Angiology

1. Angiology • Angiology: The study of the anatomy, physiology and related diseases of blood vessels.

2. Anatomy of an Artery • Tunica Adventitia/Externa: Anchors artery along its proper course (connective tissue). • Tunica Musculosa/Media: Smooth Muscle controls blood pressure. • Tunica Intima/Interna: Essentially composed of a single layer of endothelial cells.

3. Anatomy of an Artery

4. ANATOMY OF AN ARTERY

5. Capillary Beds Figure 19.4a

6. Capillary Beds Figure 19.4b

7. Typical Artery and Vein

8. Atherosclerosis and Arteriosclerosis • Atherosclerosis - the process through which cholesterol plaques form on the arterial walls. • Arteriosclerosis - The process through which cholesterol plaques become infiltrated with calcium resulting in hardening of the arteries.

9. Pathophysiology • 1. Vascular irritants irritate the tunica interna of the blood vessel. • Vascular Irritants: • a. Smoking • b. Alcohol • c. Fried foods • d. Chemical produced during stress • e. Caffeine • f. Physical trauma • g. Normal wear and tear (aging) (anti-oxidant vitamins improve circulation) • h. Environmental toxins • I. Homocysteine: intermediate chemical substance in the metabolism of the amino acid cysteine that is a strong vascular irritant. Folic acid, vitamin B12 and vitamin B6 will prevent the build up of homocysteine in the blood. • Homocysteine • Folic B12 B6 • Acid • CysteineMethionine

10. Normal Artery VS Atherosclerotic Artery

11. Protrusion of Tunica Musculosa Cells Into the Arterial Lumen • 2. Tunica intima cells die and cells from the tunica musculosa protrude through into the lumen (hole)

12. Pathophysiological Progression of Atherosclerosis

13. Macrophages • 3. Macrophages (a type of white blood cell) infiltrate the smooth muscle cells with oxidized LDL cholesterol. As the smooth muscle cells become infiltrated with cholesterol, they die and form a cholesterol plaque resulting in atherosclerosis.

14. Infiltration of LDL Cholesterol Into the Arterial Wall

15. Foam Cell

16. Arteriosclerosis • 4. A calcification of the cholesterol plaque leads to hardening of the arteries resulting in arteriosclerosis

17. Collateral Circulation • Alternate routes of blood flow developed primarily within the arterial system which help to compensate for atherosclerosis and arteriosclerosis in the body. Collateral circulation develops with time and exercise.

18. Hypercholesterolemia • Hypercholesterolemia is a term describing high serum concentrations of cholesterol. The serum concentrations of cholesterol which have been used to diagnose hypercholesterolemia have been reduced since 1980. In 1980 a serum cholesterol concentration of 220 mg of blood would have been diagnostic of hypercholesterolemia. In 1984 the level was reduced to 200mg, and in 1986 it was again reduced to 180mg.

19. Types of Cholesterol • Exogenous Cholesterol: dietary cholesterol • Endogenous Cholesterol: the amount of cholesterol produced daily by the liver

20. Variables Affecting Serum Cholesterol • 1. Genetics • 2. Diet (+/- cholesterol level 15%) • a. Saturated fat increases serum cholesterol levels • b. Unsaturated fat decreases serum cholesterol levels • c. Fiber decreases cholesterol levels • 3. Sex • a. Males -------> testosterone increases cholesterol • b. Females -----> estrogen decreases cholesterol • 4. Thyroid Function - • a. Hyperactive thyroid - decreases serum cholesterol levels • b. Hypoactive thyroid - increases serum cholesterol levels • 5. Diabetes increases cholesterol • 6. Liver Function - • a. the liver produces endogenous cholesterol • b. the liver produces the lipoproteins

21. High Density Lipoproteins • High Density Lipoproteins/ HDL’s (Good) • cholesterol • Tissues --------------> Liver

22. Low Density Lipoproteins • Low Density Lipoproteins/ LDL’s (Bad) • cholesterol • Liver -----------------> Tissues

23. Lipoprotein Profile • The lipoprotein profile provides a health care practitioner with the ratio of LDL cholesterol (Bad) to HDL cholesterol (Good) and translates this ratio into a percentage risk factor for developing cardiovascular disease for the patient. Most progressive nutritionists believe that a LDL to HDL ratio of 4 : 1 is optimal.

24. Major Arteries

25. Major Arteries

26. Aortic Arch • The aortic arch has three major branches: • Right Brachiocephalic Artery • Left Common Carotid • Left Subclavian

27. Aorta Arch and It’s Major Branches

28. Aorta and Its Superior Branches • Aorta is largest artery of the body • ascending aorta • 2 coronary arteries supply myocardium • arch of aorta -- branches to the arms & head • brachiocephalic trunk branches into right common carotid and right subclavian • left subclavian & left carotid arise independently • thoracic aorta supplies branches to pericardium, esophagus, bronchi, diaphragm, intercostal & chest muscles, mammary gland, skin, vertebrae and spinal cord

29. Coronary Circulation • Right & left coronary arteries branch to supply heart muscle • anterior & posterior interventricular aa.

30. Artery Rt/Left Anterior/Posterior Intercostal Arteries Rt/Left Phrenic Arteries Supplies Supplies blood to the anterior and posterior aspects of the ribs, intercostal muscles and associated tissues Supplies blood to the superior surface of the diaphragm Thoracic Aorta

31. Artery Rt/Left Inferior Phrenic Artery Supplies Supplies blood to the inferior surface of the diaphragm Abdominal Aorta

32. Abdominal Aorta and Its Branches • Supplies abdominal & pelvic viscera & lower extremities • celiac aa. supplies liver, stomach, spleen & pancreas • superior & inferior mesenteric aa. supply intestines • renal aa supply kidneys • gonadal aa. supply ovariesand testes • Splits into common iliacaa at 4th lumbar vertebrae • external iliac aa supplylower extremity • internal iliac aa supplypelvic viscera

33. Visceral Branches off Abdominal Aorta • Celiac artery is first branch inferior to diaphragm • left gastric artery, splenic artery, common hepatic artery • Superior mesenteric artery lies in mesentery • pancreaticoduodenal, jejunal, ileocolic, ascending & middle colic aa. • Inferior mesenteric artery • descending colon, sigmoid colon & rectal aa

34. Celiac Trunk: Artery Common Hepatic Artery Left Gastric Artery Splenic Artery Supplies Supplies blood to the liver Supplies blood to the stomach Supplies blood to the spleen Celiac Trunk

35. Celiac Trunk

36. Arteries Superior Mesenteric Artery Rt/left Suprarenal Arteries Rt/left Renal Arteries Inferior Mesenteric Artery Rt/left Gonadal Arteries Supplies Supplies blood to the small intestine Supplies blood to the rt/left suprarenal (adrenal) glands Supplies blood to the rt/left kidneys Supplies blood to the large intestine Supplies blood to gonads (ovaries/testes) Visceral Branches of the Abdominal Aorta

37. Arteries of the Abdomen Liver (cut) Diaphragm Esophagus Inferior vena cava Left gastric artery Celiac trunk Hepatic artery proper Left gastroepiploic artery Common hepatic artery Splenic artery Spleen Right gastric artery Stomach Gallbladder Pancreas (major portion lies posterior to stomach) Gastroduodenal artery Right gastroepiploic artery Superior mesenteric artery Duodenum Abdominal aorta (b) Figure 19.23b

38. Arteries of the Abdomen Opening for inferior vena cava Diaphragm Inferior phrenic artery Hiatus (opening) for esophagus Middle suprarenal artery Celiac trunk Renal artery Kidney Superior mesenteric artery Lumbar arteries Gonadal (testicular or ovarian) artery Abdominal aorta Inferior mesenteric artery Median sacral artery Common iliac artery Ureter (c) Figure 19.23c

39. Arteries of the Abdomen Transverse colon Celiac trunk Superior mesenteric artery Middle colic artery Intestinal arteries Left colic artery Right colic artery Inferior mesenteric artery Ileocolic artery Aorta Sigmoidal arteries Ascending colon Descending colon Ileum Left common iliac artery Superior rectal artery Sigmoid colon Cecum Rectum Appendix (d) Figure 19.23d

40. Arteries of the Abdominal Cavity

41. Arteries of the Abdominal Cavity

42. Arteries of the Right Upper Extremity

43. Peripheral Arteries: Upper Extremities Artery Right Brachiocephalic Artery Rt/Left Subclavian Arteries Rt/left Axillary Arteries Rt/left Brachial Arteries Rt/left Radial Arteries Rt/left Ulnar Arteries Rt/left Deep Palmar Arch Rt/left Digital Arteries Supplies Supplies blood to the right subclavian artery Supplies blood to the clavicles and surrounding soft tissue Supplies blood to the axillary regions Supplies blood to the rt/left humerus, biceps muscles, and surrounding soft tissue Supplies blood to the lateral aspects of the rt/left forearms Supplies blood to the medical aspects of the rt/left forearms Supplies blood to the digital arteries Supplies blood to the digits (fingers) of the rt/left hands

44. Arteries of the Lower Extremities

46. Artery Rt/left Common Iliac Arteries Rt/left Internal Iliac Arteries Rt/left External Iliac Arteries Rt/left Femoral Arteries Rt/left Popliteal Arteries Supplies Supplies blood to the rt/left internal and external iliac arteries Supplies blood to the pelvic muscles and organs Supplies blood to the external structures of the pelvis (hip, etc.) and femoral arteries Supplies blood to the femur, thigh muscles and skin over the thigh Supplies blood to the rt/left knees and surrounding soft tissues Peripheral ArteriesLower Extremities

47. Artery Rt/left Posterior Tibial Arteries Rt/left Anterior Tibial Arteries Rt/left Peroneal Arteries Rt/left Deep Plantar Archers Rt/left Digital Arteries Supplies Supplies blood to the rt/left calf muscles (soleus/gastrocnemius) Supplies blood to the rt/left tibialis anterior muscles and the soft tissue of the anterior aspects of the legs Supplies blood to the rt/left peroneal muscle groups and the soft tissue of the lateral aspects of the legs Supplies blood to the digital arteries of the rt/left feet Supplies blood to the digits (toes) of the rt/left feet Arteries of the Lower Leg

48. Blood Supply to the BrainThe Circle of Willis • The brain is supplied with blood by a vascular network referred to as the Circle ofWillis. The right and left vertebral arteries originate at the right and left subclavian arteries respectively, and travel cephalad towards the brain through the transverse foramen of the cervical vertebrae. At the base of the brain, the right and left vertebral arteries converge to form the basilar artery. The basilar artery divides at the base of the brain to form a right and left posterior communicating artery. These arteries form the posterior loop of the Circle of Willis. • The right carotid artery arises from the right brachiocephalic artery and travels cephalad towards the brain along the right side of the neck. The left common carotid artery arises from the aortic arch and travels cephalad towards the brain along the left side of the neck.The right and left common carotid arteries will each divide into an external and internal carotid artery. The right and left external carotids will supply the structures of the head and face, while the right and left internal carotid arteries will supply the brain. When the right and left internal carotid arteries reach the base of the brain, they give rise to a respective right and left anterior communicating artery.The right and left anterior communicating arteries form the anterior loop of the Circle of Willis. When the anterior and posterior loops join, they form a complete circle at the base of the brain known as the Circle of Willis. The Circle of Willis provides all parts of the brain with a constant, and uniform blood supply

49. Blood Supply to the Brain: Carotid and Vertebral Arteries

50. Angiogram of Carotid and Vertebral Arteries