0:17 [Music]
0:20 hello well that was nice wasn't it it's
0:21 now chucking it down with rain so I
0:23 thought I'd record another little
0:26 video um hoping the rain will stop
0:28 typical Welsh weather from Sun to rain
0:30 and you know
0:32 um everything else in between last week
0:34 we were talking about the arterial
0:35 supply to the Upper Limb so I thought
0:36 hey the obvious thing to talk about this
0:38 week would be the arterial supplies to
0:44 [Music]
0:47 right um so we're going to start off
0:49 with this guy like we did last time we
0:50 started with the aorta and followed the
0:52 arteries all the way out to the hand
0:55 we'll start with the aorta here and then
0:56 we'll uh we'll mostly work our way
0:57 through the lower limb right and we'll
0:59 see a lot of the same sort of themes
1:01 that we were talking about in the Upper
1:03 Limb being played out again in the lower
1:05 limb but we'll follow the archeries down
1:09 okay let's have a look at you then uh
1:10 I'll pick this model cuz hopefully it's
1:13 going to be fairly easy to take apart
1:15 I'm still take all this out okay so
1:17 we're taking out the GI
1:25 got a auto stops that's no good is it
1:28 right I get a different model then all
1:31 right let's try this [Applause]
1:33 [Applause]
1:38 one take out the G trct and T that's [Applause]
1:39 [Applause]
1:42 better so this is what we came for right
1:43 here's the
1:45 aorta all right so we're descending
1:48 within the abdomen really really deep
1:50 there's the aorta we're at the level
1:53 here there's the inferior meic artery
1:54 these are the gal arteries coming out of
1:58 it here and the aorta Ends by splitting
2:02 into the two common iliac arteries so we
2:03 have a left and right common iliac
2:06 artery if we were to follow the left
2:09 common iliac artery we see it dividing
2:12 again you see
2:16 that so we see an an internal iliac
2:17 artery which goes into the pelvis and is
2:19 going to supply blood to most of the
2:21 viscera of the pelvis and then we have
2:24 an external iliac artery running out
2:28 here we can see this is a um seos soos
2:30 major and Ilia soos that's forming so
2:33 it's lying on top of sois major so
2:35 that's the external iliac artery and
2:37 that's running down towards the lower
2:38 limb so that's what we're going to
2:41 follow remember there is no iliac artery
2:43 there are common iliac arteries and
2:46 external iliac arteries and internal ilc
2:48 arteries but there isn't an iliac artery
2:50 on its own always use the correct
2:53 terminology so all right moving on from
2:57 this one then okay so now we want to
2:59 look at the Upper Limb we can see
3:02 there's the common iliac artery there
3:04 and there's the internal iliac artery
3:07 going into the pelvis here and there's
3:11 the external iliac artery here okay so
3:13 now do you remember this so this here is
3:16 the ingin or ligament and when we
3:17 looking at the Upper Limb we saw how the
3:20 major artery as it as it passed into the
3:21 through the shoulder and through the
3:23 axilar and into the Upper Limb we
3:25 changed it name a number of times and
3:27 the same thing happens in the lower limb
3:30 so this external iliac artery when it
3:33 goes beneath the ingal ligament here we
3:35 change its name and it becomes the
3:38 femoral artery because it's moving into
3:40 the thigh so femoral of the thigh so
3:42 this now becomes the artery of the thigh
3:44 so it's the same blood vessel look but
3:45 it's just changing its name from
3:48 external iliac artery to femoral artery
3:50 and the femoral artery then is moving
3:52 into the anterior compartment of the thigh
3:57 um do you remember how we've got an
4:00 anterior compartment with quadriceps in
4:03 it and a medial compartment with the
4:05 adductors in it and we have a posterior
4:08 compartment with the hamstrings in it
4:09 right so go and have a look at the
4:12 muscles of the hip uh and the lower limb
4:14 um but these muscles are grouped
4:15 together and they're kept in separate
4:19 compartments by connective tissue so
4:20 this sometimes gets called the common
4:22 femoral artery but the femoral artery
4:24 moves into the anterior compartment
4:25 let's dissect away some of these muscles
4:27 see if we can see where it goes so this
4:30 is sorus cutting across here let's take sorus
4:38 off come um now we can see a lot more so
4:40 this artery then is is running deep to
4:43 sorus it's running in this subsartorial
4:45 canal and we can see that it's running
4:47 with a vein and a nerve that's the
4:50 femoral vein and the femoral nerve that
4:54 it's running with but can you see
4:57 how it's it's not just descending
4:59 through the anterior compartment but
5:01 it's running around here immediately
5:03 towards the adductor compartment towards
5:05 the medial compartment and it gives off
5:08 a deep Branch oh we can see that up here
5:10 so these are the Deep branches of the
5:14 femoral artery here uh profund femoris
5:16 so these are going into the the muscle
5:18 mass and they're going to supply blood
5:20 to the femur and to the the quadriceps
5:22 femoris muscle groups and all the other
5:24 muscles in here if we were to take away
5:26 there we go we can see some more
5:28 branches if we take off uh rectus
5:31 femoris here
5:34 but if we keep following our main
5:36 target um the feminal artery what it's
5:44 the squeaky it's trying to get into the
5:46 back of the knee into the poal fucer so
5:51 to do that um it needs to get
5:53 through the abductor muscles now what
5:56 can we see so we've got a whole bunch of
5:57 adductor muscles we've got a gillus and
6:00 adductor longus and adductor Magnus and
6:01 and all sorts and they're coming
6:03 together here and they're they're
6:06 meeting this is the there's the big toe
6:09 here this is the medial side of the knee
6:10 they're coming together to meet
6:12 semimembranosus and
6:14 semitendinosis the medial hamstring
6:17 muscles around here so we can't see too
6:19 much on this model it's getting messy
6:20 but what it's getting covered up by muscle
6:21 muscle
6:24 bulk but what we find if we look in that
6:25 adductor group is there's an adductor
6:28 Hiatus there's a gap in the muscular
6:31 attachment of the adductors to the femur
6:33 and the femoral artery goes through that
6:36 adductor Hiatus through that Gap as it
6:39 winds around and in doing so that's what
6:43 enables it to get to the poal region to
6:46 the poal fucer so when it passes through
6:49 the adductor Hiatus the femoral artery
6:51 changes its name and it becomes the popal
6:53 popal
6:55 artery so from the femoral artery up
6:58 here there are lateral and
7:02 medial circumflex femoral arteries and
7:05 those loop around the
7:08 femur um and there are also circumflex
7:11 arteries coming from the external iliac
7:13 artery up on the other side of the hip
7:15 and we see these blood vessels branches
7:16 of these blood vessels meeting and
7:18 anastomosing so we have these
7:21 anastomoses Across The Joint so this is
7:22 another example of collateral
7:24 circulation in the limb just as we see
7:27 in the Upper Limb we see collateral
7:29 circulation around each joint so around
7:32 the hip um what this means is that if
7:34 this artery was to get uded for whatever
7:36 reason there's an alternate rout of
7:39 which blood can flow around the joint to
7:41 continue to get into the limb so the
7:42 tissues of the limb won't become
7:45 ischemic common theme throughout the
7:47 limbs at all the joints as we see as we
7:51 go down so at the knee we also see we
7:53 can see some blood vessels here
7:55 superficially we also see a whole bunch
7:56 of branches so if we think about it
7:59 we've got this single popal artery
8:00 descending through the poal region
8:02 passing through the knee and it sends
8:05 off a whole bunch of branches to supply
8:06 the structures of the knee and also to
8:10 set up potential collateral circulations
8:13 uh there are anastomosis so these are so
8:17 the the Latin word for knee is genu um
8:21 which has come up before in my videos we
8:22 see knee shaped things they get called
8:25 geniculate right um or genu something or
8:28 other so these arteries
8:30 arteries
8:32 at the knee these branches of the popal
8:34 artery get called geniculate arteries we
8:37 have uh lateral Superior lateral
8:40 inferior medial Superior medial inferior
8:43 and medial genicular arteries and look
8:46 we can see these okay so let's uh take
8:55 hamstrings there we go now you can see
8:58 here look there's the femoral artery
9:00 passing through through that adductor
9:03 Hiatus that Gap in the adductor muscles
9:05 so we change its name now and we're
9:08 going to call it the popal artery poal
9:09 arter is descending through the poal
9:12 fosser and look we can see some branches
9:15 coming off here um and these are some of
9:17 the the genicular arteries like I say
9:19 they're a lot more than you can see on
9:21 this model so again we have Superior and
9:24 inferior medial and lateral so that's
9:26 four plus another medial or
9:31 middle geniculate artery so these occur
9:33 um proximal and distal to the knee joint
9:35 or you might say Superior and inferior
9:37 to the knee joint and they interconnect
9:39 with an asmosis so there's another
9:41 potential route for collateral
9:44 circulation to set up if the poar gets
9:46 occluded and if you think about it just
9:49 by keeping the knee flexed for a long
9:53 period of time um will you might need
9:55 that might be enough for blood to flow
9:57 through the collateral circulation to
9:59 get the distal in just cuz the pop AR is
10:01 going to get compressed somewhat easily
10:04 then maybe
10:07 maybe so the potin artery passes through
10:10 the poal fossa so we're descending down
10:12 and don't forget we call this the thigh
10:15 between the hip and the knee and then
10:18 distal to the knee we call that the leg
10:20 so we're descending into the leg or
10:21 we're descending into the calf you might
10:24 say and this is gastrus we take off
10:27 gastrus now what we should
10:29 see oh look we can see some more
10:31 genicular branches
10:33 here what we should see is the poal
10:38 artery ends because it splits so it it
10:41 it becomes the posterior tibular artery
10:43 but it also gives off an anterior
10:47 tibular artery so what we see here
10:50 running down the Cal remember this is
10:52 deep to gastrus and cus because I've
10:54 taken those guys off so the artery is
10:58 quite deep now um this is the posterior
11:01 tibial artery here so if this is the
11:03 posterior tibial
11:06 artery the anterior tibal artery needs
11:07 to get to the anterior compartment so
11:09 again in the calf we have a number of
11:10 compartments we have this posterior
11:13 compartment and an anterior compartment
11:16 and they're separated by the tibia and
11:19 the fibula and in between the tibia and
11:22 the fibula there's a membrane an interus
11:25 membrane just like we see in the forearm
11:28 interus so yeah it's a connective tissue
11:31 sheet in between the two bones so an
11:35 interus membrane so this means that the
11:38 anterior tibial artery has to pass
11:41 through the interus membrane to get to
11:43 the anterior compartment now we can't
11:45 see that happening there it'll be going
11:46 through there somewhere so if we turn
11:48 this around what can we see right if we
11:50 take away if we dissect away these
11:54 muscles a bit a there we
11:56 go yeah there it is so there's the
11:58 anterior tibial artery there so it's
12:01 pasted through and we can see there so
12:03 there's the fibula this is the this is lateral
12:05 lateral
12:08 right there's the little toe there's the
12:10 big toe there's the little toe so this
12:17 medial so this is the fibula around here
12:19 this is the tibia and you can see look
12:21 there's that interus membrane in between
12:26 the two so the anterior tibial artery
12:28 has passed through the osus membrane and
12:30 look it's running down on the interus membrane
12:31 membrane
12:34 anteriorly to supply blood to the
12:36 anterior compartment muscles and
12:42 leg there's another artery as well
12:44 there's a fibular artery so the
12:47 posterior tibal artery gives off a
12:50 fibular branch which runs down with the
12:52 fibula supplying blood to the Bone
12:54 itself and to other structures nearby
12:56 nearby um
12:57 um
13:00 so I'm not entirely sure what that would
13:03 be up here on this model but we can see
13:06 it just down here there's the fibular artery
13:13 there and around the so if this is the
13:15 head of the fibula around the neck of
13:17 the fibula we'd also expect to see
13:20 another circumflex fibular artery
13:22 surrounding it up there and that also
13:24 May well have connections with the other
13:26 branches around the the knee up here
13:28 there might be other
13:32 anastomoses okay so if we follow the
13:34 posterior tibial artery let me get rid
13:37 of this there's the big toe there right
13:39 so this is
13:43 medial so there's the posterior tibular
13:46 artery and look it's running medly and
13:48 it's going to run into the what's going
13:50 to fall off this I it's going to run
13:52 into the foot and I'll grab a foot model
13:55 to look at that in more detail but we've
13:57 got these two bony bits here right so if
13:59 I turn it around so
14:01 look there's the big toe there's the
14:03 little toe we got these two bony bits
14:04 and these two bony bits are things you
14:07 can palpate these are the the
14:10 malleoli um remember the the fibula is
14:12 lateral so this is the lateral malleolus
14:13 of the
14:16 fibula and this is the medial malleolus
14:17 of the
14:20 tibia and the posterior tibial artery is
14:22 going to run
14:24 around the medial malas to get into the
14:28 foot and the fibular artery is in there
14:32 uh um and that's running around the the
14:36 lateral malleolus right whereas if we look
14:37 look
14:41 anteriorly look there's the anterior
14:44 tibial artery and as it descends it's
14:46 going into the dorsum of the foot this
14:48 is the dorsal surface this is the
14:51 planter surface that you stand on so the
14:53 anterior tibial arter is actually going
14:55 to become the dorsales pedis
14:57 pedis
14:59 um which is kind of hidden here but it's
15:02 it's about there right let's let's swap
15:04 to the foot model at this
15:08 point right now oh that's nice
15:10 look there's
15:14 the posterior tibular artery there's the
15:16 big toe so this is medial this is the medial
15:17 medial
15:20 malleolus and look how the posterior tibial
15:21 tibial
15:25 artery is curling around to get into the
15:27 foot so it's the posterior tibial artery
15:29 then that's going to supply blood to the
15:31 planter foot and I'm gonna have to
15:33 disect quite a lot
15:36 here there's a lot of layers on this model
15:42 um okay that's not too bad so you can see
15:44 see
15:47 here there's the big toe right there's
15:49 the big to this is medial so the
15:52 posterior tibial artery ends as the
15:56 medial planter artery and the lateral
15:58 planter artery and these guys go into
16:02 the foot if I I'm going to take that
16:04 off I'm going to take that [Applause]
16:14 off all right so I'm just going to take
16:18 this layer away oh there's another layer
16:20 of muscle there I'm going to take oh got
16:23 to take that off got to take that off
16:25 what I'm getting down
16:28 to is another look another Arch another
16:31 AR arterial arcade here so essentially
16:33 the the Deep
16:37 um the the lateral and medial planter
16:39 arteries and the Deep planter artery
16:41 they're coming together to form um a
16:44 deep planter Arch um as we saw in the
16:47 hand we saw superficial and deep planter
16:49 superficial and deep Palmer arches in
16:50 the hand didn't we there's a planter
16:54 Arch here now I read that there is
16:58 sometimes superficial and deep planter
16:59 arches sometimes there's just a single
17:01 planter Arch and it just gets called the
17:02 planter Arch and sometimes gets called
17:04 The Deep planter
17:08 Arch um so watch out for that and then
17:10 this planter Arch is giving off a whole
17:14 bunch of uh metatarsal and digital
17:15 branches to supply the toes and the
17:17 metat tassels and stuff like that right
17:20 so that's how the posterior tibial artery
17:22 artery
17:24 ends flip it over
17:26 over
17:29 and oh I've got so many bits all right
17:33 so here is the the anterior tibal artery
17:35 here where the anterior tibal artery
17:38 passes between the two malleoli we
17:41 change its name to as I said dorsalis
17:43 pedis and this is where you can feel the
17:44 pulse we'll talk about pulses in a
17:47 moment but dorsales pedis passes down
17:49 here oh that's cool and it gives off
17:52 look this this artery here can you see
17:54 that that's disappearing down through a
17:57 hole so that's running
17:59 between the meta met tarsals the first
18:03 and second metatarsal and that that is
18:05 the Deep planter artery that I was on
18:07 about so that dives down through the
18:12 foot to join with this Arch so this Arch
18:14 is is actually supplied with blood by
18:16 the lateral and medial planter
18:20 arteries and dorsales pedis so it's a
18:21 receive it's receiving blood from both
18:24 the anterior and the posterior tibular
18:27 arteries cool huh so there are clear
18:29 anastomoses across the ankle and across
18:31 the foot as well
18:35 right the fibular artery Ends by giving
18:37 off we just about to see it in there if
18:38 I take this
18:46 there in there so that's the lateral
18:49 malleolus there It Ends by giving off
18:52 look there's a calcal branch back here
18:53 and malola
18:56 branches so the fibular artery which is
19:00 appearing here then
19:02 um so it's giving off this Branch to the
19:05 calcal bones this calcal branch is
19:08 giving off this lateral malola Branch
19:10 but look it's got to pass through the
19:12 interos the interus membrane to get out
19:15 here now something we can't see on
19:19 here is deep to these
19:21 muscles there's another arcade or kind
19:26 of dorsalis pedis once it gives off this
19:30 deep planter artery here it also well
19:32 you see it also gives off these other
19:35 branches to the toes but it continues
19:38 around like this right doesn't go all
19:39 the way around here just imagine a short
19:41 bit right like
19:46 that and that would be the rq8 artery so
19:48 we've got another Arch on this side as
19:52 well kind of and sometimes this also
19:55 anastomoses with branches from the
19:58 fibular artery and sometimes it just it
19:59 doesn't it just get off a whole bunch of
20:01 branches and ends so if we could see it
20:03 underneath those muscles we might find
20:06 the aru artery curving around like that
20:08 so it does get a lot more complicated
20:10 when you get down to the foot and the
20:12 ankle but the lower limb otherwise is
20:13 fairly straightforward when you get down
20:16 to the foot and the ankle if you know
20:17 the names of the bones of the foot and
20:22 the ankle then the arteries nearby are
20:25 much easier to name and recognize why
20:26 they follow the name of the bones
20:29 basically to learn the bones of the f
20:31 um now there are a number of places in
20:33 the lower limb where you would like to
20:36 be able to um palpate the pulse to
20:39 assess blood flow to the lower limb so
20:41 we need to have a look and see where
20:43 this the these arteries are superficial
20:45 so you can palpate them so let me put
20:47 this back [Applause]
20:55 together all right let's put back on
20:57 what can we palpate
21:01 well superior to the ingon or ligament
21:03 we're covered in um abdominal
21:05 musculature here aren't we so it might
21:07 be difficult to palpate that but here
21:10 this looks pretty superficial so here
21:13 just inferior to the ingon or ligament
21:14 you should be able to palpate your
21:16 femoral pulse you might want to try that
21:18 now unless you're in public somewhere in
21:21 which case keep R out your trasers um
21:24 but that's the femoral pulse there and
21:27 then of course it's deep to muscle until
21:31 we turn around to the poil fosser but
21:33 this is again superficial so you should
21:36 be able to find a pole pulse in there
21:38 you might want to try to find that if
21:41 you've got shorts on um or a skirt
21:43 there's the poal pulse and then the
21:45 muscles are deeper the arteries are deep
21:48 to muscles again aren't they um until we
21:51 get down towards the ankle and then down
21:56 here so we find there's the big toe so
21:59 find the medial malleolus and then
22:01 here you should be able to palpate the
22:04 pulse of the posterior tibular artery
22:06 try that and
22:10 then on the dorsum of the foot this
22:12 muscle is pretty thin here you should be
22:15 able to find around here somewhere the
22:18 pulse of the dorsalis pedis artery so
22:20 you can then work your way through the
22:23 lower limb and assess um the blood
22:25 supply to the lower limb by palpating
22:29 the pulse all right okay there you go go
22:32 the arterial supply to the lower limb
22:35 again um we're following a single artery
22:37 largely that's changing its name as we
22:39 go through the limb we find lots of
22:43 branches at the joints um and then
22:45 asmosis so the potential for a
22:46 collateral circulation around the hip
22:49 joint the knee joint and the ankle joint
22:51 just as we see in the Upper Limb and
22:53 then as we get into the foot we also see
22:56 those arteries often linking up um and
22:57 the blood supply when we get into the
22:59 foot gets pretty complicated the
23:02 important parts are the um medial and
23:04 lateral planter arteries and dorsalis
23:06 pedis and then some of the other
23:08 branches that are linking things up all
23:12 right well done
