Part 64

(4) The =sphenopalatine artery= (A. sphenopalatina) arises in the extreme anterior part of the pterygo-palatine fossa and passes into the nasal cavity, where it divides into internal and external branches. The internal branch is distributed to the mucous membrane of the septum nasi; the external one goes to the inferior turbinal, the inferior meatus, the posterior nares, and the maxillary and frontal sinuses. It may arise from the infraorbital.

(5) The =palatine= or =palato-labial artery= (A. palatina major) is the direct continuation of the internal maxillary. It passes through the palatine canal to the roof of the mouth, accompanied by the palatine nerve, and runs forward in the palatine groove, where it is joined by the vein. A little behind the plane of the corner incisor teeth it curves inward over a bar of cartilage to the foramen incisivum, where it unites with its fellow of the opposite side. The single artery thus formed passes up through the foramen and divides under the transverse dilator of the nostril into two branches. These ramify in the upper lip and anastomose with the lateral nasal and superior labial arteries. In its course in the roof of the mouth the palatine artery gives off branches to the hard and soft palate and the gums, and others which pass through the accessory palatine foramina to be distributed in the mucous membrane of the lower part of the nasal cavity. Commonly two branches, right and left, are detached from the convexity of the arch formed by the union of the two arteries; these run forward in the anterior part of the hard palate.

ARTERIES OF THE THORACIC LIMB

THE BRACHIAL ARTERY

The =brachial artery=, after turning around the lower border of the scalenus at the first rib, passes backward and a little downward across the origin of the coraco-brachialis and the insertion of the subscapularis muscle at the inner side of the shoulder joint. At the posterior border of the subscapularis it gives off the subscapular artery, and turns downward on the inner surface of the arm. In its course in the arm it inclines a little forward, crosses the humerus very obliquely, and divides at the antero-internal aspect of the distal third of the shaft of the bone into the anterior and posterior radial arteries.[162]

It is related internally to the serratus magnus and the posterior deep pectoral muscles, and the cubital lymph glands. Externally it lies on the subscapularis, the brachialis, the insertion of the teres major and latissimus dorsi, and the inner head of the triceps. The coraco-brachialis muscle lies along the front of the artery, which, however, overlaps the muscle distally. The vein crosses the inner face of the artery and runs down behind it, accompanied part way by the ulnar and radial nerves. The musculo-cutaneous and median nerves form a loop around the artery close to its origin, and the latter nerve then passes down in front of the artery. The chief branches are as follows:

1. The =suprascapular artery= (A. thoracico-acromialis) is a small and somewhat flexuous vessel, which arises near the anterior border of the subscapularis, runs upward, and dips in between that muscle and the supraspinatus. It gives branches to these muscles, the anterior deep pectoral, and the mastoido-humeralis. A branch passes in front of the coraco-brachialis to the shoulder joint and the proximal end of the humerus.

This vessel may be double, or be represented by one or more branches of the inferior cervical artery.

2. The =subscapular artery= (A. subscapularis) is a very large vessel which arises at the posterior border of the subscapularis muscle. It passes upward in the interstice between that muscle and the teres major on the inner surface of the long head of the triceps, turns around the posterior border of the scapula below the posterior angle, and ends in the infraspinatus and deltoid. Besides collaterals (Rami musculares) to the subscapularis, teres major, triceps, and tensor fasciæ antibrachii it gives off the following named branches:

(_a_) The =thoracico-dorsal= (A. thoracicodorsalis) is a long artery which is usually given off about an inch from the origin of the subscapular, crosses the inner face of the teres major, and runs upward and backward on the latissimus dorsi. It gives branches to these muscles, the abdominal panniculus and the axillary lymph glands.

(_b_) The =posterior circumflex artery= (A. circumflexa humeri posterior) arises a little above the preceding vessel and passes outward behind the shoulder joint between the long and external heads of the triceps with the axillary (or circumflex) nerve. It gives branches to these muscles, the joint capsule, and the muscles and skin of the outer side of the shoulder, anastomosing with the anterior circumflex artery.

(_c_) The =circumflex artery of the scapula= (A. circumflexa scapulæ) arises about two or three inches (ca. 5 to 7.5 cm.) above the shoulder joint, passes forward to the posterior border of the scapula, and divides into two branches. The outer one runs forward on the external surface of the scapula below the spine and gives branches to the supraspinatus, infraspinatus, and teres minor. The inner branch passes forward in a similar fashion on the costal surface of the scapula and supplies branches to the subscapularis.

3. The =anterior circumflex= (or prehumeral) =artery= (A. circumflexa humeri anterior) arises usually at the upper border of the teres major. It passes forward and outward between the two parts of the coraco-brachialis or between the latter and the humerus. It gives branches to the coraco-brachialis and deep pectoral and ends in the upper part of the biceps and in the mastoido-humeralis. It anastomoses with the posterior circumflex.

Not rarely it arises below the middle of the humerus and passes upward between the biceps and coraco-brachialis. In these cases a small branch for the coraco-brachialis is usually given off at the usual point of origin of the anterior circumflex.

4. The =deep brachial artery= (A. profunda brachii) is a large but short trunk which arises usually about the middle of the humerus. It passes backward and divides into several branches which supply the triceps, tensor fasciæ antibrachii, anconeus, and brachialis. A branch runs in the musculo-spiral groove with the radial nerve to the front of the elbow joint and anastomoses with the anterior radial. A slender branch passes down along the external border of the extensor carpi and supplies cutaneous twigs. Anastomoses occur with the ulnar and recurrent interosseous arteries.

The point of origin is inconstant and it is not uncommon to find two arteries instead. Often a large branch for the posterior deep pectoral muscle is detached close to the origin or arises from the brachial directly.

5. =Muscular branches= (Rami musculares) are distributed to the teres major, deep pectoral, coraco-brachialis, and biceps. The largest and least variable of these supplies the lower part of the biceps.

6. The =ulnar artery= (A. collateralis ulnaris superior) arises a little below the nutrient foramen of the humerus and passes downward and backward along the lower edge of the internal head of the triceps under cover of the brachial vein and the tensor fascia antibrachii. It gives branches to these muscles, the posterior superficial pectoral, the cubital lymph glands, panniculus, and skin. At the internal epicondyle of the humerus it is joined by the ulnar nerve and turns downward under the ulnar head of the flexor carpi medius. It continues with the vein and nerve under the deep fascia of the forearm between the ulnar and humeral heads of the perforans, and in the distal half of the region between the external and middle flexors of the carpus. It unites just above the carpus (under cover of the flexor carpi externus) with a branch of the radial artery, with which it forms the supracarpal arch. It detaches small collaterals to the muscles along which it passes and terminal twigs to the outer surface of the carpus.

7. The =nutrient artery of the humerus= (A. nutritia humeri) is a short vessel which enters the nutrient foramen of the humerus. It often arises from the ulnar.

8. The =anterior radial artery= (A. collateralis radialis inferior) passes downward and a little outward on the anterior face of the humerus under cover of the biceps and brachialis to the front of the elbow joint, where it is joined by the radial nerve. It then descends on the anterior surface of the radius under cover of the anterior extensor of the digit to the carpus, where it concurs in the formation of the rete carpi dorsale, anastomosing with the posterior radial and interosseous arteries. It supplies branches to the elbow joint, the biceps, brachialis, and the extensors of the carpus and digit. A cutaneous branch emerges between the distal end of the biceps and the brachialis.

THE POSTERIOR RADIAL ARTERY

The =posterior radial= or =median artery= (A. mediana) is the direct continuation of the brachial. It passes downward and slightly backward, at first on the inner surface of the humerus, and then over the capsule and internal lateral ligament of the elbow joint, under cover of the posterior superficial pectoral muscle.[163] Below the elbow it dips under the flexor carpi internus and passes down the inner part of the posterior surface of the radius. In the distal part of the forearm it inclines backward and is separated from the radius by the reinforcing band (Caput tendineum) of the superficial flexor of the digit and is continued by the large metacarpal artery.

It is accompanied by the median nerve, which lies in front of the artery at its origin, then crosses over it obliquely at the elbow joint and becomes posterior. In the arm the brachial vein lies behind and partly upon the artery; lower down there are usually two satellite veins, anterior and posterior. The chief collateral branches are as follows:

1. =Articular branches= for the elbow joint.

2. =Muscular branches= to the flexors of the carpus and digit. The largest of these arise at the proximal third of the forearm.

3. The =common interosseous artery= (A. interossea communis) is a vessel of considerable size which arises at the level of the interosseous space, through which it passes. Before entering the space it gives off a small branch, the volar interosseous (A. interossea volaris), which descends to the radial head of the perforans. In the space it supplies the nutrient arteries of the radius and ulna. Emerging from the space it gives off branches to the flexor carpi externus, a small =recurrent branch= (A. interossea recurrens) which passes upward on the outer surface of the ulna and anastomoses with the deep brachial and ulnar arteries, and is continued as the =dorsal interosseous artery=. This vessel (A. interossea dorsalis) passes down between the anterior and lateral extensors of the digit and concurs with the anterior radial in forming a network on the anterior surface of the carpus, the =rete carpi dorsale=. From the latter arise two small vessels, the =internal= and =external dorsal metacarpal arteries= (A. metacarpea dorsalis medialis, lateralis), which run distally in the grooves between the large and small metacarpal bones and anastomose with the volar metacarpal arteries.

4. The =artery of the rete carpi volare= (A. retis carpi volaris) is a small vessel which arises at the distal third of the forearm and passes downward to the posterior surface of the carpus, where it concurs with branches of the volar metacarpal arteries in forming the rete carpi volare.

5. The =external volar metacarpal artery= (A. metacarpea volaris lateralis) is a small vessel which arises just above the carpus under cover of the flexor carpi medius and anastomoses with the ulnar artery, forming the supracarpal arch. From the latter a branch descends with the outer branch of the median nerve, inclines outward toward the posterior border of the accessory carpal bone, and arrives at the head of the external metacarpal bone. Here it is connected with the internal volar metacarpal artery, usually by two transverse branches, thus forming the =deep volar= or =subcarpal arch= (Arcus volaris profundus). One of these branches lies between the subcarpal check ligament and the suspensory ligament; the other (not always present) lies beneath the latter on the large metacarpal bone. A small branch descends to the fetlock with the external metacarpal nerve. Below the arch the artery pursues a flexuous course downward on the posterior face of the large metacarpal bone alongside of the external small metacarpal and under cover of the suspensory ligament. At the distal third of the metacarpus it commonly unites with the corresponding vessel of the inner side to form a short trunk which passes backward through the angle of divergence of the branches of the suspensory ligament and joins the external digital or the common digital artery.

6. The =internal volar= or =small metacarpal artery= (A. metacarpea volaris medialis) is given off from the posterior radial at an acute angle, usually a little above the external one or by a common trunk with it. It passes down the inner side of the carpus behind the tendon of the flexor carpi internus and embedded in the posterior annular ligament. Arriving at the proximal end of the inner metacarpal bone it becomes more deeply placed and is connected with the external volar artery by one or two transverse branches as stated above. It then pursues a flexuous course downward alongside of the inner small metacarpal bone, like the corresponding external artery, with which it commonly unites as described above. It is larger than the external artery and supplies the nutrient artery to the large metacarpal bone.

The foregoing account describes the most common arrangement of the dorsal and volar metacarpal arteries. Variations in their origin and connections are common, but have no great surgical importance. Collateral branches are omitted for the same reason. In some cases the internal volar metacarpal is connected with the common digital or large metacarpal artery a little below the carpus by a branch passing obliquely across the inner border of the deep flexor tendon; this forms a superficial volar arch.

THE COMMON DIGITAL ARTERY

The =common digital= or =large metacarpal artery=[164] is the direct continuation of the posterior radial. It descends in the carpal canal along the inner side of the flexor tendons in company with the inner branch of the median nerve and a satellite vein. Continuing down the limb it preserves this relation to the tendons to the distal third of the metacarpus, where it inclines toward the middle line of the limb behind the suspensory ligament, and divides into the internal and external digital arteries. In the metacarpus the artery is related to the vein in front and the artery behind, and is covered by the fascia and skin. It furnishes collateral branches to the suspensory ligament, the flexor tendons, and the skin.

THE DIGITAL ARTERIES

The =internal= and =external digital arteries= (A. digitalis medialis, lateralis) are formed by the bifurcation of the common digital at the distal third of the metacarpus. They diverge, pass down over the outer surface of the corresponding sesamoid at the fetlock, and descend parallel with the borders of the deep flexor tendon to the volar grooves and foramina of the third phalanx. Entering the latter the two arteries unite in the semilunar canal and form the =terminal arch= (Arcus terminalis), from which numerous branches pass through the bone to the wall surface and ramify in the matrix of the wall and sole of the hoof. A number of branches emerge through the foramina at the lower border, where they anastomose with each other in arciform fashion. These branches were named by Spooner the inferior communicating arteries, and the anastomotic arch formed by them is termed the circumflex artery of the third phalanx (Chauveau) or the artery of the lower border of the third phalanx (Leisering).

Each artery is accompanied by a vein and by the digital nerves. Above the fetlock the artery is most deeply placed and is covered by the vein; the nerve is behind the vein. At the fetlock the artery has become superficial and is related to the vein in front and the posterior branch of the nerve behind. The anterior branch of the nerve crosses over the artery obliquely to the lateral aspect of the first phalanx. The vessels and nerves are crossed obliquely by a small tendinous band, the ligament of the ergot, which begins in the fibrous basis of the ergot at the back of the fetlock and extends downward and forward to end in the fascia at the side of the pastern joint.

In addition to branches to the joints, tendons and synovial sheath, ergot, and skin, the digital arteries give off:

1. The =artery of the first phalanx= or perpendicular artery (A. phalangis primæ), a short trunk which arises at a right angle about the middle of the first phalanx, and divides into dorsal and volar branches (Rami dorsales et volares). The dorsal (anterior) branch passes between the first phalanx and the extensor tendon and ramifies on the front of the digit, anastomosing with its fellow. The volar (posterior) branch dips in between the flexor tendons and the inferior sesamoidean ligaments and anastomoses with the opposite artery.

2. The =artery of the plantar cushion= (A. toricæ phalangis tertiæ) arises at the proximal border of the lateral cartilage and passes backward and downward to ramify in the plantar cushion and the matrix of the heels and frog.

3. The =dorsal artery of the second phalanx= (Ramus dorsalis phalangis secundæ) arises a little above the navicular bone, and passes forward under cover of the lateral cartilage and the extensor tendon to the front of the second phalanx, where it anastomoses with the opposite vessel. It gives branches to the skin, the tendon, the coffin joint, and the coronary matrix of the hoof.

4. The =volar artery of the second phalanx= (Ramus volaris phalangis secundæ) is smaller than the preceding, opposite to which it arises. It passes above the proximal border of the third sesamoid and unites with the opposite artery.

The arteries of the second phalanx form what is termed by Chauveau the =coronary circle=. The dorsal (anterior) part of the circle gives off commonly an artery (A. coronalis phalangis tertiæ) near either side of the extensor tendon, which divides into two branches. The central branch unites with that of the opposite side, while the other joins a branch of the artery of the plantar cushion. In this way is formed the =circumflex artery of the coronary cushion=, an anastomotic arch which lies on the extensor tendon at the coronet. In some cases descending branches of the arteries of the first phalanx concur in the formation of the arch.

5. The =dorsal artery of the third phalanx= or preplantar artery (A. dorsalis phalangis tertiæ) arises at the deep face of the wing of the third phalanx, passes outward through the notch or foramen there, and runs forward in the groove on the wall surface. It gives off ascending and descending branches, which ramify in the matrix of the wall of the hoof, anastomosing above with the circumflex artery of the coronary cushion and below with the circumflex artery of the third phalanx. Before passing through the wing it detaches a retrograde branch to the plantar cushion, and after emerging one which ramifies on the outer aspect of the lateral cartilage.

The terminal part of the digital artery after giving off the preceding vessel is sometimes termed the plantar.

BRANCHES OF THE THORACIC AORTA

In addition to the coronary arteries and the common brachiocephalic trunk (which have been described), the thoracic part of the aorta gives off branches to the thoracic walls and viscera and to the spinal cord and its membranes. The =visceral branches= (Rami viscerales) are the bronchial and œsophageal, which arise by a broncho-œsophageal trunk. The =parietal branches= (Rami parietales) are the intercostal and phrenic arteries.

1. The =broncho-œsophageal= (Truncus broncho-œsophageus) is a short, usually bulbous, trunk which arises at the sixth thoracic vertebra from the aorta or in common with the first aortic intercostal arteries. It passes (under cover of the vena azygos) down the right face of the aorta toward the bifurcation of the trachea and divides into bronchial and œsophageal branches.

(_a_) The =bronchial artery= (A. bronchialis) crosses the left face of the œsophagus to the bifurcation of the trachea, where it divides into right and left branches. Each enters the hilus of the corresponding lung above the bronchus, which it accompanies in its ramification. It supplies the lung tissue and also detaches twigs to the bronchial lymph glands and the mediastinum.