Arteries of the Upper Limbs

Subclavian artery (green)

Axillary artery (blue)

Brachial artery (pink)

Radial artery (yellow)

Ulnar artery (red)

Fig. 12.1

Principal vessels of the upper extremity

Table 12.2

Collateral vessels of the subclavian artery

Vertebral artery
Internal thoracic artery (Internal mammary artery)
Thyrocervical trunk		Inferior thyroid artery
		Suprascapular artery
		Transverse cervical artery
		Ascending cervical artery
		Superior cervical artery
Costocervical trunk		Deep cervical artery
		Superior intercostal artery

Table 12.3

Collateral branches of the axillary artery

Superior thoracic artery
Thoraco-acromial artery	Acromial branch Clavicular branch Deltoid branch Pectoral branch
Lateral thoracic artery
Subscapular artery	Thoracodorsal artery Circumflex scapular artery
Anterior humeral circumflex artery
Posterior humeral circumflex artery

Table 12.4

Collateral branches of the brachial artery

Deep artery of the arm	Medial collateral artery Radial collateral artery
Superior ulnar collateral artery
Inferior ulnar collateral artery

Table 12.5

Collateral branches of the radial artery

Radial recurrent artery
Palmar carpal branch
Superficial palmar branch
Dorsal carpal branch	Dorsal metacarpal arteries Dorsal digital arteries
Princeps pollicis artery
Radial indicis artery
Deep palmar arch	Palmar metacarpal arteries Perforating branch

Table 12.6

Collateral branches of the ulnar artery

Ulnar recurrent artery
Common interosseous artery	Posterior interosseous artery
	Recurrent interosseous artery
	Anterior interosseous artery
Superficial palmar branch
Volar carpal
Dorsal carpal
Deep volar
Superficial volar arch	Common palmar digital arteries
	Proper palmar digital arteries

Fig. 12.2

Anterior humeral circumflex artery (arrowhead) and posterior humeral circumflex artery (arrow)

Fig. 12.3

Radial artery (arrow) and radial artery bifurcation

Fig. 12.4

Ulnar and radial arteries

Fig. 12.5

Dorsal metacarpal arteries (a) and palmar (b)

The most frequent anatomic variants of the arteries of the upper extremity are shown in Figs. 12.6–12.8

Fig. 12.6

a Early origin of the ulnar artery proximal from the proximal third of the humeral artery (arrow); b regular origin at the level of antecubital fossa

Fig. 12.7

Agenesis of the intermediate and distal phalanges of the 3rd finger. Right hand: palmar (a) and dorsal (b) surface. The ulnar and radial arteries provide branches for the 1 st finger and for the 4th and 5th fingers. The radial artery provides branches to the 3rd finger and the ulnar artery to the 1st, 2nd, 4 th and 5th fingers

Fig. 12.8

Polydactyly with fusion of some fingers. Left hand: a dorsal surface, b palmar surface, c medial surface. The ulnar and radial arteries provide terminal branches for all the fingers, except for the 5th finger, which is vascularized by the ulnar artery

12.2 12.2 CTA Technique

The basic technical parameters and the strategies of administration of the contrast agent are reported in Tables 12.7 and 12.8. All data refer to a person with a body weight of approximately 70 kg (154 pounds). Refer to www.MDCT.net for additional information.

Patient Preparation

The patient is positioned in a prone or supine position and the head enters the scanner first with the affected extremity extended above the head, in the center of the gantry with the palm ventral and the fingers spread apart. The contralateral arm is placed at the patient’s side. Pillows or other supports are utilized as needed so that the patient can maintain this position and the extension of the upper extremity.
For the examination of the thoracic outlet syndrome (TOC), the supine patient has to be in a neutral position with the upper extremities placed along the body. The affected extremity is extended upwards with the head rotated contralaterally.
The peripheral venous access (with an 18–20 G needle) is placed in the extremity contralateral to the affected limb, in order to avoid artifacts during the passage of the contrast agent.
Remove any metallic material present in the neck, chest and upper extremities.

Table 12.7

Scan parameters

	4 MDCT	16 MDCT	64 MDCT	128 MDCT	Dual-energy
					scanners
kVp	120	120	120	120	120
mAs	200-300	200-300	180-200	180	120-180
Collimation (mm)	4 x 2.5	16 x 0.75	64 x 0.625	128 x 0.6	64 x 0.6 x 2
Slice reconstruction (mm)	1-3	0.625-1	0.5-1	0.6	0.6
Slice reconstruction (mm)	0.4 x 0.6	0.5-1	0.5	0.4	0.4