Veins: superior vena cava, inferior vena cava, pulmonary, internal jugular, subclavian, axillary, brachiocephalic, cephalic, common iliac, external iliac, internal iliac, femoral, great saphenous, renal, superior mesenteric, inferior mesenteric, hepatic portal, gonadal
Describe the pathway of blood as it travels through the circulatory system using the vessels listed above, and state whether blood is oxygenated or deoxygenated at any point in the pathway.
Blood Vessels
Our large, complex bodies need blood to deliver nutrients to and remove wastes from our trillions of cells. The heart, as discussed in the previous chapter, pumps blood throughout the body in a network of blood vessels. Together, these three components—blood, heart, and vessels—makes up the cardiovascular system.
Virtually every cell, tissue, organ, and system in the body is impacted by the circulatory system. This includes the generalized and more specialized functions of transport of materials, capillary exchange, maintaining health by transporting white blood cells and various immunoglobulins (antibodies), hemostasis, regulation of body temperature, and helping to maintain acid-base balance. Table 11.1 summarizes the important relationships between the circulatory system and the other body systems.
Table 11.1 Interaction of the Circulatory System with Other Body Systems. A table depicting the various body systems and the role of the circulatory system in each.
SYSTEM
ROLE OF CIRCULATORY SYSTEM
Digestive
Absorbs nutrients and water; delivers nutrients (except most lipids) to liver for processing by hepatic portal vein; provides nutrients essential for hematopoiesis and building hemoglobin.
Endocrine
Delivers hormones: atrial natriuretic hormone (peptide) secreted by the heart atrial cells to help regulate blood volumes and pressures; epinephrine, ANH, angiotensin II, ADH, and thyroixine to help regulate blood pressure; estrogen to promote vascular health in women and men.
Integumentary
Carries clotting factors, platelets, and white blood cells for hemostasis, fighting infection, and repairing damage; regulates temperature by controlling blood flow to the surface, where heat can be dissipated; provides some coloration of integument; acts as a blood reservoir.
Lymphatic
Transports various white blood cells, including those produced by lymphatic tissue, and immunoglobulins (antibodies) throughout the body to maintain health; carries excess tissue fluid not able to be reabsorbed by the vascular capillaries back to the lymphatic system for processing.
Muscular
Provides nutrients and oxygen for contraction; removes lactic acid and distributes heat generated by contraction; muscular pumps aid in venous return; exercise contributes to cardiovascular health and helps to prevent atherosclerosis.
Nervous
Produces cerebrospinal fluid (CSF) within choroid plexuses;contributes to blood-brain barrier; cardiac and vasomotor centers regulate cardiac output and blood flow through vessels via the autonomic system.
Reproductive
Aids in erection of genitalia in both sexes during sexual arousal; transports gonadotropic hormones that regulate reproductive functions.
Respiratory
Provides blood for critical exchange of gases to carry oxygen needed for metabolic reactions and carbon dioxide generated as byproducts of these processes.
Skeletal
Provides calcium,phosphate, and other minerals critical for bone matrix; transports hormones regulating buildup and absorption of matrix including growth hormone (somatotropin), thyroid hormone, calcitronins, and parathryoid hormones; erythropoietin stimulates myeloid cell hematopoiesis; some level of protection for select vessels by bony structures.
Urinary
Delivers 20% of resting circulation to kidneys for filtering, reabsorption of useful products, and secretion of excesses; regulates blood volume and pressure by regulating fluid loss in the form of urine and by releasing the enzyme renin that is essential in the renin-angiotensin-aldosterone mechanism.
Types of Blood Vessels
Blood is carried through the body via blood vessels. An artery is a blood vessel that carries blood away from the heart, eventually reaching a capillary bed, where nutrients and wastes are exchanged. The blood then is returned to the heart in veins, vessels that bring blood towards the heart. Depending on the diameter of the vessel, they can be further classified:
Arteries transport blood away from the heart and branch into smaller vessels, forming arterioles.
Arterioles are smaller in diameter and distribute blood to capillary beds, the sites of exchange with the body tissues.
A capillary is a microscopic channel that supplies blood to the tissues themselves, a process called perfusion.
Exchange of gases and other substances occurs in the capillaries between the blood and the surrounding cells and their tissue fluid (interstitial fluid).
For capillaries to function, their walls must be leaky, allowing substances to pass through.
Capillaries lead back to small vessels known as venules.
Venules are small veins that converge into larger veins.
A vein is a blood vessel that conducts blood toward the heart
Compared to arteries, veins are thin-walled vessels with large and irregular lumens
Larger veins are commonly equipped with valves that promote the unidirectional flow of blood toward the heart and prevent backflow toward the capillaries caused by the inherent low blood pressure in veins as well as the pull of gravity (Figure 11.1)
Other ways in which the body assists the transport of venous blood back to the heart involve contractions of skeletal muscles in the extremities (Figure 11.1), as well as pressure variations caused by breathing motion in the chest.
Shared Structures of blood vessels
Different types of blood vessels vary slightly in their structures, but they share the same general features. Arteries and arterioles have thicker walls than veins and venules because they are closer to the heart and receive blood that is surging at a far greater pressure (Figure 11.2). Each type of vessel has a lumen—a hollow passageway through which blood flows. Arteries have smaller lumens than veins, a characteristic that helps to maintain the pressure of blood moving through the system. Together, their thicker walls and smaller diameters give arterial lumens a more rounded appearance in cross section than the lumens of veins. in comparison to arteries, venules and veins withstand a much lower pressure from the blood that flows through them. Their walls are considerably thinner and their lumens are correspondingly larger in diameter, allowing more blood to flow with less vessel resistance. In addition, many veins of the body, particularly those of the limbs, contain valves that assist the unidirectional flow of blood toward the heart. This is critical because blood flow becomes sluggish in the extremities, as a result of the lower pressure and the effects of gravity.
Both arteries and veins have the same three distinct tissue layers, called tunics, for the garments first worn by ancient Romans. From the most interior layer to the outer, these tunics are the tunica intima, the tunica media, and the tunica externa (Figure 11.2).
The tunica intima (also called the tunica interna) is composed of epithelial and connective tissue layers. Lining the tunica intima is the specialized simple squamous epithelium called the endothelium, which is continuous throughout the entire vascular system, including the lining of the chambers of the heart.
The tunica media is the substantial middle layer of the vessel wall. It is generally the thickest layer in arteries, and it is much thicker in arteries than it is in veins. The tunica media consists of layers of smooth muscle supported by connective tissue. Contraction of the smooth muscle allows arteries to vasoconstrict, which decreases blood flow and increases blood pressure. Similarly, vasodilation increases blood flow as the smooth muscle relaxes, allowing the lumen to widen and blood pressure to drop.
The outer tunic, the tunica externa (also called the tunica adventitia), is a substantial sheath of connective tissue composed primarily of collagenous fibers with some bands of elastic fibers. This is normally the thickest tunic in veins and may be thicker than the tunica media in some larger arteries.
Circulatory Pathways
Arteries and veins transport blood in two distinct circuits: the systemic circuit and the pulmonary circuit (Figure 11.3). Systemic arteries provide blood rich in oxygen to the body’s tissues. The blood returned to the heart through systemic veins has less oxygen, since much of the oxygen carried by the arteries has been delivered to the cells. In contrast, in the pulmonary circuit, arteries carry blood low in oxygen exclusively to the lungs for gas exchange. Pulmonary veins then return freshly oxygenated blood from the lungs to the heart to be pumped back out into systemic circulation.
As you learn about the vessels of the systemic and pulmonary circuits, notice that many arteries and veins share the same names, parallel one another throughout the body, and are very similar on the right and left sides of the body. For example, you will find a pair of femoral arteries and a pair of femoral veins, with one vessel on each side of the body. In contrast, some vessels closer to the midline of the body, such as the aorta, are unique. Moreover, some superficial veins, such as the great saphenous vein in the femoral region, have no arterial counterpart. Another phenomenon that can make the study of vessels challenging is that names of vessels can change with location. Like a street that changes name as it passes through an intersection, an artery or vein can change names as it passes an anatomical landmark. For example, the left subclavian artery becomes the axillary artery as it passes through the body wall and into the axillary region, and then becomes the brachial artery as it flows from the axillary region into the upper arm (or brachium).
As you read about circular pathways, notice that there is an occasional, very large artery referred to as a trunk, a term indicating that the vessel gives rise to several smaller arteries. For example, the celiac trunk gives rise to the left gastric, common hepatic, and splenic arteries.
As you study circulatory pathways, imagine you are on a “Voyage of Discovery” similar to Lewis and Clark’s expedition in 1804–1806, which followed rivers and streams through unfamiliar territory, seeking a water route from the Atlantic to the Pacific Ocean. You might envision being inside a miniature boat, exploring the various branches of the circulatory system. This simple approach has proven effective for many students in mastering these major circulatory patterns. Another approach that works well for many students is to create simple line drawings similar to the ones provided, labeling each of the major vessels. It is beyond the scope of this course to name every vessel in the body. However, we will attempt to discuss the major pathways for blood and acquaint you with the major named arteries and veins in the body.
Pulmonary Circulation
Blood returning from the systemic circuit enters the right atrium (Figure 11.4) via the superior and inferior venae cavae and the coronary sinus, which drains the blood supply of the heart muscle. This blood is relatively low in oxygen and relatively high in carbon dioxide, since much of the oxygen has been extracted for use by the tissues and the waste gas carbon dioxide was picked up to be transported to the lungs for elimination. From the right atrium, blood moves into the right ventricle, which pumps it to the lungs for gas exchange. This system of vessels is referred to as the pulmonary circuit.
The single vessel exiting the right ventricle is the pulmonary trunk. At the base of the pulmonary trunk is the pulmonary semilunar valve, which prevents backflow of blood into the right ventricle during ventricular diastole. The pulmonary trunk divides into two branches, the left pulmonary artery going to the left lung and the rightpulmonary artery going to the right lung. The pulmonary arteries divide into smaller branches within the lungs, eventually leading to the pulmonary capillaries, which surround lung structures known as alveoli that are the sites of oxygen and carbon dioxide exchange. Oxygenated blood flows from the pulmonary capillaries into a series of pulmonary venules that eventually lead to two leftpulmonary veins and two right pulmonary veins, which return blood to the left atrium.
Overview of Systemic Arteries
Blood relatively high in oxygen concentration is returned from the pulmonary circuit to the left atrium via the four pulmonary veins. From the left atrium, blood moves into the left ventricle, which pumps blood into the aorta. The aorta and its branches—the systemic arteries—send blood to virtually every organ of the body (Figure 11.5).
The Aorta and its superior branches
The aorta is the largest artery in the body (Figure #). It arises from the left ventricle; at the base of the aorta is the aortic semilunar valve that prevents backflow of blood into the left ventricle while the heart is relaxing. The aorta consists of the ascending aorta, the aortic arch, and the descending aorta (thoracic aorta), which passes through the diaphragm and becomes the abdominal aorta. The abdominal aorta terminates when it bifurcates into the two common iliac arteries at the level of the fourth lumbar vertebra. Arteries originating from the aorta ultimately distribute blood to virtually all tissues of the body.
The first vessels that branch from the ascending aorta are the paired coronary arteries (Figure 11.6). The coronary arteries encircle the heart, forming a ring-like structure that divides into the next level of branches that supplies blood to the heart tissues. This was discussed in greater detail in the previous chapter on the heart.
There are three major branches of the aortic arch: the brachiocephalic artery (trunk), the left common carotid artery, and the left subclavian (literally “under the clavicle”) artery. The brachiocephalic artery is located only on the right side of the body; there is no corresponding artery on the left. The brachiocephalic artery branches into the right subclavian artery and the right common carotid artery. The left subclavian and left common carotid arteries arise independently from the aortic arch but otherwise follow a similar pattern and distribution to the corresponding arteries on the right side.The common carotid arteries divide into internal and external carotid arteries. The internal carotid arteries along with the vertebral arteries are the two primary suppliers of blood to the human brain. The internal carotid artery continues through the carotid canal of the temporal bone and enters the base of the brain through the carotid foramen where it gives rise to several branches (Figures 11.7-11.8). The external carotid artery supplies blood to numerous structures within the face, lower jaw, neck, esophagus, and larynx. Each subclavian artery supplies blood to the arms, chest, shoulders, back, and central nervous system.
Arteries serving the upper limbs
As the subclavian artery exits the thorax into the axillary region (armpit), it is renamed the axillary artery. It then continues into the upper arm, or brachium, and becomes the brachial artery (Figure 11.9). The brachial artery supplies blood to much of the brachial region and divides at the elbow into several smaller branches, including the radial and ulnar arteries, which continue into the forearm, or antebrachium. The radial artery and ulnar artery parallel their namesake bones, giving off smaller branches until they reach the wrist, or carpal region. At this level, they fuse to form the superficial and deep palmar arches that supply blood to the hand, as well as the digital arteries that supply blood to the digits.
Arteries of the abdomen
After crossing through the diaphragm at the aortic hiatus, the thoracic aorta is called the abdominal aorta (see Figure 11.10), which gives rise to several important branches. A single celiac trunk (artery) emerges and divides into the left gastric artery to supply blood to the stomach and esophagus, the splenic artery to supply blood to the spleen, and the common hepatic artery, which in turn gives rise to the hepatic artery proper to supply blood to the liver, the right gastric artery to supply blood to the stomach, the cystic artery to supply blood to the gall bladder, and several branches, one to supply blood to the duodenum and another to supply blood to the pancreas. Two additional single vessels arise from the abdominal aorta. These are the superior and inferior mesenteric arteries. The superior mesenteric artery arises approximately 2.5 cm after the celiac trunk and branches into several major vessels that supply blood to the small intestine (duodenum, jejunum, and ileum), the pancreas, and a majority of the large intestine. The inferior mesenteric artery supplies blood to the distal segment of the large intestine, including the rectum. It arises approximately 5 cm superior to the common iliac arteries.
In addition to these single branches, the abdominal aorta gives rise to several significant paired arteries along the way. These include the inferior phrenic arteries, the adrenal arteries, the renal arteries, the gonadal arteries, and the lumbar arteries. Each inferior phrenic artery is supplies blood to the inferior surface of the diaphragm. The adrenal artery supplies blood to the adrenal (suprarenal) glands and arises near the superior mesenteric artery. Each renal artery branches approximately 2.5 cm inferior to the superior mesenteric arteries and supplies a kidney. The right renal artery is longer than the left since the aorta lies to the left of the vertebral column and the vessel must travel a greater distance to reach its target. Each gonadal artery supplies blood to the gonads, or reproductive organs, and is also described as either an ovarian artery or a testicular artery (internal spermatic), depending upon the sex of the individual. An ovarian artery supplies blood to an ovary, uterine (Fallopian) tube, and the uterus, and is located within the suspensory ligament of the uterus. It is considerably shorter than a testicular artery, which ultimately travels outside the body cavity to the testes, forming one component of the spermatic cord.The aorta divides at approximately the level of vertebra L4 into a left and a right common iliac artery. The common iliac arteries provide blood to the pelvic region and ultimately to the lower limbs. They split into external and internal iliac arteries approximately at the level of the lumbar-sacral articulation. Each internal iliac artery sends branches to organs within the pelvic cavity. The much larger external iliac artery supplies blood to each of the lower limbs.
Arteries serving the lower limbs
The external iliac artery exits the body cavity and enters the femoral region of the lower leg (Figure 11.11). As it passes through the body wall, it is renamed the femoral artery. It has several smaller branches to supply thigh. As the femoral artery passes posterior to the knee near the popliteal fossa, it is called the popliteal artery. The popliteal artery branches into the anterior and posterior tibial arteries. The anterior tibial artery is located between the tibia and fibula, and supplies blood to the muscles and skin of the anterior tibial region. Upon reaching the tarsal region, it becomes the dorsalis pedis artery, which branches repeatedly and provides blood to the tarsal and dorsal regions of the foot. The posterior tibial artery provides blood to the muscles and skin on the posterior surface of the tibial region. The fibular artery (peroneal artery) branches from the posterior tibial artery.
Overview of Systemic Veins
Systemic veins return blood to the right atrium. Since the blood has already passed through the systemic capillaries, it will be relatively low in oxygen concentration. In many cases, there will be veins draining organs and regions of the body with the same name as the arteries that supplied these regions and the two often parallel one another. This is often described as a “complementary” pattern. However, there is a great deal more variability in the venous circulation than normally occurs in the arteries.
In both the neck and limb regions, there are often both superficial and deeper levels of veins. The deeper veins generally correspond to the complementary arteries. The superficial veins do not normally have direct arterial counterparts, but in addition to returning blood, they also make contributions to the maintenance of body temperature. When the ambient temperature is warm, more blood is diverted to the superficial veins where heat can be more easily dissipated to the environment. In colder weather, there is more constriction of the superficial veins and blood is diverted deeper where the body can retain more of the heat.
Tracing blood flow through arteries follows the current in the direction of blood flow, so that we move from the heart through the large arteries and into the smaller arteries to the capillaries. From the capillaries, we move into the smallest veins and follow the direction of blood flow into larger veins and back to the heart. Figure 11.12 below outlines the path of the major systemic veins.
The superior vena cava and veins of the head and neck
The right atrium receives all of the systemic venous return. Most of the blood flows into either the superior vena cava or inferior vena cava. If you draw an imaginary line at the level of the diaphragm, systemic venous circulation from above that line will generally flow into the superior vena cava; this includes blood from the head, neck, chest, shoulders, and upper limbs. The exception to this is that most venous blood flow from the coronary veins flows directly into the coronary sinus and from there directly into the right atrium. Beneath the diaphragm, systemic venous flow enters the inferior vena cava, that is, blood from the abdominal and pelvic regions and the lower limbs.
The superior vena cava drains most of the body superior to the diaphragm (Figure 11.13). On both the left and right sides, the subclavian vein forms when the axillary vein passes through the body wall from the axillary region. It fuses with the external and internal jugular veins from the head and neck to form the brachiocephalic vein.
Blood from the brain and the superficial facial vein flow into each internal jugular vein (Figure 11.14). Blood from the more superficial portions of the head, scalp, and cranial regions flow into each external jugular vein. Although the external and internal jugular veins are separate vessels, there are anastomoses between them close to the thoracic region. Blood from the external jugular vein empties into the subclavian vein.
Circulation to the brain is both critical and complex. Many smaller veins of the brain stem and the superficial veins of the cerebrum lead to larger vessels referred to as dural venous sinuses, located between layers of dura mater. These include the superior and inferior sagittal sinuses, straight sinus, cavernous sinuses, left and right sinuses, the petrosal sinuses, and the occipital sinuses. Ultimately, most of these sinuses will lead back to the inferior jugular vein.
Veins Draining the Upper Limbs
The digital veins in the fingers come together in the hand to form the palmar venous arches (Figure 11.15). From here, the veins come together to form the radial vein, the ulnar vein, and the median antebrachial vein. The radial vein and the ulnar vein parallel the bones of the forearm and join together at the antebrachium to form the brachial vein, a deep vein that flows into the axillary vein in the brachium.
The median antebrachial vein parallels the ulnar vein, is more medial in location, and joins the basilic vein in the forearm. As the basilic vein reaches the antecubital region, it gives off a branch called the median cubital vein that crosses at an angle to join the cephalic vein. The median cubital vein is the most common site for drawing venous blood in humans. The basilic vein continues through the arm medially and superficially to the axillary vein.
The cephalic vein begins in the antebrachium and drains blood from the superficial surface of the arm into the axillary vein. It is extremely superficial and easily seen along the surface of the biceps brachii muscle in individuals with good muscle tone and in those without excessive subcutaneous adipose tissue in the arms. As the axillary vein passes through the body wall and enters the thorax, it becomes the subclavian vein.
The inferior vena cava
Most of the blood inferior to the diaphragm drains into the inferior vena cava before it is returned to the heart. Lying just beneath the parietal peritoneum in the abdominal cavity, the inferior vena cava parallels the abdominal aorta, where it can receive blood from abdominal veins.
Blood supply from the kidneys flows into each renal vein, normally the largest veins entering the inferior vena cava. A number of other, smaller veins empty into the left renal vein. Each adrenal vein drains the adrenal or suprarenal glands located immediately superior to the kidneys. The right adrenal vein enters the inferior vena cava directly, whereas the left adrenal vein enters the left renal vein.
From the male reproductive organs, each testicular vein flows from the scrotum, forming a portion of the spermatic cord. Each ovarian vein drains an ovary in females. Each of these veins is generically called a gonadal vein. The right gonadal vein empties directly into the inferior vena cava, and the left gonadal vein empties into the left renal vein.
Each side of the diaphragm drains into a phrenic vein; the right phrenic vein empties directly into the inferior vena cava, whereas the left phrenic vein empties into the left renal vein. Blood supply from the liver drains into each hepatic vein and directly into the inferior vena cava. Since the inferior vena cava lies primarily to the right of the vertebral column and aorta, the left renal vein is longer, as are the left phrenic, adrenal, and gonadal veins. The longer length of the left renal vein makes the left kidney the primary target of surgeons removing this organ for donation.
Veins draining the lower limbs
From the smaller veins in the foot, blood supply drains into the anterior and posterior tibial veins. The anterior tibial vein drains the area near the tibialis anterior muscle and combines with the posterior tibial vein and the fibular vein to form the popliteal vein. The posterior tibial vein drains the posterior surface of the tibia and joins the popliteal vein. The fibular vein drains the muscles and skin in proximity to the fibula and also joins the popliteal vein. As the popliteal vein passes behind the knee in the popliteal region, it becomes the femoral vein (Figure 11.16).
The great saphenous vein and the deep femoral vein also drain into the femoral vein. The great saphenous vein is a prominent surface vessel located on the medial surface of the leg and thigh that collects blood from the superficial portions of these areas. The deep femoral vein, as the name suggests, drains blood from the deeper portions of the thigh.
As the femoral vein penetrates the body wall from the femoral portion of the upper limb, it becomes the external iliac vein, a large vein that drains blood from the leg to the common iliac vein. Smaller veins from the pelvic organs and skin drain into the internal iliac vein. The external and internal iliac veins combine near the inferior portion of the sacroiliac joint to form the common iliac vein. Similar to the common iliac arteries, the common iliac veins come together at the level of L5 to form the inferior vena cava.
Hepatic portal system
The liver is a complex biochemical processing plant. It packages nutrients absorbed by the digestive system; produces plasma proteins, clotting factors, and bile; and disposes of worn-out cell components and waste products. Instead of entering the circulation directly, absorbed nutrients and certain wastes (for example, materials produced by the spleen) travel to the liver for processing. They do so via the hepatic portal system (Figure 11.17). Portal systems begin and end in capillaries. In this case, the initial capillaries from the stomach, small intestine, large intestine, and spleen lead to the hepatic portal vein and end in specialized capillaries within the liver, the hepatic sinusoids.
The hepatic portal system consists of the hepatic portal vein and the veins that drain into it. The hepatic portal vein itself is relatively short, beginning at the level of L2 with the confluence of the superior mesenteric vein and splenic vein. It also receives blood from the inferior mesenteric vein. The superior mesenteric vein receives blood from the small intestine, two-thirds of the large intestine, and the stomach. The inferior mesenteric vein drains the distal third of the large intestine, including the descending colon, the sigmoid colon, and the rectum. The splenic vein is formed from branches from the spleen, pancreas, and portions of the stomach, and the inferior mesenteric vein. After its formation, the hepatic portal vein also receives branches from the gastric veins of the stomach and cystic veins from the gall bladder. The hepatic portal vein delivers materials from these digestive and circulatory organs directly to the liver for processing.Because of the hepatic portal system, the liver receives its blood supply from two different sources: from normal systemic circulation via the hepatic artery and from the hepatic portal vein. The liver processes the blood from the portal system to remove certain wastes and excess nutrients, which are stored for later use. This processed blood, as well as the systemic blood that came from the hepatic artery, exits the liver via the right, left, and middle hepatic veins, and flows into the inferior vena cava.