinical: In portal hypertension (cirrhosis), blood diverts through portosystemic anastomoses:
- Esophageal varices (left gastric ↔ esophageal veins → SVC) → rupture = massive hematemesis
- Caput medusae (paraumbilical veins dilate around umbilicus)
- Hemorrhoids (superior rectal ↔ middle/inferior rectal veins)
- Splenomegaly + ascites
- Azygos system also connects SVC ↔ IVC as a collateral route
6. AZYGOS SYSTEM
| Vein | Drains | Notes |
|---|---|---|
| Azygos vein | Right side thoracic wall, drains into SVC | Connects SVC and IVC as collateral |
| Hemiazygos | Left lower thoracic wall | Crosses to join azygos at T9 |
| Accessory hemiazygos | Left upper thoracic wall | Crosses to azygos at T7 |
Clinical: If the IVC is occluded (thrombosis, tumor), the azygos system provides collateral drainage. Azygos vein dilatation can mimic a right paratracheal mass on CXR.
QUICK CLINICAL SUMMARY TABLE
| Clinical Scenario | Vessel Involved |
|---|---|
| MI anterior | LAD occlusion |
| MI inferior | RCA occlusion |
| Rupture of berry aneurysm → SAH | Circle of Willis (anterior communicating most common) |
| Stroke (carotid territory) | Internal carotid / MCA |
| Vertebrobasilar insufficiency | Vertebral / basilar artery |
| AAA (most common site) | Infrarenal aorta (below renal arteries) |
| Leriche syndrome | Aortoiliac occlusion |
| Volkmann's ischemia | Brachial artery (supracondylar fracture) |
| Varicose veins | Great saphenous vein (incompetent valves) |
| DVT → PE | Deep calf → popliteal → femoral veins |
| Esophageal varices | Left gastric ↔ esophageal portosystemic shunt |
| Cavernous sinus thrombosis | Facial vein (danger triangle of face) |
| SVC syndrome | SVC compression (lung cancer, lymphoma) |
| CABG graft | Left internal thoracic artery (LIMA) + GSV |
| Blood transfusion / IV drip | Median cubital vein |
| Radial artery line | Radial artery (Allen's test first) |
| Femoral access (angiography) | Femoral artery / femoral vein |
Sources: Fischer's Mastery of Surgery 8e | Gray's Anatomy for Students | THIEME Atlas of Anatomy | Color Atlas of Human Anatomy Vol. 2 | Sabiston Textbook of Surgery
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