Anatomy - Dialysis access surgery: Brachiocephalic fistula (“direct antecubital fistula”) - Vascular Surgery

  1. Upper limb blood supply

     Upper limb blood supply
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    The arterial blood supply to the arm is via the subclavian artery, which arises from the aorta or brachiocephalic trunk. After passing through the posterior scalene gap, it continues as the axillary artery. The axillary artery supplies the shoulder girdle and then becomes the brachial artery, which supplies the upper arm. At the cubital fossa, the brachial artery divides into the radial and ulnar arteries, which run along the forearm to the hand. The arteries are accompanied by homonymous veins.

  2. Subclavian artery

    Important branches

    Important anastomoses


    Suprascapular artery

    Transverse cervical artery → dorsal scapular artery

    • Scapular anastomosis between suprascapular artery and circumflex scapular artery (branch of axillary artery)
    • Acromial rete
    • Shoulder
  3. Axillary artery



    Important anastomoses


    • In the axilla it runs lateral to the axillary vein
    • Anastomoses with the subclavian artery
    • Distal to the axilla it becomes the brachial artery
    • Superior thoracic artery
    • Thoracoacromial artery → pectoral branch, acromial branch, clavicular branch, and deltoid branch
    • Lateral thoracic artery
    • Subscapular artery → thoracodorsal artery and circumflex scapular artery
    • Anterior circumflex humeral artery
    • Posterior circumflex humeral artery
    • Acromial rete: between thoracoacromial artery and suprascapular artery (branch of subclavian artery)
    • Scapular anastomosis
    • Vascular rete around the surgical neck of the humerus (between the anterior and posterior circumflex humeral arteries) 
    • Shoulder
  4. Brachial artery



    Important anastomoses


    • Courses distad in medial bicipital groove
    • Deep brachial artery
    • Superior ulnar collateral artery
    • Inferior ulnar collateral artery
    • Articular network of elbow
    • Upper arm
    • Elbow
Radial artery

CourseBranchesImportant anastomosesDistributionPasses through the radial sheathAt the wrist runs to

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