How are the vessels located? Veins and functions: human blood vessels. Small circle of blood circulation

Blood vessels in the human body carry out the function of transferring blood from the heart to all tissues of the body and vice versa. The scheme of interweaving of vessels in the bloodstream allows you to smoothly ensure the operation of all important organs or systems. The total length of human blood vessels reaches 100,000 km.

Blood vessels are tubular formations of different lengths and diameters, through the cavity of which blood moves. The heart acts as a pump, so blood under powerful pressure circulates throughout the body. The speed of blood circulation is quite high, since the system of blood movement itself is closed.

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Structure and classification

In simple terms, blood vessels are flexible, elastic tubes through which blood flows. The vessels are strong enough to withstand even chemical exposure. High strength due to the structure of the three main layers:

The entire vascular network (dispersion scheme), as well as types of blood vessels, includes millions of tiny nerve endings, which are called effectors, receptor compounds in medicine. They have a close, proportional relationship with the nerve endings, reflexively providing nervous regulation blood flow in the vascular cavity.

What is the classification of blood vessels? Medicine divides the vascular pathways according to the type of structure, characteristics, functionality into three types: arteries, veins, capillaries. Each type has great importance in the structure of the vascular network. These main types of blood vessels are described below.

Arteries are blood vessels that originate from the heart and heart muscle and go to the vital important bodies. It is noteworthy that in ancient medicine these tubes were considered air-carrying, since they were empty when the corpse was opened. The movement of blood through the arterial channels is carried out under high pressure. The walls of the cavity are quite strong, elastic, reaching several millimeters in density in various anatomical regions. Arteries are divided into two groups:

Arteries of the elastic type (aorta, its largest branches) are located as close as possible to the heart. These arteries conduct blood - this is their main function. Under the influence of powerful heart rhythms, blood under great pressure rushes through the arteries. The walls of the artery according to the elastic type are quite strong and perform mechanical functions.

Muscular type arteries are represented by many small and medium-sized arteries. In them, the pressure of the blood mass is no longer so great, so the walls of the vessels are constantly contracting to further move the blood. The walls of the arterial cavity consist of a smooth muscular fibrous structure, the walls are constantly changing towards narrowing or natural expansion to ensure uninterrupted blood flow along their paths.

capillaries

They belong to a variety of the smallest vessels in the entire vascular system. Localized between arterial vessels, vena cava. The diameter parameters of the capillaries vary in the range of 5-10 µm. Capillaries are involved in organizing the exchange of gaseous substances and special nutrients between tissues and the blood itself.

Oxygen-containing molecules, carbon dioxide, metabolic products in the opposite direction penetrate the tissues and organs through the fine structure of the capillary walls.

Veins, on the contrary, have a different function - they provide blood flow to the heart muscle. The rapid movement of blood through the cavity of the veins is performed in the opposite direction from the flow of blood through the arteries or capillaries. Blood through the venous bed does not pass under strong pressure, so the walls of the vein contain less muscle structure.
The vascular system is a vicious circle in which blood regularly circulates from the heart throughout the body, and then, in the opposite direction through the veins to the heart. It turns out a complete cycle that provides adequate vital activity of the body.

The functionality of vessels depending on the type

The circulatory vascular system is not only a conductor of blood, but has a powerful functional effect on the body as a whole. In anatomy, six subspecies are distinguished:

• precardiac (hollow, pulmonary veins, pulmonary arterial trunk, elastic type of arteries).
• main (arteries and veins, large or medium-sized vessels, arteries of the muscular type, enveloping the organ from the outside);
• organ (veins, capillaries, intraorgan arteries responsible for the full trophism of internal organs and systems).

Pathological conditions of the circulatory system

Vessels, like other organs, can be affected by specific diseases, have pathological conditions, developmental anomalies that are the result of other serious diseases and their cause.

There are several serious vascular diseases that have a severe course and consequences for the general health of the patient:

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Blood vessels in the human body are a unique system for transporting blood to important systems and organs, tissues and muscle structure.
The vascular system ensures the excretion of decay products as a result of vital activity. The circulatory system must work correctly, therefore, in case of any manifestations of alarming symptoms, you should immediately consult a doctor and begin preventive measures to further strengthen the vascular branches and their walls.

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BLOOD VESSELS (vasa sanguifera s. sanguinea) - elastic tubes of various calibers that make up a closed system, through which blood flows in the body from the heart to the periphery and from the periphery to the heart. The cardiovascular system of animals and humans ensures the transport of substances in the body and thereby participates in metabolic processes. It distinguishes the circulatory system with a central organ - the heart (see), which acts as a pump, and the lymphatic system (see).

Comparative anatomy

The vascular system arises in the body of multicellular animals due to the need for cell life support. Absorbed from the intestinal tube nutrients carried by fluid throughout the body. Extravascular transport of fluids through interstitial fissures is replaced by intravascular circulation; at the person in vessels circulates apprx. 20% of the total body fluid. Many invertebrates (insects, mollusks) have an open vascular system (Fig. 1a). In annelids, a closed hemolymph circulation appears (Fig. 1, b), although they still do not have a heart, and blood is pushed through the vessels due to the pulsation of 5 pairs of "hearts" - pulsating tubes; contractions of the muscles of the body help these "hearts". In lower vertebrates (lancelet), the heart is also absent, the blood is still colorless, the differentiation of arteries and veins is well expressed. In fish, at the anterior end of the body, near the gill apparatus, an expansion of the main vein appears, where the veins of the body are collected - the venous sinus (Fig. 2), followed by the atrium, ventricle and arterial cone. From it, blood enters the ventral aorta with its arterial gill arches. At the border of the venous sinus and the arterial cone, a valve appears that regulates the passage of blood. The heart of fish passes only venous blood. In the capillaries of the gill filaments, an exchange of gases takes place, and oxygen dissolved in water enters the blood, in order to follow further along the dorsal aorta into the circulation circle and spread in the tissues. As a result of the change of gill breathing to pulmonary breathing in terrestrial animals (amphibians), a small (pulmonary) circulation occurs, and with it a three-chambered heart appears, consisting of two atria and one ventricle. The appearance of an incomplete septum in it is characteristic of reptiles, and in crocodiles the heart is already four-chambered. Birds and mammals, like humans, also have a four-chambered heart.

The appearance of the heart is due to an increase in tissue mass, an increase in resistance to blood flow. The original vessels (protocapillaries) were indifferent, equally loaded, and uniform in structure. Then the vessels delivering blood to a segment of the body or to an organ acquired the structural features characteristic of arterioles and arteries, and the vessels at the outlet of blood from the organ became veins. Between the primitive arterial vessels and the ways of outflow of blood, a capillary network of the organ was formed, which assumed all metabolic functions. Arteries and veins have become typical transport vessels, some more resistive (arteries), others primarily capacitive (veins).

The arterial system in the process of evolutionary development turned out to be associated with the main arterial trunk - the dorsal aorta. Its branches penetrated all segments of the body, stretched along the hind limbs, took over the blood supply to all organs of the abdominal cavity and pelvis. From the ventral aorta with its gill arches originated the carotid arteries (from the third pair of branchial arterial arches), the aortic arch and the right subclavian artery (from the fourth pair of branchial arterial arches), the pulmonary trunk with the ductus arteriosus and pulmonary arteries (from the sixth pair of arterial branchial arches). With the formation of the arterial system of primates and humans, a restructuring of the arterial links occurred. So, the tail artery disappeared, the remnant of a swarm in humans is the median sacral artery. Instead of several renal arteries, a paired renal artery was formed. The arteries of the extremities underwent complex transformations. For example, the axillary, brachial, median, which later became the ancestor of the radial and ulnar arteries, stood out from the interosseous artery of the limbs of reptiles in mammals. The sciatic artery - the main arterial highway of the hind limb of amphibians and reptiles - gave way to the femoral artery.

In the history of the development of venous vessels, the existence of two portal systems in lower vertebrates - hepatic and renal - was noted. The portal system of the kidneys is well developed in fish, amphibians, reptiles, weakly in birds.

With the reduction of the primary kidney in reptiles, the portal renal system disappeared. The final kidney appeared with its glomeruli and outflow of blood into the inferior vena cava. The paired anterior cardinal veins, which receive blood from the head in fish, as well as the paired posterior cardinal veins, lost their significance with the transition of animals to terrestrial life. Amphibians also retain the collectors that connect them - the Cuvier ducts that flow into the heart, but over time, in higher vertebrates, only the coronary sinus of the heart remains from them. Of the paired symmetrical anterior cardinal veins, a person retains the internal jugular veins, which merge together with the subclavian veins into the superior vena cava, and from the posterior cardinal veins - asymmetric unpaired and semi-unpaired veins.

The portal system of the liver arises in fish in connection with the subintestinal vein. Initially, the hepatic veins flowed into the venous sinus of the heart, where blood also came from the cardinal veins through the right and left Cuvier ducts. With the extension of the venous sinus of the heart in the caudal direction, the orifices of the hepatic veins moved caudally. The trunk of the inferior vena cava was formed.

Limf, the system developed as a derivative of venous system or irrespective of it in connection with a parallel current of interstitial liquids as a result of merge of mesenchymal spaces. It is also assumed that the predecessor of the blood and lymphatic channels in vertebrates was the hemolymphatic system of invertebrates, in which nutrients and oxygen were transferred to the cells.

Anatomy

The blood supply to all organs and tissues in the human body is carried out by the vessels of the systemic circulation. It starts from the left ventricle of the heart with the largest arterial trunk - the aorta (see) and ends in the right atrium, into which the largest venous vessels of the body - the superior and inferior vena cava (see) join. Throughout the aorta from the heart to the fifth lumbar vertebra, numerous branches depart from it - to the head (printing. Fig. 3) common carotid arteries (see. Carotid artery), to the upper limbs - subclavian arteries (see. Subclavian artery), to the lower limbs - iliac arteries. Arterial blood is delivered through the thinnest branches to all organs, including the skin, muscles, and skeleton. There, passing through the microcirculatory bed, the blood gives off oxygen and nutrients, captures carbon dioxide and toxins to be removed from the body. Through the postcapillary venules, the blood, which has become venous, enters the tributaries of the vena cava.

Under the name "pulmonary circulation" stands out a complex of vessels that pass blood through the lungs. Its beginning is the pulmonary trunk emerging from the right ventricle of the heart (see), according to Krom, venous blood follows into the right and left pulmonary arteries and further into the capillaries of the lungs (printing Fig. 4). Here, the blood gives off carbon dioxide, and captures oxygen from the air and is sent through the pulmonary veins from the lungs to the left atrium.

from blood capillaries digestive tract blood is collected in the portal vein (see) and goes to the liver. There it spreads through the labyrinths of thin vessels - sinusoidal capillaries, from which tributaries of the hepatic veins are then formed, flowing into the inferior vena cava.

Larger To. from among the main ones follow between organs and are designated as arterial highways and venous collectors. Arteries lie, as a rule, under the cover of muscles. They are sent to the blood-supplied organs along the shortest path. In accordance with this, they are deployed on the flexion surfaces of the limbs. Correspondence of arterial highways to the main formations of the skeleton is observed. There is a differentiation of the visceral and parietal arteries, the latter in the trunk region retain a segmental character (eg, intercostal arteries).

The distribution of arterial branches in the organs, according to M. G. Prives, is subject to certain laws. In parenchymal organs, either there are gates through which an artery enters, sending branches in all directions, or arterial branches sequentially enter the organ in steps along its length and are connected inside the organ by longitudinal anastomoses (for example, a muscle), or, finally, they penetrate into the organ arterial branches from several sources along the radii (eg, thyroid gland). Arterial blood supply to hollow organs occurs in three types - radial, circular and longitudinal.

All veins in the human body are localized either superficially, in the subcutaneous tissue, or in the depths of the anatomical regions along the arteries, usually accompanied by pairs of veins. Superficial veins, due to multiple anastomoses, form venous plexuses. Deep venous plexuses are also known, for example, pterygoid on the head, epidural in spinal canal around the pelvic organs. special kind venous vessels are the sinuses of the dura mater of the brain.

Variations and anomalies of large blood vessels

K. s. vary widely in position and size. Distinguish the malformations To. pages leading to pathology, and also the deviations which are not reflected in health of the person. Among the first are coarctation of the aorta (see), non-closure of the ductus arteriosus (see), discharge of one of the coronary arteries of the heart from the pulmonary trunk, phlebectasia of the internal jugular vein, arteriovenous aneurysms (see Aneurysm). Much more often in practically healthy people there are varieties of the normal location of K. pages, cases of their unusual development, compensated by reserve vessels. So, with dextrocardia, the right-sided position of the aorta is noted. The doubling of the superior and inferior vena cava does not cause any patol, disorders. Very diverse options for the departure of branches from the aortic arch. Sometimes additional arteries (eg, hepatic) and veins come to light. Often there is either a high confluence of veins (eg, common iliac veins during the formation of the inferior vena cava), or, conversely, a low one. This is reflected in the total length of K. s.

It is expedient to divide all variations To. depending on their localization and topography, on their number, branching or merging. At disturbance of a current of a blood on natural highways (eg, at injury or a prelum) new ways of a blood-groove are formed, the atypical pattern of distribution To. is created page. (acquired anomalies).

Research methods

Methods of anatomical research. Distinguish methods of a research To. on dead preparations (preparation, injection, impregnation, staining, electron microscopy) and methods of in vivo research in the experiment (X-ray, capillaroscopy, etc.). Filling K. with. anatomists began to use coloring solutions or solidifying masses as early as the 17th century. Anatomists J. Swammerdam, F. Ruysch and I. Lieberkün achieved great success in injection technique.

On anatomical preparations, arterial injection is achieved by inserting an injection needle into the vessel lumen and filling it with a syringe. It is more difficult to inject veins that have valves inside. In the 40s. 20th century A. T. Akilova, G. M. Shulyak proposed a method for injecting veins through the spongy bone, where an injection needle is inserted.

In the manufacture of vascular preparations, the injection method is often combined with the corrosion method, developed in the middle of the 19th century by J. Girtle. The mass introduced into the vessels (molten metals, hot hardening substances - wax, paraffin, etc.) gives casts of the vascular plexuses, the composition of which remains strong to - after the melting of all surrounding tissues (Fig. 3). Modern plastic materials create conditions for the production of corrosive preparations of jewelry fineness.

Of particular value is the injection To. solution of silver nitrate, which allows, when studying their walls, to see the boundaries of endothelial cells. Impregnation K. s. silver nitrate by immersing fragments of organs or membranes in a special solution was developed by V. V. Kupriyanov in the 60s. 20th century (tsvetn. fig. 2). She laid the foundation for non-injection methods for studying the vascular bed. These include luminescent microscopy of microvessels, histochemical, their detection, and subsequently - electron microscopy (including transmission, scanning, scanning) of the vascular walls. In the experiment, intravital administration of radiopaque suspensions (angiography) into the vessels is widely carried out in order to diagnose developmental anomalies. An auxiliary method should be considered radiography K. pages, into the lumen of which a catheter is inserted from radiopaque materials.

Due to the improvement of optics for capillaroscopy (see), it is possible to observe K. page. and capillaries in the conjunctiva of the eyeball. Reliable results are given by photographing To. page. retina through the pupil using a retinophoto apparatus.

Data of intravital research of anatomy To. in experimental animals, they are documented by photographs and films, on which accurate morphometric measurements are made.

Research methods in the clinic

Survey of the patient with various pathology To. page, as well as other patients, has to be complex. It begins with anamnesis, examination, palpation and auscultation and ends with instrumental research methods, bloodless and surgical.

Bloodless research To. should be carried out in an isolated spacious, well-lit (preferably daylight) room with a constant temperature of at least 20 °. Surgical research methods must be carried out in a specially equipped X-ray operating room, equipped with everything necessary, including to deal with possible complications, with full observance of asepsis.

When collecting an anamnesis, special attention is paid to occupational and household hazards (frostbite and frequent cooling of the extremities, smoking). Among the complaints, special attention should be paid to the chilliness of the lower extremities, fatigue when walking, paresthesia, dizziness, unsteadiness of gait, etc. Particular attention is paid to the presence and nature of pain, a feeling of heaviness, bursting, fatigue limbs after standing or physical. stress, the appearance of edema, skin itching. Establish the dependence of complaints on the position of the body, season, find out their connection with common diseases, trauma, pregnancy, operations, etc. Be sure to specify the sequence and time of occurrence of each complaint.

The patient is undressed and examined in a supine and standing position, while comparing the symmetrical parts of the body and especially the limbs, noting their configuration, the color of the skin, the presence of areas of pigmentation and hyperemia, the nature of the pattern of the saphenous veins, the presence of expansion of the superficial veins and their nature, localization and prevalence . Exploring the lower limbs, fix attention on the vascular pattern of the anterior abdominal wall, gluteal regions and lower back. When examining the upper limbs, the condition of the vessels and skin of the neck, shoulder girdle and chest is taken into account. At the same time, attention is paid to the difference in the circumference and volume of individual segments of the limbs in a horizontal and vertical position, the presence of edema and pulsating formations along the vascular bundles, the severity of the hairline, the color and dryness of the skin, and in particular its individual sections.

The skin turgor, the severity of the skin fold, seals along the vessels, painful points, the localization and size of defects in the aponeurosis are determined, the temperature of the skin of different sections of the same limb and in symmetrical areas of both limbs is compared, the skin is felt in the zone of trophic lesions.

When examining the state of blood circulation in the extremities, palpation of the main arteries is of particular value. Palpation of the pulse in each individual case should be carried out in all points of the vessels accessible for palpation bilaterally. Only under this condition can a difference in the magnitude and nature of the pulse be detected. It should be noted that with tissue swelling or significantly pronounced subcutaneous fatty tissue, it is difficult to determine the pulse. The absence of pulsation in the arteries of the foot can not always be considered a reliable sign of circulatory disorders of the limb, since this is observed with anatomical variants of localization K. s.

Diagnosis of vascular diseases is considerably enriched by listening To. and recording phonograms. This method allows you to identify not only the presence of stenosis or aneurysmal expansion of the arterial vessel, but also their location. With the help of phonoangiography, the intensity of noises and their duration can be determined. New ultrasound equipment based on the Doppler phenomenon will also help in diagnosis.

With thrombolytic diseases To. limbs, it is very important to identify peripheral circulatory insufficiency. For this purpose various funkts, tests are offered. The most common of these are the Oppel test, the Samuels test and the Goldflam test.

Oppel's test: the patient in the supine position is asked to raise the lower limbs to an angle of 45 ° and hold them in this position for 1 minute; at insufficiency of peripheral circulation in the field of a sole appears blanching, a cut is absent normally.

Samuels test: the patient is asked to raise both extended lower limbs to an angle of 45 ° and perform 20-30 flexion-extensor movements in the ankle joints; blanching of the soles and the time of its onset indicate the presence and severity of circulatory disorders in the limb.

The Goldflam test is performed according to the same method as the Samuels test: the time of appearance of muscle fatigue on the side of the lesion is determined.

For specification of a condition of the valve device of veins also carry out funkts, tests. Insufficiency of the ostial (inlet) valve of the great saphenous vein of the leg is established using the Troyanov-Trendelenburg test. The patient in a horizontal position raises the lower limb until the saphenous veins are completely emptied. A rubber tourniquet is applied to the upper third of the thigh, after which the patient gets up. The harness is removed. In valvular insufficiency, dilated veins fill retrograde. For the same purpose, a Hackenbruch test is performed: in an upright position, the patient is asked to cough vigorously, while a push of blood is felt with the hand lying on the dilated vein of the thigh.

The patency of the deep veins of the lower extremities is determined by the Delbe-Perthes march test. In an upright position, the patient is placed with a rubber tourniquet in the upper third of the lower leg and asked to walk. If the superficial veins empty at the end of walking, the deep veins are patent. For the same purpose, you can apply a lobelin test. After elastic bandaging of the entire lower limb, 0.3-0.5 ml of 1% lobelin solution is injected into the veins of the rear of the foot. If within 45 sec. cough does not appear, the patient is asked to walk on the spot. If there is no cough for another 45 seconds. consider that deep veins are impassable.

The state of the valvular apparatus of the perforating veins of the lower leg can be judged by the results of the Pratt, Sheinis, Talman and five-flange tests.

Pratt's test: in a horizontal position, the patient's raised leg is bandaged with an elastic bandage, starting from the foot to the upper third of the thigh; a tourniquet is applied above; the patient gets up; without dissolving the tourniquet, they remove the previously applied bandage turn by turn and begin to apply another bandage from top to bottom, leaving gaps of 5-7 cm between the first and second bandages; the appearance of protrusions of the veins in these intervals indicates the presence of incompetent perforating veins.

Sheinis test: after applying three tourniquets to the raised leg, the patient is asked to walk; by filling the veins between the tourniquets, the localization of insufficient perforating veins is established.

Talman's test: one long rubber tourniquet is applied in the form of a spiral on an elevated leg with empty veins and the patient is asked to walk; the interpretation of the results is the same as with the Sheinis test.

Five tourniquet test: carried out in the same way, but with the imposition of two tourniquets on the thigh and three on the lower leg.

The specified wedge, tests are only qualitative. With their help, it is impossible to determine the amount of retrograde blood flow. Alekseev's method allows to establish it to some extent. The examined limb is raised up until the saphenous veins are completely emptied. In the upper third of the thigh, a Beer bandage is applied, squeezing both veins and arteries. The examined limb is lowered into a special vessel filled with warm water to the brim. At the top edge of the vessel there is a drain pipe for draining the displaced water. After the limb is submerged, the amount of water displaced is accurately measured. Then remove the bandage and after 15 seconds. measure the amount of additionally displaced water, which is designated as the total volume of arteriovenous) inflow (V1). Then everyone repeats again, but about the cuff below the Beer bandage, maintaining a constant pressure of 70 mm Hg. Art. (for compression of veins only). The amount of water displaced is defined as the volume of arterial inflow in 15 seconds. (V2). The volumetric velocity (S) of retrograde venous filling (V) is calculated by the formula:

S = (V1 - V2)/15 ml/sec.

From an extensive arsenal of instrumental methods used to examine patients with peripheral arterial disease, especially widely in angiol. practice uses arterial oscillography (see), reflecting the pulse fluctuations of the arterial wall under the influence of changing pressure in the pneumatic cuff. This technique allows you to determine the main parameters of blood pressure (maximum, average, minimum), to identify changes in the pulse (tachycardia, bradycardia) and heart rhythm disturbances (extrasystole, atrial fibrillation). Oscillography is widely used to determine the reactivity, elasticity of the vascular wall, its ability to expand, to study vascular reactions (Fig. 4). The main indicator in oscillography is the gradient of the oscillographic index, which, in the presence of vascular pathology, indicates the level and severity of the lesion.

According to the oscillograms obtained during the study of the limbs at various levels, it is possible to determine the place where a relatively high oscillatory index is observed, i.e., practically the place of narrowing of the vessel or thrombus. Below this level, the oscillatory index sharply decreases, since the movement of blood below the thrombus goes through collaterals, and pulse fluctuations become smaller or completely disappear and are not displayed on the curve. Therefore, for a more detailed study, it is recommended to record oscillograms at 6-8 different levels of both limbs.

At obliterating endarteritis there is a decrease in the amplitude of oscillations and the oscillatory index, primarily on the dorsal arteries of the feet. As the process develops, a decrease in the index is also observed on the lower leg (Fig. 4b). At the same time, the deformation of the oscillographic curve occurs, the edge in this case becomes stretched, the elements of the pulse wave in it turn out to be poorly expressed, and the top of the teeth acquires a vaulted character. The oscillatory index on the thigh, as a rule, remains within the normal range. With obstruction of the bifurcation of the aorta and arteries in the iliac-femoral zones, oscillography does not make it possible to determine the upper level of blockage of the vessel.

At an obliterating atherosclerosis in the field of an ileal or femoral zone patol, changes on an oscillogram arise mainly at measurement in proximal departments of extremities (fig. 4, c). A feature of the proximal forms of damage to the arteries of the extremities is often the presence of two blocks, which can occur both on one and on both extremities of the same name only at different levels. Oscillography is more indicative of obstruction in the underlying segments (thigh, lower leg). It establishes the upper level of the lesion, but does not make it possible to judge the degree of compensation of the collateral circulation.

One of the methods of angiography is aortography (see). There are direct and indirect aortography. Among the methods of direct aortography, only translumbar aortography has retained its value - a method, with Krom, the aorta is punctured by translumbar access and the contrast agent is injected directly through the needle (Fig. 14). Direct aortography techniques such as puncture of the ascending aorta, its arch and descending aorta thoracic aorta are not used in modern clinics.

Indirect aortography consists in the introduction of a contrast agent into the right side of the heart or into the pulmonary artery through a catheter and obtaining the so-called. levograms. In this case, the catheter is passed into the right atrium, right ventricle or trunk of the pulmonary artery, where a contrast agent is injected. After passing it through the vessels of the small circle, the aorta is contrasted, the edges are fixed on a series of angiograms. The use of this method is limited due to the strong dilution of the contrast agent in the vessels of the pulmonary circulation and, therefore, insufficient "tight" contrasting of the aorta. However, in cases where it is impossible to perform retrograde aortic catheterization through the femoral or axillary arteries, it may be necessary to use this method.

Ventriculoaortography is a method of introducing a contrast agent into the cavity of the left ventricle of the heart, from where it enters the aorta and its branches with the natural blood flow. The injection of a contrast agent is carried out either through a needle, edges are entered percutaneously directly into the cavity of the left ventricle, or through a catheter, carried out from the right atrium by transseptal puncture of the interatrial septum into the left atrium and then into the left ventricle. The second way is less traumatic. These methods of contrasting the aorta are used extremely rarely.

The counter current method consists in percutaneous puncture of the axillary or femoral artery, passing the needle along the conductor retrograde to the blood flow into the vessel in order to better fix it, and injecting a significant amount of contrast medium under high pressure against the blood flow. For better contrasting in order to reduce cardiac output, the injection of a contrast agent is combined with the patient performing a Valsalva test. The disadvantage of this method is a strong overstretching of the vessel, which can lead to damage to the inner membrane and subsequent thrombosis.

Percutaneous catheterization aortography is used most often. The femoral artery is usually used to pass the catheter. However, the axillary artery may also be used. Through these vessels, catheters of a sufficiently large caliber can be inserted and, therefore, a contrast agent can be injected under high pressure. This makes it possible to more clearly contrast the aorta and adjacent branches.

For a research of arteries use an arteriography (see), edges it is made by a direct puncture of the corresponding artery and retrograde introduction of a contrast agent in its gleam or by percutaneous catheterization and a selective angiography. Direct puncture of the artery and angiography are performed mainly with contrasting of the arteries of the lower extremities (Fig. 15), less often - the arteries of the upper extremities, common carotid, subclavian and vertebral arteries.

Catheterization arteriography is performed with arteriovenous fistulas of the lower extremities. In these cases, the catheter is passed antegrade on the side of the lesion or retrograde through the contralateral femoral and iliac arteries until the aortic bifurcation and then antegrade along the iliac arteries on the side of the lesion and further in the distal direction to the required level.

For contrasting the brachiocephalic trunk, the arteries of the shoulder girdle and upper limbs, as well as the arteries of the thoracic and abdominal aorta, transfemoral retrograde catheterization is more indicated. Selective catheterization requires the use of catheters with a specially designed beak or the use of guided systems.

Selective arteriography gives the most complete picture of the angioarchitectonics of the studied basin.

In the study of the venous system, puncture vein catheterization is used (see Puncture venous catheterization). It is carried out according to the Seldinger method by percutaneous puncture of the femoral, subclavian and jugular veins and the catheter through the blood flow. These accesses are used for catheterization of the superior and inferior vena cava, hepatic and renal veins.

Vein catheterization is carried out in the same way as arterial catheterization. Injection of a contrast agent due to the lower blood flow velocity is performed at a lower pressure.

Contrasting the system of the superior and inferior vena cava (see Cavography), renal, adrenal and hepatic veins is also carried out by catheterization.

Phlebography of the extremities is performed by introducing a contrast agent through the blood flow through a puncture needle or through a catheter inserted into one of the peripheral veins by venosection. There is a distal (ascending) phlebography, retrograde femoral phlebography, pelvic phlebography, retrograde phlebography of the leg veins, retrograde orocavography. All studies are carried out by intravenous administration of radiopaque preparations (see Phlebography).

Usually for contrasting of veins of the lower extremities puncture or expose a back vein of a thumb or one of back metatarsal veins, enter a catheter into to-ruyu. To prevent the flow of a contrast agent into the superficial veins of the leg, the legs are bandaged. The patient is transferred to a vertical position and injected with a contrast agent. If a contrast agent is injected against the background of the Valsalva maneuver, then with moderate valvular insufficiency, reflux of the contrast agent into the femoral vein may occur, and with severe valvular insufficiency, reflux of the contrast agent may reach the veins of the leg. The X-ray image of the veins is fixed using a series of radiographs and the X-ray cinematography method.

Many changes in K. page. are inherently compensatory-adaptive. These include, in particular, atrophy of arteries and veins, manifested by a decrease in the number of contractile elements in their walls (mainly in the middle shell). Such atrophy can develop both on a physiological (involution of the arterial duct, umbilical vessels, venous duct in the postembryonic period), and on a pathological (desolation of arteries and veins when they are compressed by a tumor, after ligation) basis. Quite often adaptive processes are shown by a hypertrophy and a hyperplasia of smooth muscle cells and elastic fibers of walls To. page. An illustration of such changes can serve as elastosis and myoelastosis of arterioles and small arterial vessels of the systemic circulation in hypertension and a largely similar restructuring of the lung arteries in hypervolemia of the pulmonary circulation that occurs with some congenital heart defects. Of exceptionally great importance in the restoration of hemodynamic disturbances in organs and tissues is increased collateral circulation, accompanied by recalibration and neoplasm To. in a zone patol, obstacles to a blood-groove. The “arterialization” of veins also belongs to adaptive manifestations, for example, in arteriovenous aneurysms, when in the place of an anastomosis the veins acquire a gistol, a structure approaching the structure of the arteries. The adaptive essence is carried also by changes in arteries and veins after creation of artificial vascular anastomoses (arterial, venous, arteriovenous) with to lay down. purpose (see Shunting of blood vessels). In the hemomicrocirculation system, adaptive processes are morphologically characterized by neoplasm and restructuring of terminal vessels (precapillaries into arterioles, capillaries and postcapillaries into venules), increased blood flow from the arteriolar to the venular section with an increase in the number of arteriovenular shunts, hypertrophy and hyperplasia of smooth muscle cells in precapillary sphincters, the closure of which prevents the flow of excess amounts of blood into the capillary networks, an increase in the degree of tortuosity of arterioles and precapillaries with the formation of loops, curls and glomerular structures along their course (Fig. 19), contributing to the weakening of the force of the pulse impulse in the arteriolar link of the microvasculature.

Extremely various morfol. changes occur during autotransplantation, allotransplantation and xenotransplantation To. using autologous, allogeneic and xenogenic vascular grafts, respectively. Thus, in venous autografts transplanted into arterial defects, processes of organization of graft structures losing viability with their replacement develop. connective tissue and the phenomena of reparative regeneration with the neoplasm of elastic fibers and smooth muscle cells, culminating in the "arterialization" of the autovein. In the case of replacement of an arterial vessel defect with a lyophilized allogeneic artery, a “sluggish” rejection reaction occurs, accompanied by a gradual destruction of the graft, the organization of a dead tissue substrate, and recovery processes leading to the formation of a new vessel, characterized by the predominance of collagen fibrils in its walls. With plastic K. s. with the help of synthetic prostheses (explantation), the walls of the latter are covered with a fibrinous film, germinate with granulation tissue and undergo encapsulation with endothelization in their subsequent inner surface (Fig. 20).

Changes To. with age reflect processes of their fiziol, postembryonic growth, adaptation to the conditions of a hemodynamics changing during a life and senile involution. Senile changes in blood vessels in general are manifested by atrophy in the walls of arteries and veins of contractile elements and reactive proliferation of connective tissue, Ch. arr. in the inner shell. In the arteries of the elderly, involutive sclerotic processes are combined with atherosclerotic changes.

Pathology

Malformations of blood vessels

Malformations of blood vessels, or angiodysplasia, are congenital diseases manifested by anatomical and functional disorders vascular system. In the literature, these defects are described under various names: branched angioma (see Hemangioma), phlebectasia (see Angiectasia), angiomatosis (see), phlebarteriectasia, Parks Weber syndrome (see Parks Weber syndrome), Klippel-Trenaunay syndrome, arteriovenous angioma etc.

Malformations To. occur in 7% of cases of patients with other congenital vascular diseases. The vessels of the extremities, neck, face, and scalp are most often affected.

Proceeding from anatomic and morfol. signs of malformations To. can be divided into the following groups: 1) vein malformations (superficial, deep); 2) malformations of arteries; 3) arteriovenous defects (arteriovenous fistulas, arteriovenous aneurysms, arteriovenous vascular plexuses).

Each of the above types of angiodysplasia can be single or multiple, limited or widespread, combined with other malformations.

The etiology has not been completely elucidated. Consider that for formation of defect To. a number of factors matter: hormonal, tempera

round, fetal injury, inflammation, infection, toxicosis. According to Malan and Puglionisi (E. Malan, A. Puglionisi), the occurrence of angiodysplasia is the result of a complex violation of the embryogenesis of the vascular system.

Malformations of the superficial veins are the most frequent and account for 40.8% of all angiodysplasias. Either only the saphenous veins are involved in the process, or it spreads to deeper tissues and affects the veins of the muscles, intermuscular spaces, and fascia. There is a shortening of the bones, an increase in the volume of soft tissues. Localization of the defect - upper and lower limbs.

Morphologically, the defect is manifested by a number of structural features that are pathognomonic for this species. Some of them include angiomatous complexes with smooth muscle fibers in the walls of blood vessels; others are represented by ectatic, thin-walled veins with an uneven lumen; the third are sharply dilated muscle-type veins, in the walls of which a chaotic orientation of smooth muscles is found.

Rice. Fig. 22. The lower limbs of a 2.5-year-old child with a malformation of the deep veins of the limbs (Klippel-Trenaunay syndrome): the limbs are enlarged, edematous, there are extensive vascular spots on the skin, the subcutaneous veins are dilated.

Rice. 23. Bottom part face and neck of a 6-year-old child with phlebectasia of the internal jugular veins: spindle-shaped formations on the front surface of the neck, more on the left (the picture was taken at the moment of the patient's tension).

Rice. Fig. 24. The lower limbs of a 7-year-old child with right-sided congenital arteriovenous defects: the right limb is enlarged in size, the saphenous veins are dilated, there are pigment spots in some parts of the limb (the limb is in a forced position due to contracture).

Clinically, the defect is manifested by varicose veins. The expansion of the veins is different - stem, nodal, in the form of conglomerates. Often there are combinations of these forms. The skin over the dilated veins is thinned, bluish in color. The affected limb is enlarged in volume, deformed, which is associated with blood overflow of dilated venous vessels (Fig. 21). Characteristic signs are emptying symptoms and sponges, the essence of which is to reduce the volume of the affected limb at the time of its lifting up or when pressing on the dilated venous plexuses as a result of emptying the vicious vessels.

On palpation, tissue turgor is sharply reduced, movements in the joints are often limited due to bone deformation, dislocations. There are constant severe pain, trophic disorders.

Phlebograms show dilated, deformed veins, accumulation of a contrast agent in the form of shapeless spots.

Treatment consists in the possible complete removal of the affected tissues and vessels. In especially severe cases, when radical treatment is impossible, patol, formations are partially excised and multiple stitching of the remaining altered areas is performed with silk or nylon sutures. With a widespread lesion, surgical treatment should be carried out in several stages.

Malformations of deep veins are manifested by congenital disorders of blood flow through the main veins. They occur in 25.8% of all angiodysplasia cases. The defeat of the deep veins of the extremities is described in the literature as the Klippel-Trenaunay syndrome, which for the first time in 1900 gave a characteristic wedge, a picture of this defect.

Morfol, the study of the defect allows us to distinguish two variants of the anatomical "block": the dysplastic process of the main vein and its external compression due to the disorganization of the arterial trunks, muscles, as well as fibrous cords, tumors. The histoarchitectonics of the saphenous veins indicates the secondary, compensatory nature of ectasias.

Klippel-Trenaunay syndrome is observed only on the lower extremities and is characterized by a triad of symptoms: varicose saphenous veins, an increase in the volume and length of the affected limb, pigment or vascular spots (Fig. 22). Patients complain of heaviness in the limbs, pain, fatigue. Constant signs are hyperhidrosis, hyperkeratosis, ulcerative processes. Associated symptoms include bleeding from the intestines and urinary tract, deformities of the spine and pelvis, joint contractures.

In the diagnosis of defect, the leading role belongs to phlebography, which reveals the level of the block of the main vein, its length, the state of the saphenous veins, for which the identification of embryonic trunks by outer surface limbs and along the sciatic nerve is considered hallmark vice.

Treatment is associated with certain difficulties. Radical treatment with normalization of blood flow is possible with external compression of the vein and consists in eliminating the blocking factor. In cases of aplasia or hypoplasia, restoration of blood flow by plasty of the main vein is indicated, however, such operations are associated with the risk of graft thrombosis. It should be emphasized that attempts to remove dilated saphenous veins with unrestored blood flow through the main veins is fraught with the risk of severe venous insufficiency in limb and death.

Congenital phlebectasia of the jugular veins account for 21.6% of other vascular malformations.

Morfol, the picture is characterized by a pronounced underdevelopment of the muscular-elastic frame of the vein wall up to its complete absence.

Clinically defect is shown by emergence at the patient on a neck during shout, tension of tumorous education (fig. 23), a cut in a normal state disappears and is not defined. With phlebectasia of the internal jugular veins, the formation has a fusiform shape and is located in front of the sternocleidomastoid muscle. Phlebectasia of the saphenous veins of the neck have a rounded or stem shape and are well contoured under the skin. With phlebectasia of the internal jugular veins, accompanying signs are hoarseness of the voice, shortness of breath. Complications of the defect include wall ruptures, thrombosis and thromboembolism.

Treatment of patients is only surgical. With phlebectasia of the saphenous veins, excision of the affected areas of the vessels is indicated. In phlebectasia of the internal jugular veins, the method of choice is to strengthen the vein wall with an implant.

Defects of arterial peripheral vessels are observed extremely rarely and are expressed in the form of narrowing or aneurysm-like expansions of the arteries. The wedge, a picture of these defects and surgical tactics do not differ from those at the acquired defeats of arteries.

Arteriovenous defects are manifested by congenital arteriovenous communications in the form of fistulas, aneurysms, and vascular plexuses. Compared with other angiodysplasias, arteriovenous defects are less common and occur in 11.6% of cases. They can be observed in all organs, however, the limbs are most often affected, have a local or widespread character.

Typical morfol. change from K. page. is their restructuring in the form of "arterialization" of the veins and "venization" of the arteries.

The wedge, the picture of congenital arteriovenous defects consists of local and general symptoms.

Local symptoms include: hypertrophy of the affected organ, osteomegaly, varicose veins and pulsation of the subcutaneous veins, pigmented or vascular spots (Fig. 24), increased pulsation of the main vessels, local hyperthermia, trophic skin disorders, systole-diastolic murmur with an epicenter over the patol area, shunt. Common symptoms are: tachycardia, arterial hypertension, pronounced changes in heart function. Constant ulcerative and necrotic processes, often accompanied by bleeding.

Examination of patients reveals a pronounced arterialization) of venous blood. At an arteriography it is possible to reveal an arrangement "patol, educations. Characteristic angiographic signs of defect are: simultaneous filling by a contrast agent of arteries and veins, depletion of a vascular drawing distal to anastomoses, accumulation of a contrast agent in places of their localization.

Treatment consists in elimination patol, communications between arteries and veins by bandaging and intersection of fistulas, removal of aneurisms, excision of arteriovenous textures within healthy fabrics. With diffuse lesions of the vessels of the extremities, the only radical method of treatment is amputation.

Damage

Injuries To. more common in war time. So, during the Great Patriotic War (1941 -1945) damage to the main K. with. met in 1% of the wounded. Isolated injuries of arteries accounted for 32.9%, and veins - only 2.6%, combinations of damage to arteries and veins - 64.5%. Classification of gunshot wounds To. developed in the same period (Table 1). Quite often damages of vessels are combined with fractures of bones, an injury of nerves that burdens a wedge, a picture and the forecast.

In peacetime practice, injuries and damage to arteries and veins amount to approx. 15% of all emergency pathology To. The majority of damages To. occurs as a result of accidents in transport, knife and less often gunshot wounds.

Damage to the arteries is divided into closed and open. The closed damages To. pages, in turn, divide into contusions when there is damage only to an internal cover of a vessel, and gaps at which there is a damage of all three layers of a wall. With ruptures and injuries of the artery, blood is poured into the surrounding tissues and a cavity is formed that communicates with the lumen of the vessel (Fig. 25) pulsating hematoma (see). When the artery is injured, the pulsation distal to the injury site is weakened or completely absent. In addition, the phenomena of ischemia of the area are observed, to-ruyu this artery feeds (see Ischemia), and the degree of ischemia can be different, and therefore has a different effect on the fate of the limb (Table 2), up to the development of gangrene (see) .

Each wound To. it is followed by bleeding (see), the K-roe can be primary (at the time of injury of a vessel or immediately after it), and secondary, a cut, in turn, is divided into early and later. Early secondary bleeding occurs during the first day after injury and may be the result of an increase in blood pressure, improved blood circulation, etc. Late secondary bleeding that develops after 7 or more days may occur as a result of infection of the wound passing to the wall of the K.s. The cause of secondary bleeding can also be foreign bodies that are close to the wall of the K.s.

Diagnosis of damage to the main To. in most cases it is put on the basis of the expressed wedge, pictures, especially at lateral wounds. It is more difficult to recognize complete ruptures of the vessel, since the screwing of the inner lining of the artery contributes to the spontaneous arrest of bleeding, and due to the divergence of the ends of the artery, these injuries are often not recognized even during surgical treatment of the wound. The greatest number of diagnostic errors occurs with closed vascular injuries. With such injuries, only the inner and middle membranes of the vessel are often damaged with impaired blood flow, which is not always easy to recognize even during the revision of the vessel during the operation. In certain cases, especially at the closed injury, there is a need for carrying out an arteriography, edges allows to reveal nature, prevalence and localization of damage, and also to choose a method of operational treatment and its volume. The diagnosis of spasm or compression of the artery should also be substantiated by arteriography or revision of the vessel during surgery. wound treatment.

The first action at treatment of wounds To. is a temporary stop of bleeding. For this purpose use a pressure bandage (see), pressing To. throughout with the help of a finger, closing the hole in the wound with fingers inserted into the wound according to N. I. Pirogov, applying a demeure clamp and tamponade of the wound with gauze swabs (see Tamponade). In addition, general hemostatic agents (10% solution of calcium chloride, vitamin K, fibrinogen, etc.) can be used.

After applying one of the temporary methods of stopping bleeding, in most cases there is a need for a final stop of bleeding. The methods of the final stop of bleeding include: ligation of the artery in the wound or throughout and the imposition of a vascular suture (see) or a patch on a defect in the artery wall. Two facts established by domestic surgeons during the Second World War should be taken into account: ligation of the main arteries of the extremities in 50% of cases led to their gangrene, and reconstructive operations, in particular, vascular suture, were possible only in 1% of operations on vessels.

In peacetime, surgical treatment should be aimed at restoring the main blood flow. An effective restorative operation can be performed in case of trauma To. at different times: from several hours to several days. The possibility of surgical intervention should be judged by the state and changes in tissues in the area of ​​ischemia and damage. Recovery operations for trauma To. can be extremely varied. The main type of surgical intervention in case of damage to the arterial trunks is a manual lateral or circular suture; At complication of an injury To. widespread thrombosis, it is necessary to pre-produce thrombectomy (see) from the central and distal ends of the damaged artery. With combined damage to large arterial and venous trunks, one should strive to restore the patency of both K. s. This is especially important in severe limb ischemia. Ligation of the main vein under such conditions, even when full arterial blood flow is restored, significantly contributes to the regression of ischemia and, causing venous blood stasis, can lead to thrombosis in the arterial suture. In case of arterial injuries accompanied by a large tissue defect, the replacement of the artery defect with a synthetic corrugated prosthesis or autovein is used (Fig. 26 and 27).

Staged treatment

In military field conditions, the first medical aid on the battlefield (in the lesion) in cases of external bleeding is reduced to its temporary stop. Stopping bleeding begins with finger pressing of blood vessels in typical places, then apply pressure bandage. If bleeding continues, a tourniquet is applied (see Hemostatic tourniquet). In the absence of fractures, forced flexion of the limb can be used, the edges should be bandaged to the body.

First aid includes control and change of tourniquets from improvised means to standard ones.

During first aid (PMP), the wounded with continued bleeding, with bandages soaked with blood, and with tourniquets are sent to the dressing room. Apply the following ways to temporarily stop bleeding: applying a pressure bandage; tamponade of wide wounds, if possible, stitching the edges of the skin over the tampon, followed by the application of a pressure bandage; clamping the vessel visible in the wound, and its subsequent ligation; if it is impossible to stop the bleeding by the listed methods, a tourniquet is applied. Under the tourniquet on the limb on the side opposite to the location of the vascular bundle, a plywood tire wrapped with cotton should be placed. Above the level of the tourniquet, local anesthesia is performed (conduction or case blockade). Enter analgesics. After a temporary stop of bleeding, immobilization is used. Upon admission of the wounded with tourniquets, the validity and correctness of their application are monitored: novocaine blockade is performed above the tourniquet, the vessel above the tourniquet is pressed with fingers, the tourniquet is slowly relaxed. With the resumption of bleeding, you should try to stop it by the listed methods without the use of a tourniquet; if this fails, then the tourniquet is applied again. All harnesses from improvised means are replaced with service ones. If, after removing the tourniquet, the bleeding does not resume, then a pressure bandage is applied to the wound, and the tourniquet is left on the limbs untightened (provisional tourniquet). With rigor mortis of the muscles of the limb, removal of the tourniquet is contraindicated.

All wounded with temporarily stopped bleeding are subject to evacuation in the first place.

At qualified assistance(MSB), in the process of medical sorting, the following groups of the wounded are identified: with applied tourniquets; with severe blood loss; with uncompensated ischemia; with compensated ischemia.

With a minimum and reduced amount of assistance, the wounded are sent to the dressing room with tourniquets, massive blood loss and uncompensated limb ischemia. Antishock measures in this group are usually carried out in parallel with surgical treatment.

With full assistance, all those admitted with vascular injuries are sent to the dressing room, except for the wounded with compensated ischemia without a history of bleeding, who are expedient to be sent to hospital facilities in the first place for assistance.

If the limb is in a state of rigor mortis due to the imposition of a tourniquet, it is subject to amputation at the level of the tourniquet.

When providing qualified assistance, the final stop of bleeding is shown with the restoration of the patency of the vessel by suturing (under appropriate conditions).

In the conditions of a difficult medical and tactical situation, as well as in the absence of surgeons who know the technique of a vascular suture, it is necessary to ligate the vessel with a number of precautions to avoid gangrene of the limb (see Vascular collaterals, Ligation of blood vessels). The ligation of the vessel is also allowed in case of its large defects, requiring long labor-intensive plastic surgeries.

In hospitals in the process of honey. sorting reveal the following categories of the wounded: 1) wounded with restored vessels, the Crimea continues treatment, and at indications make repeated recovery operations; 2) the wounded with dead limbs, the Crimea determine the level of necrosis and truncate the limb; 3) wounded with temporarily stopped or self-stopped bleeding, in which the vessels, when providing qualified assistance, were not restored due to the conditions of the situation; they are undergoing remedial operations.

Recovery operations are contraindicated in the general serious condition of the wounded, with the development wound infection, in the midst of radiation sickness.

In hospitals, the wounded are also operated on for secondary bleeding, festering hematomas and aneurysms (mainly the vessel is ligated throughout).

Operations for traumatic aneurysms (hematomas), as well as the restoration of ligated vessels, should be performed as early as possible, because subsequently, due to the development of collaterals, the distal part of the damaged vessel narrows sharply, as a result of which the restoration of the main blood flow often becomes impossible, while collaterals during excision, aneurysms are destroyed and the blood circulation of the limb deteriorates sharply.

At operations concerning damages of vessels of various localization it is necessary to remember a number of anatomic and a wedge, features which knowledge will allow to avoid emergence of serious complications.

Injuries to the subclavian vessels are often combined with trauma to the brachial plexus, which often leads to diagnostic errors, since movement and sensitivity disorders due to ischemia are regarded as an injury to the nerve trunks. In order to avoid massive bleeding that is difficult to stop, in order to create a good operative access, it is necessary to cut or resect a part of the clavicle for the duration of the operation, followed by its implantation.

In case of injuries of axillary vessels, it is necessary to carefully examine all veins, and ligate damaged venous trunks to avoid air embolism (see) or thromboembolism (see).

The brachial artery has an increased propensity for prolonged spasm compared to other arteries, which can sometimes cause no less serious circulatory disorders of the limb than with a complete interruption of the artery. During operations on this vessel, mandatory local application of novocaine and papaverine is necessary.

If one of the arteries of the forearm is injured, there is no need for a reconstructive operation, the ligation of the vessel is safe.

Extensive damage to the iliac arteries most often requires alloplasty. It is advisable, unlike operations on other segments, to strive to restore the iliac veins, since in this anatomical region there are not always sufficient detours of blood outflow.

Damage to the femoral artery is most dangerous in the zone of the adductor (Hunter's) canal and often leads to gangrene of the limb. With simultaneous damage to the femoral and great saphenous veins, it is necessary to restore one of the venous outflow collectors.

Damage to the popliteal artery in 90% of patients is accompanied by gangrene of the lower leg. Along with the emergency restoration of the artery, it is advisable to restore the damaged vein, since venous stasis contributes to the development of severe ischemic tissue edema, which can cause re-ischemia after the restoration of arterial patency. To avoid this complication, the restoration of the popliteal vessels in uncompensated ischemia should end with the dissection of the fascial sheaths of the leg muscles.

Damage to the arteries of the lower leg is usually accompanied by a spasm that extends to the entire arterial network of the segment. In such cases, the use of antispasmodics is indicated, and with an unremovable spasm - fasciotomy.

The literature discusses the technique of temporary vascular prosthesis, which, according to some authors, can allow the restoration of blood vessels in two stages: at the stage of qualified assistance, the restoration of blood flow with the help of temporary prosthesis and at the stage of rendering specialized care final restoration of the vessel. It is difficult to count on the successful implementation of this method, since the exposure of the damaged ends of the vessel and their processing for effective prosthetics require such a degree of skill from the surgeon, which also allows restoration of the vessel. In addition, temporary prosthetics during a long evacuation may be complicated by thrombosis of the prosthesis, prolapse of the end of the prosthesis from the vessel and resumption of bleeding. However, temporary prosthetics is undoubtedly an appropriate measure during a reconstructive operation, since it allows to reduce the duration of ischemia, restore the normal color of the tissues and provide a more radical treatment of the wound.

(see), post-thrombotic disease, varicose veins (see). In surgical practice, most often there are patients suffering from atherosclerotic lesions of the aorta and large main arteries of the extremities, as well as organ vessels (renal, mesenteric and celiac arteries). The defeat of the main arteries of the extremities is accompanied by ischemia of the corresponding area, characterized by pallor of the skin, pain, limited mobility and trophic disorders, which in some cases turn into gangrene (see).

Narrowing of the carotid arteries leads to cerebral ischemia. The severity of the manifestation of the disease and its prognosis depend on which artery is switched off from the bloodstream, as well as on the degree of development of collateral circulation.

The narrowing of the renal artery due to atherosclerosis, arteritis or fibromuscular dysplasia is accompanied by persistent arterial hypertension (see Arterial hypertension), which is sometimes malignant (renovascular hypertension) and not amenable to conservative treatment.

The narrowing of the vessels of the mesentery is accompanied by a clinic of abdominal angina with sharp pains in the abdomen and dyspeptic disorders (see. Abdominal toad).

Acute thrombosis or embolism of the arterial trunks of the extremities or the terminal aorta is accompanied by signs of acute ischemia of the extremities. Embolism is more often observed in women, acute thrombosis - in men due to their greater susceptibility to atherosclerotic lesions of the arteries. Acute thromboses and embolisms often affect the bifurcation of the aorta and the vessels of the lower extremities; vessels of the upper extremities are much less often affected.

Post-thrombotic disease is a disease that develops as a result of a deep vein thrombosis. Morfol, its basis is structural lesions of deep veins in the form of re-canalization or their occlusion. In the pathogenesis of post-thrombotic disease, disturbances in venous blood return due to perverted blood flow through deep, perforating and superficial veins, microcirculatory shifts and insufficient lymph circulation play a role. According to the wedge, the picture distinguishes edematous, edematous-varicose, varicose-trophic and trophic forms. There are stages of compensation, sub-compensation and decompensation. The diagnosis is made on the basis of anamnestic data, a wedge, symptoms and phlebographic studies. The course is chronic. Indications for surgical treatment are trophic changes in the skin and secondary varicose veins of the superficial veins, subject to recanalization of the deep veins of the leg. It consists in total or subtotal ligation of the perforating veins of the lower leg, supplemented by the removal of only varicose veins. Segmental lesions of the iliac and femoral veins may be an indication for bypass shunting and replacement surgery for the edematous form of the disease. Regardless of the operation performed, it is necessary to continue conservative treatment; physiotherapeutic procedures, elastic compression, drug therapy, dignity. treatment.

Tumors

Tumors (angiomas) repeat the structure of vessels - arteries, veins, capillaries, or are derived cells that form special structures in the vascular walls.

Vascular tumors occur at any age regardless of gender. Their localization is different: skin, soft tissues, internal organs, etc. In the development of vascular tumors, great importance is attached to dysembryoplasia in the form of splitting off of angioblastic elements, which in the embryonic period or after birth begin to proliferate, forming malformed vessels of different structures. Tumors develop on the basis of these dysembryoplasias or without connection with them.

There are benign tumors: hemangioma (see), endothelioma (see), differentiated hemangiopericytoma (see), glomus tumors (see), angiofibroma (see) and malignant: malignant angioendothelioma (see), malignant (undifferentiated) Hemangiopericytoma .

A wedge, displays depend on the sizes and localization of a tumor. Malignant tumors give hematogenous metastases.

Treatment is surgical, cryotherapy, radiation.

Operations

In the 20th century vascular surgery achieves significant success, which is associated with the introduction of special instruments into practice, the improvement of the vascular suture (see), the development of radiopaque research methods, and the creation of specialized institutions. Common to all operations on K. s., in addition to the usual conditions necessary for any intervention, are measures that prevent bleeding and other dangerous consequences - thrombosis of K. s., ischemic changes in the tissues of a limb, organ or area of ​​​​the body that are supplied with blood through this vascular pathway. In this regard, the method of preparing the patient for surgery and the features of postoperative management are of great importance. Dangerous consequences of blood loss are prevented by blood transfusion (see) into a vein or artery. Therefore during each operation on To. it is necessary to have a supply of preserved blood and blood-substituting fluids (see).

Since, along with the dangers of bleeding and the consequences of blood loss (see) during operations on K. s. possible occurrence of a thrombus in the lumen of the vessel and embolism, it is necessary to determine the parameters of blood coagulation before and after surgery. In case of increased blood clotting, anticoagulants should be prescribed in the preoperative period.

At operations on To. apply various methods of anesthesia, but most often inhalation anesthesia (see). For special indications, use

Rice. Fig. 28. Schematic representation of operations to restore the main blood flow in case of segmental occlusion of the arteries: a - bypass shunting; b - endarterectomy; c - resection of the clogged segment of the artery with its prosthetics (1 - clogged section of the artery, 2 - graft, 3 - dissected section of the artery, 4 - removed section of the artery).

Indications for operations on K. s. are diverse, but segmental occlusions of the arteries with the patency of the vessel above and below the site of blockage most often serve as indications for operations on the arteries. Other indications are injuries to K. with., their tumors, varicose veins, pulmonary embolism, etc. Restoration of the main blood flow is achieved by resection of the clogged segment of the artery with its prosthesis, bypass shunting and endarterectomy (Fig. 28).

For prosthetics To. autovein and synthetic prostheses are widely used. The disadvantage of an autovein is its low suitability for prosthetics of large-caliber arteries due to the lack of veins of the appropriate diameter, which could be resected without great damage to the body. Besides, gistol, researches in the remote postoperative period showed that the autovein is exposed sometimes to connective tissue degeneration that can be the reason of thrombosis of a vessel or formation of an aneurysm.

The use of synthetic prostheses has fully justified itself in prosthetics of the aorta and large diameter arteries. When prosthetics of arterial vessels of smaller diameter (femoral and popliteal arteries), the results were much worse, because in these areas there are more favorable conditions for the occurrence of thrombosis. In addition, the lack of proper elasticity and extensibility of the prosthesis leads to frequent thrombosis, especially if the graft crosses the joint line.

Another type of intervention aimed at restoring the main blood flow is endarterectomy. The first endarterectomy was made by R. Dos Santos (1947). Endarterectomy methods can be conditionally divided into closed, semi-open and open. The method of closed endarterectomy is that the operation is performed with a special tool from a transverse section of the artery. A semi-open endarterectomy is the removal of the inner lining from several transverse incisions in an artery. Open endarterectomy involves the removal of the modified inner membrane through a longitudinal arteriotomy over the site of occlusion.

Endarterectomy by the eversion method has been introduced into practice, the essence of which is that after the artery is isolated and the site of occlusion is crossed distally, atherosclerotic plaques are exfoliated with a special tool along with the changed inner membrane, the outer and middle membranes are turned inside out to the end of the plaque. After that, the artery is screwed back again and anastomosed with a circular manual or mechanical suture. The indication for this method of endarterectomy is segmental atherosclerotic occlusion of insignificant extent.

In case of widespread atherosclerotic occlusions without severe destruction of the vessel walls, endarterectomy is performed using the eversion method, followed by reimplantation of the vessel. In this case, the entire affected area of ​​the arterial trunk is resected. Next, endarterectomy is performed using the eversion method. After reverse screwing of the artery, the formed autograft is checked for tightness and end-to-end is sutured back to its original place by two anastomoses.

Significant extent of occlusion with wall destruction (calcification, ulcerative atheromatosis), arteritis or vessel hypoplasia are indications for autotransplantation with explantation. At this method the transplant consisting of a synthetic prosthesis is used, and in places fiziol, folds, for example, under an inguinal sheaf, the autoartery is located. The main advantage of this method is that in the place of the greatest traumatization of the vessel (hip, knee, shoulder joints), not an alloprosthesis passes, but an autoartery.

The issues of surgical treatment are widely developed arterial hypertension associated with occlusive lesions of the renal arteries. The choice of surgical intervention for this disease depends on the cause and nature of the lesion. The method of transortal endarterectomy is applicable only for atherosclerosis, when there is a segmental lesion of the mouth of the renal arteries. Since atherosclerosis is the most common cause renovascular hypertension, then this method is most widely used. With fibromuscular dysplasia, since patol, the process can be of a diverse nature (tubular, multifocal, etc.), the range of surgical interventions is much wider and includes autoarterial prosthetics of the renal artery, its resection with end-to-end anastomosis and reimplantation of the renal artery orifice. With a widespread lesion of the renal artery on the basis of arteritis, the most expedient operations remain resection of the renal artery with its prosthesis and aortorenal bypass surgery. An autoarterial graft from the deep femoral artery is used as a plastic material.

Reconstructive operations on the branches of the aortic arch are one of the new and unique types of vascular surgery. Segmental occlusions located in the proximal parts of the arterial bed are the most accessible for surgical correction. The main type of reconstruction for both stenosis and complete blockage of the brachiocephalic branches is endarterectomy.

Resection of the affected area of ​​the artery with its plasty is permissible only in the initial sections of the innominate, common carotid and subclavian arteries (before branches depart from them). For the success of surgical treatment of this pathology, the correct choice of surgical access to the branches of the aortic arch is of great importance.

Methods of operations on the veins and their features are given in special articles (see Varicose veins, Ligation of blood vessels, Thrombophlebitis, Phlebothrombosis).

In the postoperative period, the most important measures are the prevention of inflammatory complications, thrombosis and embolism. Anticoagulants (most often heparin) are used 24 hours after surgery. Heparin is administered intravenously at a dose of 2500-3000 IU every 4-6 hours. within 3-5 days. It is desirable to maintain the blood coagulation time according to Burker within 7-8 minutes.

Results of surgical treatment of wounds and diseases To. generally favorable.

In the treatment of congenital anomalies To. (aneurysms, arteriovenous anastomoses) almost no lethality and ischemic complications occur, which is associated with adequate development of collateral circulation in these cases and good development of methods of surgical interventions.

The results of surgical treatment of benign tumors To. depend on the location and extent of the lesion. Complete cure of extensive skin hemangiomas in some cases can not be achieved. Surgical treatment of malignant angiomas cannot be considered satisfactory due to rapid growth, recurrence and metastasis. The results of treatment of endarteritis depend on the severity of the process. Treatment of thrombophlebitis in connection with the introduction of active anticoagulants and improvement surgical methods improved significantly.

Further progress in vascular surgery largely depends on the introduction of new methods into practice. early diagnosis diseases To. and improvement of operational methods of treatment, and first of all microsurgery (see).

tables

Table 1. CLASSIFICATION OF GUN SHOT WOUNDS OF THE VESSELS BY THE TYPE OF THE DAMAGED VESSEL AND THE CLINICAL NATURE OF THE WOUND (from the book "The experience of Soviet medicine in the Great Patriotic War 1941 - 1945")

Table 2. CLASSIFICATION, DIAGNOSIS, PROGNOSIS AND TREATMENT OF ISCHEMIA IN LIMB VESSEL INJURIES (according to V. A. Kornilov)

Bibliography:

Anatomy- Vishnevsky A. S. and Maksimenkov A. N. Atlas of the peripheral nervous and venous systems, L., 1949; Grigoryeva T. A. Innervation of blood vessels, M., 1954, bibliogr.; Dogel I. M. Comparative anatomy, physiology and pharmacology of blood and lymphatic vessels, vol. 1-2, Kazan, 1903 -1904; D about l-go-Saburov B. A. Essays on the functional anatomy of the vascular system, L., 1961, bibliogr.; Kupriyanov V. V. Ways of microcirculation, Chisinau, 1969, bibliogr.; Chernukh A. M., Aleksandrov P. N. and Alekseev O. V. Microcirculations, M., 1975, bibliogr.; Angiology, hrsg. v. M. Ratschow, Stuttgart, 1959; Blood vessels and lymphatics, ed. by D. I. Abramson, N. Y.-L., 1962; Cliff W. J. Blood vessels, Cambridge, 1976, bibliogr.; The peripheral blood vessels, ed. by J. L. Orbison a. D. E. Smith, Baltimore, 1963.

Pathology- Askerkhanov R.P. Surgery of peripheral veins, Makhachkala, 1973; Vishnevsky A. A. and Shraiber M. I. Military field surgery, M., 1975; Zaretsky V. V. and V y x about in with to and I am A. G. Clinical thermography, M., 1976, bibliogr.; Zorin A. B., Kolesov E. V. and Silin V. A. Instrumental methods for diagnosing heart defects and blood vessels, L., 1972, bibliogr.; And with and to about in Yu. F. and T and-x about N about in Yu. A. Inborn defects of peripheral vessels at children, M., 1974, bibliogr.; Clement A. A. and Vedensky A. N. Surgical treatment of diseases of the veins of the extremities, L., 1976; Knyazev M. D. and B e l about r at with about in O. S. Acute thromboses and embolisms of bifurcation of an aorta and arteries of extremities, Minsk, 1977, bibliogr.; Kornilov V. A. and Kostyuk G. A * Long-term results of treatment of injuries of the main arteries of the extremities, Vestn, hir., t. 116, No. 2, p. 127, 1976; Krakovsky N. I. and Taran about vich V. A. Hemangiomas, M., 1974, bibliogr.; Lytkin M.I. and K o l about m and e c V.P. Acute trauma of the main blood vessels, L., 1973, bibliogr.; Milov anov A. P. Pathomorphology of angiodysplasia of the extremities, M., 1978; The experience of Soviet medicine in the Great Patriotic War of 1941 - 1945, v. 19, p. 26, M., 1955; Petrovsky BV Surgical treatment of vascular wounds, M., 1949, bibliogr.; about N e, Our experience in emergency vascular surgery, Khirurgiya, No. 4, p. 9, 1975; Petrovsky B.V., Belichenko I.A. and Krylov V.S. Surgery of the branches of the aortic arch, M., 1970, bibliogr.; Petrovsky B. V., To N I z e in M. D. and With to at and-n I am M. A. Operations at chronic occlusions of an aortofemoral zone, Khirurgiya, No. 1, p. 12, 1971; Reconstructive surgery, ed. B. V. Petrovsky, p. 107, M., 1971; Guidelines for the pathoanatomical diagnosis of human tumors, ed. N. A. Kraevsky and A. V. Smolyannikov, p. 57, M., 1976, bibliography; Savelyev V. S., D at m-p e E. P. and I b l about to about in E. G. Diseases of the main veins, M., 1972; Lehrbuch der Rontgendiagnostik, hrsg. v. H. R. Schinz u. a., Bd 4, Vol. 1, Stuttgart, 1968; Lou Gibson H. Photography by infrared, N. Y., 1978; L u z s a G. X-ray anatomy of the vascular system, Budapest, 1974; Vascular surgery, ed. by R. B. Rutherford, Philadelphia, 1977.

B. V. Petrovsky, M. D. Knyazev, V. S. Saveliev; I. I. Deryabin, V. A. Kornilov (military), Yu. F. Isakov, Yu. A. Tikhonov (det. hir.), V. V. Kupriyanov (an.), I. G. Olkhovskaya ( onc.), H. E. Yarygin (stalemate. An.).

Blood vessels (vasa sanguifera, vaea sanguinea)

form a closed system through which the blood of the heart is transported to the periphery of all organs and tissues and back to the heart. Arteries carry blood away from the heart, and veins return blood to the heart. between arterial and venous departments of the circulatory system there is a microvasculature connecting them, including arterioles, venules, ( cm. microcirculation) .

ANATOMY AND HISTOLOGY

Blood supply to all organs and tissues in the human body is carried out through the vessels of the systemic circulation ( rice. one ). It starts from the left ventricle of the heart (Heart) with the largest arterial trunk - the aorta (Aorta) and ends in the right atrium, into which the largest venous vessels of the body flow - the superior and inferior vena cava. Arteries are vascular tubes lined from the inside with endothelial cells, together with the underlying tissue layer (subendothelium) forming the inner membrane. The middle, or muscular, membrane of the arteries is separated from the internal by a very thin internal elastic membrane. built from smooth muscle cells. Closer to the internal elastic membrane lie muscle cells of an almost circular direction. Then they follow more and more obliquely, and finally many of them acquire a longitudinal direction. The totality of all muscle elements has strands running in a spiral ( rice. 2 ). At the same time, the number of layers of the spiral in children is less than in adults. The degree of helix inclination also increases with age. This structure of the muscular membrane provides blood in a spiral (twisted), which improves the efficiency of hemodynamics and is energy efficient.

On top of the muscular membrane lies the outer elastic membrane, consisting of bundles of elastic fibers. It does not have barrier functions and is intimately associated with the adventitia (outer membrane), rich in small vessels, feeding the wall of the artery, and nerve endings. The outer shell is surrounded by loose connective tissue. The main arteries, together with the satellite veins and their accompanying nerve ( neurovascular) are usually surrounded by a fascial sheath.

Depending on the severity of the tissue elements of the wall, arteries of the elastic type (), muscular type (for example, arteries of the limbs) and mixed (carotid arteries) are distinguished. By the nature of branching, arteries of the main and loose types are distinguished. The topography of the arterial trunks is subject to certain rules that have the meaning of laws. First of all, arteries follow the shortest path, i.e. are straight forward. The number of main arteries often correlates with the number of axial bones of the skeleton. In the region of the joints of the extremities, multiple branches depart from the main arteries, forming plexuses around the joints. The larger the volume of the organ and its, the larger the blood supplying it. For example, it consumes a maximum of oxygen, so blood delivery to it must be continuous and significant in volume. A high arterial index is characteristic of the kidneys, through which a large mass of blood passes.

terminal arteries gradually pass into arterioles, the wall of which loses 3 shells. the arteriole is bordered by a single layer of muscle cells that wrap around the vessel in a spiral. Outside of the muscle cells lies a layer of loose connective tissue, consisting of bundles of collagen fibers and adventitial cells. Giving up precapillaries or losing muscle cells, it turns into a typical one. The precapillary, or precapillary arteriole, is a vascular tube connecting the capillary to the arteriole. Sometimes this part of the microcirculation is called the precapillary sphincter. Arterioles and precapillaries regulate the filling of capillaries with blood, in connection with which they are called "faucets of regional blood circulation."

Capillaries are the thinnest-walled vessels; they are the basic units of peripheral blood flow. After passing the capillaries, the blood loses and takes carbon dioxide from the tissues. Through the venules, it rushes into the veins, first into the collecting veins, and then into the outlet and main veins. In addition to the main ones, plexus-like veins (for example, in the wall of the stomach), arcade (for example, veins of the mesentery of the intestine), spiral (in particular, in the uterine mucosa), throttle, equipped with additional muscle cuffs (for example, in the adrenal gland), villous (in choroid plexuses ventricles of the brain), muscleless (diploic, hemorrhoidal, sinusoidal), etc. The wall of the veins does not have a distinct layering, the boundaries between the membranes are poorly expressed. Middle shell poor in muscle cells. Only the portal vein has a massive muscular membrane, which is why it is called the "arterial vein". The wall of the vein is thinner, does not differ in elasticity and is easily stretched. The speed of blood flow through the veins and the pressure in them is much lower than in the arteries.

In the lumen of many veins there are valves - folds of the inner shell, resembling a swallow's nest in shape ( rice. 3 ). Typically, the valve flaps are opposite each other. The valves in the veins of the lower extremity are especially numerous. The division of the blood stream into intervalvular segments promotes its movement towards the heart and prevents its reflux.

All veins, with the exception of the main veins, are connected into plexuses due to multiple anastomoses (anastomoses), which can be located outside the organs (extraorganic venous plexuses) and inside them, which creates favorable conditions for the redistribution of blood. The intraorganic liver is distinguished by the fact that two venous systems meet in it. The portal vein delivers nutrient-rich blood. Its branches end in sinusoidal capillaries, in which the connection of venous and arterial blood takes place. In the liver lobules, these capillaries merge into the central veins, with which the hepatic veins begin, which drain venous blood from the liver into the inferior vena cava, and through it into.

The pulmonary circulation begins with the pulmonary trunk from the right ventricle of the heart. As a result of the division of the pulmonary trunk, the right and left pulmonary arteries are formed, delivering venous blood to the lungs, which gives off carbon dioxide in the lungs and is saturated with atmospheric oxygen, passing through the capillaries of the alveoli. Venules are harvested from capillaries arterial blood, which fills the system of pulmonary veins flowing into the left,

The heart is supplied with blood through the right and left coronary (coronary) arteries (the first branches of the aorta), the outflow of blood from the tissues of the heart through several veins takes place in the inflow of the right atrium.

In the vascular system of the body, in addition to arterial and venous fistulas, there are anastomoses between the branches of the arteries and the tributaries of the veins. They are called arteriovenous anastomoses, which is not entirely accurate, because. such communications are at the level of arterioles and venules and should be called arteriovenular anastomoses. Their presence creates conditions for extracapillary (juxtacapillary) blood flow, which is of auxiliary importance in microhemodynamics. blood through these anastomoses contributes to the unloading of the capillary bed, increases the propulsive power of the veins and improves thermoregulation.

Vascular collaterals are individual vessels or groups of them capable of carrying blood, usually in the same direction in which it follows through the main vessels. This is an additional, auxiliary bloodstream that provides collateral, or roundabout,. There are roundabout arterial, venous and lymphatic vessels. They should not be presented as single, rectilinear arteries or veins running parallel to the main vascular highways. Often, collateral blood flow occurs through chains of arteries or veins that connect (anastomose) to each other at various conditions. A classic example of collateral vessels can be the connections of the branches of the deep artery of the shoulder with the branches of the radial artery, which allow compensating for the consequences of compression or obstruction of the brachial artery below the level of origin of the deep artery of the shoulder ( rice. four ). In case of obstruction of blood flow through the inferior vena cava, the blood finds extremely difficult paths to the heart. Many cavo-caval and portocaval anastomoses are included, for example, the veins of the anterior abdominal wall ("") expand, where the tributaries of the superior and inferior vena cava meet. Vascular collaterals can be divided into intrasystemic (through anastomoses of branches of the same artery or tributaries of the same vein) and intersystemic (for example, through anastomoses of the anterior and posterior intercostal arteries).

In the case of occlusion of the main vascular trunk, vascular collaterals develop primarily inside the muscles, a little later they are found in the fascia, periosteum, along the nerves. All possible circuitous communications are mobilized and new collateral ways are formed. The development of vascular collaterals occurs under the influence of increased blood pressure in the arteries proximal to the site or occlusion of the vessel. In the veins, when the outflow of blood is disturbed, the pressure increases distally from the site of occlusion. The lack of blood in the ischemic area is also important for activating the growth of new vessels. The so-called is based on this.

EXAMINATION METHODS

Examination of a patient with a disease To. begins with the study of history, examination, palpation and auscultation. When clarifying the conditions of life and work of the patient, they pay special attention to factors that can contribute to the development of K.'s diseases, especially smoking, hypothermia, and work associated with prolonged stay on the legs. When analyzing complaints, the presence of a feeling of chilliness in the lower extremities, rapid fatigue when walking, the appearance of pain in the legs, paresthesia, and swelling in the legs by the end of the day are noted.

The patient is examined in the supine and standing position, while comparing the symmetrical parts of the body and especially the limbs, noting their configuration, skin, the presence of areas of pigmentation and hyperemia, the pattern of the saphenous veins, the presence of expansion of the superficial veins and their localization and prevalence.

Palpation of the pulse on the main arteries in each case should be carried out at all points of the vessels accessible for palpation on both sides. Usually determined on the radial arteries and arteries of the feet. With swelling, the study of the pulse is difficult. K. s. reveals an aneurysmal dilatation of an arterial vessel. K. s. is of great diagnostic value - with stenosis, it is heard of varying intensity. The presence of a stenotic process is also indicated by an increase in the gradient on the limbs over 20 mmHg st. In thrombosis and obliterating diseases of the vessels of the extremities, it is important to determine the state of the peripheral circulation. For this, several functional tests. The most common samples are Oppel, Samuels and Goldflam.

Oppel's test: the lying patient is asked to raise the extended lower limbs by 45 ° and hold them in this position for 1 min; with insufficiency of peripheral circulation in the area of ​​\u200b\u200bthe sole, blanching appears, which is normally absent.

Samuels test; a lying patient is offered to raise both extended lower limbs by 45 ° and do 20-30 flexion-extensor movements in the ankle joints; blanching of the soles and the time of its onset indicate the presence and severity of peripheral circulatory disorders. To conduct the Goldflam test, the same technique is used; however, take into account the time of appearance of muscle fatigue on the side of the lesion.

If you have varicose veins (Varicose veins) lower extremities, it is necessary to assess the condition of the valvular apparatus of the veins and the patency of the deep veins. The Troyanov-Trendelenburg test allows you to determine the state of the inlet valve of the great saphenous vein of the leg: in the supine position, raises the leg until the saphenous veins are completely emptied. After that, a rubber tourniquet is applied to the upper third of the thigh. Then the patient is offered to stand up, and the tourniquet is removed. In the presence of valve insufficiency, retrograde filling of varicose veins is noted. A “cough push” test is also used, which is considered positive if, during the coughing of the patient, a slight push is detected by palpation in the projection of the mouth of the great saphenous vein.

The state of deep veins is especially important to assess before the operation of excision of varicose saphenous veins. To do this, a Delbe-Perthes march test is carried out, the soloist is asked to walk with a tourniquet applied to the upper third of the lower leg. With good patency of the deep veins, the superficial veins empty.

For a more complete analysis of the state To. in the hospital, instrumental research methods are used. Of the non-invasive methods, the most important role in the diagnosis of obliterating diseases of the arteries of the extremities, ultrasound methods play: Doppler ultrasound, ultrasound with spectral analysis of the Doppler signal. Informative is the determination of segmental pressure at various levels of the main arteries, as well as the definition of the ankle index - the ratio of segmental pressure on the foot to the pressure on the radial artery (normally 1-1.2).

When examining patients with diseases of the veins of the extremities, occlusive plethysmography, phlebotonometry and radionuclide methods for studying muscle blood flow are used. Register in the position of the patient lying and walking. This allows you to evaluate the function of the so-called musculo-venous pump of the leg.

The most complete information about the state of K. s. can be obtained with an X-ray contrast study - angiography (Angiography) , which is performed mainly in surgical departments. Changes in the aorta and its large branches are detected using aortography - an X-ray contrast study of the aorta. A radiopaque substance is injected into the lumen of the aorta either by puncturing it with translumbar access ( translumbar), or (much more often) using percutaneous catheterization through the femoral artery. Computed tomography (CT) is used to diagnose diseases of the large arteries (such as aortic aneurysms) . To estimate a condition of an internal cover To. with various diseases during the operation, in some cases it helps, carried out with the help of a special endoscope.

PATHOLOGY

Malformations(angiodysplasia) occur on early phases formation of the vascular system of the embryo - in the period from 4 to 6 weeks. intrauterine development. The frequency of vascular malformations, according to various authors, ranges from 1 in 50,000 to 1 in 500,000.

Capillary dysplasia - red vascular spots that do not rise with the skin and do not show a tendency to grow. angiomas differ in structure and increase in size, synchronous with the age of the child. capillary dysplasia presents significant difficulties due to the resistance of capillaries to cryogenic, chemical, radiation, surgical, laser exposure.

In the clinical picture of malformations of superficial veins, the most important symptom is their varicose expansion. over varicose veins can be thinned, has a bluish color. In some cases, it loses its natural shape. Phleboliths are sometimes palpated in the area of ​​varicose veins. Characteristic of these venous dysplasias is "sponges" - a decrease in the volume of the limb when it is squeezed at the location of the viciously developed vessels, due to the outflow of blood from the dilated veins. The progression of the pathological process leads to the development of contractures, which is associated with damage to muscle tissue, and sometimes bones. In this case, there are no veins and venous nodes. is based on angiographic data, which reveals dilated tortuous veins and accumulations of a radiopaque substance in the form of "lakes", "lacunae". Treatment of malformations of superficial veins is only surgical, it consists in the maximum excision of malformed vessels and affected tissues. favorable with timely treatment.

Phlebectasia of the internal and external jugular veins, sometimes bilateral, manifests itself during exercise in the form of bulges in front of the sternocleidomastoid muscle and behind it. Upon termination of the load, venous bulging disappears. With phlebectasia of the external jugular veins, pathologically altered areas are excised. With phlebectasia of the internal jugular veins, the expanded part of the vein is wrapped with a nylon mesh or a polyurethane spiral.

The clinical picture of the malformation of the deep veins of the lower extremities is dominated by a triad of symptoms - varicose veins of the superficial veins without their pulsation, elongation and thickening of the limb, the presence of vascular or age spots. Sometimes edema is noted, hypertrichosis is possible, as well. In the diagnosis, angiography takes the leading place, which makes it possible to reveal the absence of deep veins, the presence of wide laterally located embryonic veins, due to which the outflow of venous blood from the affected limb is carried out. Arterial vessels, as a rule, are not changed.

Treatment of malformations of deep veins of the lower extremities is surgical, aimed at restoring blood flow in them. It should be carried out at the age of 3-4 years. In cases where it is started later, it will only be possible to stop the process of formation of venous insufficiency. With hypoplasia of the veins and their external compression, they are carried out, which allows you to normalize blood flow. With pronounced hypoplasia or aplasia, the affected area is excised using microsurgical techniques and replaced with a graft of the great saphenous vein taken from the other side. It is also possible to move the superficial vein into the preserved fragment of the deep, fragment of the autovein with a valve. All these interventions contribute to the normalization of blood flow, the elimination or stabilization of the process. The prognosis for timely treatment is favorable.

Congenital arteriovenous dysplasia is manifested by local and general symptoms. Locally, an increase in the limb in volume, its lengthening, an increase in temperature, pulsation of the veins, synchronous with the arterial pulse, the presence of systolic-diastolic noise over the projection of arteriovenous communications are observed. Often there are trophic ulcers and bleeding. Vascular spots, usually bright pink in color, may be visible on the skin. General symptoms associated with an overload, first of the right, and then of the left half of the heart -, arterial, heart failure. The diagnosis is based on the results of angiographic examination: along with well-contrasted dilated arteries, early contrasting of the veins (without the capillary phase), expansion of the venous vessels, and sometimes a capillary phase sharply shortened in time with the early appearance of the venous phase of blood flow are detected. In rheography, the curve is characterized by a rapid rise in the pulse wave and an increased rate of arterial blood flow, a decrease in peripheral resistance. Local arteriovenous excised. Apply endovascular occlusion of arteriovenous communications with embolizing substances (hydrogel, jelly) or Gianturco's spiral. The prognosis depends on the volume of arterial blood discharge into the venous bed and on the compensatory capabilities of the cardiovascular system.

Damage vessels are often combined with bone fractures, nerve injury, which aggravates the clinical picture and. Terrible manifestations of blood vessels (Bleeding , traumatic shock , Embolism , Gangrene, etc.) necessitate such emergency measures as prevention and treatment of shock, local ischemic changes, wound infection (see Wounds) .

Diseases. Among the most dangerous diseases aorta and arteries include aneurysms (aneurysms of vessels of the brain and spinal cord). Their danger lies in the possible rupture and the occurrence of massive bleeding. Aneurysms are caused by congenital (coarctation of the aorta) , Marfan syndrome) and acquired (, syphilis,) diseases, as well as injuries. aneurysm depends on its location and size (see Aortic Aneurysm , Aneurysms of the vessels of the brain and spinal cord) . In the area of ​​aneurysms of the abdominal part of the aorta or peripheral arteries, a pulsating tumor-like formation is determined and a peculiar one is felt. On auscultation over the area of ​​the aneurysm, systolic sounds are heard (see Vascular murmurs) .

Often there are occlusive lesions of the arteries, leading to narrowing or complete blockage of the lumen. The leading causes of occlusive lesions are atherosclerosis and. With occlusive lesions of the branches of the aortic arch, the brain and upper limbs develop. Patients complain of headaches, tinnitus, memory impairment, staggering when walking, in the eyes. Possible lethargy, weakness of convergence, changes in coordination of movements, mono- and hemiparesis. Surgical treatment. With damage to the arteries supplying blood to the abdominal organs, chronic abdominal ischemia develops, which is manifested by abdominal pain that occurs after eating, impaired bowel function, and weight loss. Surgical treatment.

In case of violation of the outflow of blood through the vena cava due to thrombosis or compression from the outside, syndromes of the superior or inferior vena cava develop. observed in patients with intrathoracic tumors, aneurysm of the ascending aorta, less often with thrombosis of the vena cava. Manifested by edema, cyanosis of the face, upper torso and upper extremities. more often occurs with ascending thrombosis of the vena cava and with compression by tumors. It is manifested by edema and cyanosis of the lower half of the trunk and lower extremities.

benign tumors(angiomas) can arise from blood (hemangiomas) and lymphatic vessels (lymphangiomas) Hemangiomas account for about 25% of all benign tumors and 45% of all soft tissue tumors. According to the microscopic structure, benign hemangioendothelioma, capillary (juvenile), cavernous and racemic hemangiomas are distinguished,. Benign is rare, mostly in early childhood. It is localized mainly in the skin and subcutaneous tissue. Capillary (juvenile) is also more common in children. It is located mainly in the skin, less often in the mucous membrane of the mouth, organs of the gastrointestinal tract and in the liver. Often has infiltrating growth. Cavernous (cavernous) hemangioma consists of vascular cavities of various sizes and shapes, communicating with each other. It is localized in the liver, less often in spongy bones, muscles, and the gastrointestinal tract. Racemic hemangioma (venous, arterial, arteriovenous) is a conglomerate of malformed vessels. Found in the head and neck region. - a common dysplastic vascular system, in which, for example, the entire limb, or its peripheral, is involved in the process.

In most cases, the source of development of hemangiomas are excessive vascular rudiments, which in the embryonic period or soon after begin to proliferate. There is an opinion that benign vascular tumors occupy, as it were, a middle position between malformations and blastomas.

Depending on the localization, hemangiomas of the integumentary tissues (, subcutaneous tissue, mucous membranes), musculoskeletal system (and bones) and parenchymal organs(liver). The most common hemangiomas of integumentary tissues, especially the skin of the face. It is usually pink or purplish blue, painless, somewhat raised above the skin. When pressed with a finger, the hemangioma flattens, turns pale, and after taking the finger away, it fills with blood again. A characteristic feature of hemangioma is rapid progressive growth: from a pinpoint tumor found at birth, it can reach a large size in a few months, leading to cosmetic defects and functional disorders. Sometimes there are complications in the form of ulceration and infection of the tumor, bleeding from it, phlebitis and thrombosis. tongue can reach a large size, making breathing difficult.

Hemangiomas of the subcutaneous tissue and muscles are more often found on the extremities, mainly on the lower ones. The skin over the tumor may not be changed. When a hemangioma communicates with a large arterial trunk, its pulsation is determined, a noise is heard above the tumor. Available pain syndrome due to infiltration of surrounding tissues, concomitant phlebitis and thrombosis. With prolonged growth of the tumor, muscle develops, there is a violation of the function of the limb.

Bone hemangiomas (mainly cavernous) are rare, they account for 0.5-1.0% of all benign bone neoplasms. Equally often occur in men and women at any age. Favorite -, bones of the skull, pelvis, less often long tubular bones of the limbs. often multiple. Possible prolonged asymptomatic course. In the future, with common neoplasms, pain, bone deformity, pathological appear. Clinical manifestations are more related to localization. Most often, symptoms of compression in the form of radicular pain, spinal manifestations are observed with damage to the vertebrae.

Benign vascular tumors also include glomus (, Barre-Masson's tumor), which is rare, usually in the elderly, It is localized more often in the area of ​​​​the nail bed of the fingers and toes. The size of the tumor is small - from 0.5 to 1-2 cm in diameter. It has a rounded shape, purple-cyanotic color. A characteristic clinical sign of glomus tumors is a strong pain syndrome that occurs with various external, even minimal, irritations.

Diagnosis of hemangiomas of the integument and muscles is not difficult. The characteristic color and the ability to contract when squeezed are their main features. The most reliable way to diagnose bone hemangioma is. When the spine is damaged, the swelling of the vertebral body is determined radiographically, the bone structure is represented by rough vertically directed trabeculae, against which separate rounded enlightenments are visible. The same changes can be detected in the arches and transverse processes. At pathological fracture the structure of the vertebra changes due to wedge-shaped deformation, and in these cases, if there are no changes in the arches and transverse processes, hemangiomas are very difficult. With hemangiomas of long tubular bones, a club-shaped deformation of the bone is observed with changes in its structure, the edges acquire a cellular pattern. In these cases, angiography is a valuable diagnostic method, which makes it possible to identify gaps and cavities in the affected part of the bone.

For the treatment of hemangiomas, injections of sclerosing agents, radiation therapy, surgical and cryotherapeutic methods are used. Among the sclerosing substances, 70% has become widespread. Radiation therapy is used for cavernous and capillary hemangiomas of the integument and the musculoskeletal system. With bone hemangiomas, radiation therapy is carried out only in the presence of clinical manifestations (pain, dysfunction, etc.). radiation, the magnitude and number of dose fields depend on the location of the neoplasm and its size.

Excision of hemangioma is the main and most radical method of treatment. (treatment with carbon dioxide snow) is most effective for small skin hemangiomas.

The prognosis for benign vascular tumors is satisfactory. Removal of the neoplasm provides.

Best Results in cosmetic and prognostic terms, it gives a radical hemangioma in early childhood, when it is small. The prognosis is less favorable for large hemangiomas located in hard-to-reach areas (internal organs, areas of large vessels).

Malignant tumors blood vessels are very rare compared to benign ones. There are hemangiopericytoma and hemangioendothelioma. Many authors, recognizing the validity of the allocation of these forms, combine them into one group of angaosarcomas. The reason for this is the rarity of neoplasms and great difficulties, and sometimes the impossibility of establishing the histogenesis of the tumor. Angiosarcomas are the second most common among soft tissue sarcomas. People of both sexes aged 40-50 years get sick equally often. The favorite localization is the limbs, mainly the lower ones. Patients usually accidentally palpate a tumor located in the thickness of the tissues. Tumor without clear contours has a bumpy surface ( rice. 5 ). Sometimes several nodes, merging, acquire the character of a diffuse infiltrate. Unlike other forms of soft tissue sarcomas, angiosarcomas grow rapidly, have a tendency to sprout skin, ulcerate, and often metastasize to regional ones. Typical in the lungs, internal organs, bones.

Diagnosis of angiosarcomas in the early stages of the disease is difficult. In severe cases, the typical location of the tumor, the rapid course of the disease with a short history, the tendency of the tumor to ulcerate, and the obligatory puncture help to correctly recognize. The final diagnosis is made only after a morphological examination of the tumor.

For the treatment of angiosarcomas in the early stages, a wide excision of the tumor along with the surrounding tissues and retonar lymph nodes can be used. At large sizes limb tumors are shown (). Radiation methods are mainly used in combination with surgical intervention. As an independent method, it is used for palliative purposes.

Angiosarcoma is one of the most malignant tumors. The prognosis for this disease is unfavorable - 9% of patients survive for 5 years. The vast majority die within the first 2 years of diagnosis.

OPERATIONS

The most common indications for surgery are the lower extremities, vascular injuries, segmental stenosis and occlusion of the aorta, its branches (carotid, vertebral, mesenteric arteries, celiac trunk), renal arteries and vessels of the lower extremities. Operations on vessels are also performed for arteriovenous fistulas and aneurysms, portal hypertension, stenosis and occlusion of the vena cava, tumor lesions of the vessels, thromboembolism of various localization. A major success of angiosurgery is reconstructive surgery on the coronary arteries of the heart, intracranial vessels of the brain and other vessels with a diameter of less than 4 mm. Operations using microsurgical techniques are becoming more common (see Microsurgery) .

There are ligature operations and restorative, or reconstructive. The simplest reconstructive operations are the imposition of a lateral vascular suture in case of injury, and the “ideal” one in case of acute thrombosis of the artery, as well as the removal of a parietal thrombus along with the corresponding section of the inner lining of the thrombosed artery. In case of occlusive and stenotic lesions of the arteries, to restore the main blood flow, arterectomy, resection of the vessel, and using grafts or synthetic prostheses are performed. The side plate of the vessel wall with various patches is used less frequently. Endovascular interventions, consisting in the expansion of stenotic vessels (aorta, arteries, veins) with the help of special balloon catheters, are becoming more common.

In operations on the vessels, a vascular is used. It can be circular (circular) and lateral. A circular continuous vascular suture is usually applied when connecting the vessels to be sutured end to end. Rarely use interrupted sutures. A lateral vascular suture is applied to the vessel wall at the site of injury.

In the postoperative period, careful monitoring of patients is necessary, because. possible from operated vessels or their acute. As a rule, it is necessary to carry out targeted rehabilitation measures and long-term catheterization , puncture vessel catheterization). In this case, as a rule, the technique of vascular catheterization proposed by Seldinger (S.I. Seldinger) is used. It consists in percutaneous puncture of an artery or vein using a special trocar, through which a flexible conductor is passed into the lumen of the vessel, and a polyethylene catheter is passed through it.

Bibliography: Isikov Yu.F. and Tikhonov Yu.A. Congenital malformations of peripheral vessels in children, p. 144, M., 1974; Kupriyanov V.V. Ways of microcirculation, Chisinau, 1969; Milovanov A.P. angiodysplasia of extremities, M., 1978; Pathological human tumors, ed. ON THE. Kraevsky and others. 59, 414, M., 1982; Pokrovsky A.V. Diseases of the aorta and its branches; M., 1979, aka Clinical, M., 1979; Cardiovascular, ed. IN AND. Burakovsky and L.A. Bokeria, M., 1989; Trapeznikov N.N. etc. Malignant tumors of soft tissues of the extremities and torso, Kyiv, 1981; Shoshenko K.A. and others. Architectonics of the bloodstream, Novosibirsk, 1982.

Rice. 1. Scheme of human circulation: 1 - capillaries of the head, upper parts of the trunk and upper limbs; 2 - brachiocephalic trunk; 3 - pulmonary trunk; 4 - left pulmonary veins; 5 - left atrium; 6 - left ventricle; 7 - celiac trunk; 8 - left gastric artery; 9 - capillaries of the stomach; 10 - splenic artery; 11 - capillaries of the spleen; 12 - abdominal part of the aorta; 13 - splenic vein; 14 - mesenteric artery; 15 - intestinal capillaries; 16 - capillaries of the parts of the trunk and lower extremities; 17 - mesenteric vein; 18 - inferior vena cava; 19 - renal artery; 20 - kidney capillaries; 21 - renal vein; 22 - portal vein; 23 - liver capillaries; 24 - hepatic veins; 25 - thoracic duct; 26 - common hepatic artery; 27 - right ventricle; 28 - right atrium; 29 - ascending aorta; 30 - superior vena cava; 31 - right pulmonary veins; 32 - capillaries of the lung.

Rice. 2. Scheme of the structure of the walls of the arteries: 1 - artery of the muscular type; 2 - vessels of the vascular wall; 3 - muscle strands of the artery wall (arranged in a spiral); 4 - muscular membrane; 5 - internal elastic membrane; 6 - endothelium; 7 - outer elastic membrane; 8 - outer shell (adventitia).

Biological Encyclopedic Dictionary - This term has other meanings, see Vessel. Blood vessels of the human body (diagram) Blood vessels elast ... Wikipedia

Elastic tubular formations in the body of animals and humans, through which blood moves from the heart or the central pulsating vessel to the tissues of the body (arteries, arterioles, arterial capillaries) and from them to the heart (venous capillaries, venules, veins) ... encyclopedic Dictionary

blood vessels- kraujagyslės statusas T sritis Kūno kultūra ir sportas apibrėžtis Įvairaus spindžio vamzdeliai, kuriais kraujas teka iš širdies į audinius, organus ir iš jų atgal. Kraujagyslės skirstomos į arterijas (gyvagysles), venas ir kapiliarus. atitikmenys … Sporto terminų žodynas

Elastic tubular formations in the body of animals and humans, through which blood moves from the heart or center. pulsating vessel to the tissues of the body (arteries, arterioles, arterial capillaries) and from them to the heart (venous capillaries, venules, veins) ... Natural science. encyclopedic Dictionary

1 - dorsal artery of the foot; 2 - anterior tibial artery (with accompanying veins); 3 - femoral artery; 4 - femoral vein; 5 - superficial palmar arch; 6 - right outer iliac artery and the right external iliac vein; 7-right internal iliac artery and right internal iliac vein; 8 - anterior interosseous artery; 9 - radial artery (with accompanying veins); 10 - ulnar artery (with accompanying veins); 11 - inferior vena cava; 12 - superior mesenteric vein; 13 - right renal artery and right renal vein; 14 - portal vein; 15 and 16 - saphenous veins of the forearm; 17- brachial artery (with accompanying veins); 18 - superior mesenteric artery; 19 - right pulmonary veins; 20 - right axillary artery and right axillary vein; 21 - right pulmonary artery; 22 - superior vena cava; 23 - right brachiocephalic vein; 24 - right subclavian vein and right subclavian artery; 25 - right common carotid artery; 26 - right internal jugular vein; 27 - external carotid artery; 28 - internal carotid artery; 29 - brachiocephalic trunk; 30 - external jugular vein; 31 - left common carotid artery; 32 - left internal jugular vein; 33 - left brachiocephalic vein; 34 - left subclavian artery; 35 - aortic arch; 36 - left pulmonary artery; 37 - pulmonary trunk; 38 - left pulmonary veins; 39 - ascending aorta; 40 - hepatic veins; 41 - splenic artery and vein; 42 - celiac trunk; 43 - left renal artery and left renal vein; 44 - inferior mesenteric vein; 45 - right and left testicular arteries (with accompanying veins); 46 - inferior mesenteric artery; 47 - median vein of the forearm; 48 - abdominal aorta; 49 - left common iliac artery; 50 - left common iliac vein; 51 - left internal iliac artery and left internal iliac vein; 52 - left external iliac artery and left external iliac vein; 53 - left femoral artery and left femoral vein; 54 - venous palmar network; 55 - a large saphenous (hidden) vein; 56 - small saphenous (hidden) vein; 57 - venous network of the rear of the foot.

1 - venous network of the rear of the foot; 2 - small saphenous (hidden) vein; 3 - femoral-popliteal vein; 4-6 - venous network of the rear of the Hand; 7 and 8 - saphenous veins of the forearm; 9 - posterior ear artery; 10 - occipital artery; 11- superficial cervical artery; 12 - transverse artery of the neck; 13 - suprascapular artery; 14 - posterior circumflex artery; 15 - artery, enveloping the scapula; 16 - deep artery of the shoulder (with accompanying veins); 17 - posterior intercostal arteries; 18 - superior gluteal artery; 19 - lower gluteal artery; 20 - posterior interosseous artery; 21 - radial artery; 22 - dorsal carpal branch; 23 - perforating arteries; 24 - external upper artery of the knee joint; 25- popliteal artery; 26-popliteal vein; 27-external lower artery of the knee joint; 28 - posterior tibial artery (with accompanying veins); 29 - peroneal, artery.

Diagram of the human cardiovascular system

The most important task of the cardiovascular system is to provide tissues and organs with nutrients and oxygen, as well as to remove the products of cell metabolism (carbon dioxide, urea, creatinine, bilirubin, uric acid, ammonia, etc.). Enrichment with oxygen and removal of carbon dioxide occurs in the capillaries of the pulmonary circulation, and saturation with nutrients in the vessels of the systemic circulation during the passage of blood through the capillaries of the intestine, liver, adipose tissue and skeletal muscles.

The human circulatory system consists of the heart and blood vessels. Their main function is to ensure the movement of blood, carried out thanks to the work on the principle of a pump. With the contraction of the ventricles of the heart (during their systole), blood is expelled from the left ventricle into the aorta, and from the right ventricle into the pulmonary trunk, from which, respectively, the large and small circles of blood circulation (BCC and ICC) begin. The large circle ends with the inferior and superior vena cava, through which venous blood returns to the right atrium. And the small circle is represented by four pulmonary veins, through which arterial, oxygenated blood flows to the left atrium.

Based on the description, arterial blood flows through the pulmonary veins, which does not correspond to everyday ideas about the human circulatory system (it is believed that venous blood flows through the veins, and arterial blood flows through the arteries).

After passing through the cavity of the left atrium and ventricle, the blood with nutrients and oxygen enters the capillaries of the BCC through the arteries, where it exchanges oxygen and carbon dioxide between it and the cells, delivers nutrients and removes metabolic products. The latter with the blood flow reach the excretory organs (kidneys, lungs, glands of the gastrointestinal tract, skin) and are excreted from the body.

BPC and ICC are connected sequentially. The movement of blood in them can be demonstrated using the following scheme: right ventricle → pulmonary trunk → small circle vessels → pulmonary veins → left atrium → left ventricle → aorta → large circle vessels → inferior and superior vena cava → right atrium → right ventricle.

Depending on the function performed and the structural features of the vascular wall, the vessels are divided into the following:

1. 1. Shock-absorbing (vessels of the compression chamber) - aorta, pulmonary trunk and large arteries of the elastic type. They smooth out periodic systolic waves of blood flow: soften the hydrodynamic shock of blood ejected by the heart during systole, and ensure the movement of blood to the periphery during diastole of the ventricles of the heart.
2. 2. Resistive (vessels of resistance) - small arteries, arterioles, metarterioles. Their walls contain a huge number of smooth muscle cells, thanks to the contraction and relaxation of which they can quickly change the size of their lumen. Providing variable resistance to blood flow, resistive vessels maintain blood pressure (BP), regulate the amount of organ blood flow and hydrostatic pressure in the vessels of the microvasculature (MCR).
3. 3. Exchange - ICR vessels. Through the wall of these vessels, the exchange of organic and inorganic substances, water, gases between blood and tissues. The blood flow in the MCR vessels is regulated by arterioles, venules and pericytes - smooth muscle cells located outside the precapillaries.
4. 4. Capacitive - veins. These vessels are highly extensible, due to which they can deposit up to 60–75% of the circulating blood volume (CBV), regulating the return of venous blood to the heart. The veins of the liver, skin, lungs and spleen have the most depositing properties.
5. 5. Shunting - arteriovenous anastomoses. When they open, arterial blood is discharged along the pressure gradient into the veins, bypassing the ICR vessels. For example, this happens when the skin is cooled, when the blood flow is directed through arteriovenous anastomoses to reduce heat loss, bypassing the skin capillaries. At the same time, the skin turns pale.

The ICC serves to oxygenate the blood and remove carbon dioxide from the lungs. After the blood has entered the pulmonary trunk from the right ventricle, it is sent to the left and right pulmonary arteries. The latter are a continuation of the pulmonary trunk. Each pulmonary artery, passing through the gates of the lung, branches into smaller arteries. The latter, in turn, pass into the ICR (arterioles, precapillaries and capillaries). In the ICR, venous blood is converted into arterial blood. The latter enters from the capillaries into venules and veins, which, merging into 4 pulmonary veins (2 from each lung), flow into the left atrium.

BPC serves to deliver nutrients and oxygen to all organs and tissues and remove carbon dioxide and metabolic products. After the blood has entered the aorta from the left ventricle, it is directed to the aortic arch. Three branches depart from the latter (brachiocephalic trunk, common carotid and left subclavian arteries), which supply blood to the upper limbs, head and neck.

After that, the aortic arch passes into the descending aorta (thoracic and abdominal). The latter at the level of the fourth lumbar vertebra is divided into common iliac arteries, which supply blood to the lower limbs and pelvic organs. These vessels are divided into external and internal iliac arteries. The external iliac artery passes into the femoral artery, supplying arterial blood to the lower extremities below the inguinal ligament.

All arteries, heading to tissues and organs, in their thickness pass into arterioles and further into capillaries. In the ICR, arterial blood is converted into venous blood. Capillaries pass into venules and then into veins. All veins accompany arteries and are named similarly to arteries, but there are exceptions (portal vein and jugular veins). Approaching the heart, the veins merge into two vessels - the inferior and superior vena cava, which flow into the right atrium.

Sometimes a third circle of blood circulation is isolated - cardiac, which serves the heart itself.

Arterial blood is indicated in black in the picture, and venous blood is indicated in white. 1. Common carotid artery. 2. Aortic arch. 3. Pulmonary arteries. 4. Aortic arch. 5. Left ventricle of the heart. 6. Right ventricle of the heart. 7. Celiac trunk. 8. Superior mesenteric artery. 9. Inferior mesenteric artery. 10. Inferior vena cava. 11. Bifurcation of the aorta. 12. Common iliac arteries. 13. Vessels of the pelvis. 14. Femoral artery. 15. Femoral vein. 16. Common iliac veins. 17. Portal vein. 18. Hepatic veins. 19. Subclavian artery. 20. Subclavian vein. 21. Superior vena cava. 22. Internal jugular vein.

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Vessels

Blood circulates throughout the body through a complex system of blood vessels. This transport system delivers blood to every cell in the body so that it "exchanges" oxygen and nutrients for waste products and carbon dioxide.

Some numbers

There are over 95,000 kilometers of blood vessels in the body of a healthy adult. More than seven thousand liters of blood are pumped through them daily.

The size of blood vessels varies from 25 mm (aortic diameter) to eight microns (capillary diameter).

What are the vessels?

All vessels in the human body can be divided into arteries, veins and capillaries. Despite the difference in size, all vessels are arranged approximately the same.

From the inside, their walls are lined with flat cells - endothelium. With the exception of capillaries, all vessels contain tough and elastic collagen fibers and smooth muscle fibers that can contract and expand in response to chemical or neural stimuli.

Arteries carry oxygen-rich blood from the heart to tissues and organs. This blood is bright red, which is why all the arteries look red.

Blood moves through the arteries with great force, so their walls are thick and elastic. They are made up of large amounts of collagen, which allows them to withstand blood pressure. The presence of muscle fibers helps turn the intermittent supply of blood from the heart into a continuous flow in the tissues.

As they move away from the heart, the arteries begin to branch, and their lumen becomes thinner and thinner.

The thinnest vessels that deliver blood to every corner of the body are capillaries. Unlike arteries, their walls are very thin, so oxygen and nutrients can pass through them into the cells of the body. This same mechanism allows waste products and carbon dioxide to pass from the cells into the bloodstream.

Capillaries, through which oxygen-poor blood flows, gather into thicker vessels - veins. Due to the lack of oxygen, venous blood is darker than arterial blood, and the veins themselves appear bluish. They carry blood to the heart and from there to the lungs for oxygenation.

The walls of the veins are thinner than the arterial ones, since the venous blood does not create such strong pressure like arterial.

What are the largest blood vessels in the human body?

The two largest veins in the human body are the inferior vena cava and the superior vena cava. They bring blood to the right atrium: the superior vena cava from the upper body, and the inferior vena cava from the bottom.

The aorta is the largest artery in the body. It comes out of the left ventricle of the heart. Blood enters the aorta through the aortic canal. The aorta branches into large arteries that carry blood throughout the body.

What is blood pressure?

Blood pressure is the force with which blood presses against the walls of the arteries. It increases when the heart contracts and pumps out blood, and decreases when the heart muscle relaxes. Blood pressure is stronger in the arteries and weaker in the veins.

Blood pressure is measured with a special device - a tonometer. Pressure indicators are usually written in two digits. So, the normal pressure for an adult is considered to be 120/80.

The first number, systolic pressure, is a measure of the pressure during a heartbeat. The second is diastolic pressure, the pressure when the heart relaxes.

Pressure is measured in the arteries and is expressed in millimeters of mercury. In the capillaries, the pulsation of the heart becomes imperceptible and the pressure in them drops to about 30 mm Hg. Art.

A blood pressure reading can tell your doctor how your heart is working. If one or both numbers are higher than normal, this indicates increased pressure. If lower - about lowered.

High blood pressure indicates that the heart is working with excess load: it needs more effort to push blood through the vessels.

It also suggests that a person has an increased risk of heart disease.

The most important

Vessels are needed by the body to deliver blood rich in nutrients and oxygen to all organs and tissues. Learn how to keep blood vessels healthy.

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Large human vessels

Title: Human Anatomy

Genre: Biology with the basics of genetics

Blood vessels

In the human body there are vessels (arteries, veins, capillaries) that supply blood to organs and tissues. These vessels form a large and small circle of blood circulation.

Large vessels (aorta, pulmonary artery, vena cava and pulmonary veins) serve mainly as pathways for the movement of blood. All other arteries and veins can, in addition, regulate the flow of blood to the organs and its outflow by changing their lumen. Capillaries are the only part of the circulatory system where the exchange between blood and other tissues takes place. According to the predominance of a particular function, the walls of vessels of different calibers have an unequal structure.

The structure of the walls of blood vessels

The wall of the artery consists of three layers. The outer shell (adventitia) is formed by loose connective tissue and contains vessels that feed the wall of the arteries, vascular vessels (vasa vasorum). The middle shell (media) is formed mainly by smooth muscle cells of a circular (spiral) direction, as well as elastic and collagen fibers. It is separated from the outer shell by an outer elastic membrane. The inner shell (intima) is formed by the endothelium, basement membrane and subendothelial layer. It is separated from the middle shell by an internal elastic membrane.

In large arteries in the middle shell, elastic fibers predominate over muscle cells, such arteries are called elastic-type arteries (aorta, pulmonary trunk). The elastic fibers of the vessel wall counteract the excessive stretching of the vessel by blood during systole (contraction of the ventricles of the heart), as well as the movement of blood through the vessels. During diastole

bleating of the ventricles of the heart), they also ensure the movement of blood through the vessels. In the arteries of "medium" and small caliber in the middle shell, muscle cells predominate over elastic fibers, such arteries are muscle-type arteries. The middle arteries (muscular-elastic) are referred to as arteries mixed type(carotid, subclavian, femoral, etc.).

Veins are large, medium and small. The walls of veins are thinner than the walls of arteries. They have three shells: outer, middle, inner. In the middle shell of the veins, there are few muscle cells and elastic fibers, so the walls of the veins are pliable and the lumen of the vein does not gape on the cut. small, medium and some large veins have venous valves - semilunar folds on the inner shell, which are located in pairs. Valves allow blood to flow towards the heart and prevent it from flowing back. The veins of the lower extremities have the greatest number of valves. Both vena cava, veins of the head and neck, renal, portal, pulmonary veins do not have valves.

Veins are divided into superficial and deep. Superficial (saphenous) veins follow independently, deep - in pairs adjacent to the same name arteries of the limbs, so they are called accompanying veins. In general, the number of veins exceeds the number of arteries.

Capillaries - have a very small lumen. Their walls consist of only one layer of flat endothelial cells, to which individual connective tissue cells adjoin only in places. Therefore, capillaries are permeable to substances dissolved in the blood and function as an active barrier that regulates the transfer of nutrients, water and oxygen from the blood to the tissues and the reverse flow of metabolic products from the tissues into the blood. The total length of human capillaries in the skeletal muscles, according to some estimates, is 100 thousand km, their surface area reaches 6000 m.

Small circle of blood circulation

The pulmonary circulation begins with the pulmonary trunk (brittle trunk) and originates from the right ventricle, at level IV thoracic vertebra forms a bifurcation of the pulmonary trunk and divides into the right and left pulmonary arteries, which branch out in the lungs. In the lung tissue (under the pleura and in the region of the respiratory bronchioles), small branches of the pulmonary artery and bronchial branches of the thoracic aorta form a system of inter-arterial anastomoses. They are the only place in the vascular system where

the movement of blood along a short path from the systemic circulation directly to the pulmonary circulation. From the capillaries of the lung, venules begin, which merge into larger veins and, ultimately, in each lung form two pulmonary veins. The right superior and inferior pulmonary veins and the left superior and inferior pulmonary veins pierce the pericardium and empty into the left atrium.

Systemic circulation

The systemic circulation begins from the left ventricle of the heart by the aorta. Aorta (aorta) - the largest unpaired arterial vessel. Compared to other vessels, the aorta has the largest diameter and a very thick wall, consisting of a large number of elastic fibers, which is elastic and durable. It is divided into three sections: the ascending aorta, the aortic arch and the descending aorta, which, in turn, is divided into the thoracic and abdominal parts.

The ascending aorta (pars ascendens aortae) emerges from the left ventricle and in the initial section has an extension - the aortic bulb. At the location of the aortic valves on its inner side there are three sinuses, each of them is located between the corresponding semilunar valve and the aortic wall. The right and left coronary arteries of the heart depart from the beginning of the ascending aorta.

The aortic arch (arcus aortae) is a continuation of the ascending aorta and passes into its descending part, where it has aortic isthmus - a slight narrowing. From the aortic arch originate: the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. In process of an otkhozhdeniye of these branches diameter of an aorta noticeably decreases. At level IV of the thoracic vertebrae, the aortic arch passes into the descending part of the aorta.

The descending part of the aorta (pars descendens aortae), in turn, is divided into the thoracic and abdominal aorta.

Thoracic aorta (a. thoracalis) passes through the chest cavity in front of the spine. Its branches feed the internal organs of this cavity, as well as the walls of the chest and abdominal cavities.

The abdominal aorta (a. abdominalis) lies on the surface of the bodies of the lumbar vertebrae, behind the peritoneum, behind the pancreas, duodenum and root of the mesentery of the small intestine. The aorta gives off large branches to the abdominal viscera. At level IV of the lumbar vertebra, it divides into two common iliac arteries (the place of separation is called the aortic bifurcation). The iliac arteries supply the walls and innards of the pelvis and lower extremities.

Branches of the aortic arch

The brachiocephalic trunk (truncus brachiocephalicus) departs from the arc at level II of the right costal cartilage, has a length of about 2.5 cm, goes up and to the right, and at the level of the right sternoclavicular joint is divided into the right common carotid artery and the right subclavian artery.

The common carotid artery (a. carotis communis) on the right departs from the brachiocephalic trunk, on the left - from the aortic arch (Fig. 86).

Coming out of the chest cavity, the common carotid artery rises as part of the neurovascular bundle of the neck, lateral to the trachea and esophagus; does not give branches; at the level of the upper edge of the thyroid cartilage, it divides into the internal and external carotid arteries. Not far from this point, the aorta passes in front of the transverse process of the sixth cervical vertebra, against which it can be pressed to stop bleeding.

The external carotid artery (a. carotis externa), rising along the neck, gives off branches to the thyroid gland, larynx, tongue, submandibular and sublingual glands, and a large external maxillary artery.

The external maxillary artery (a. mandibularis externa) bends over the edge of the lower jaw in front of the chewing muscle, where it branches in the skin and muscles. The branches of this artery go to the upper and lower lip, anastomosing with similar branches of the opposite side, form a perioral arterial circle around the mouth.

At the inner corner of the eye, the facial artery anastomoses with the orbital artery, one of the large branches of the internal carotid artery.

Rice. 86. Arteries of the head and neck:

1 - occipital artery; 2 - superficial temporal artery; 3 - posterior ear artery; 4 - internal carotid artery; 5 - external carotid artery; 6 - ascending cervical artery; 7 - thyroid trunk; 8 - common carotid artery; 9 - superior thyroid artery; 10 - lingual artery; 11 - facial artery; 12 - lower alveolar artery; 13 - maxillary artery

Medial to the mandibular joint, the external carotid artery divides into two terminal branches. One of them - the superficial temporal artery - is located directly under the skin of the temple, in front of the ear opening and nourishes the parotid gland, temporalis muscle and scalp. Another, deep branch - the internal maxillary artery - feeds the jaws and teeth, masticatory muscles, walls

nasal cavity and adjacent

Rice. 87. Arteries of the brain:

11 with them bodies; gives away

I - anterior communicating artery; 2 - before- „,

the lower cerebral artery smelling the cerebral artery; 3 - internal carotid ar-Ґ Ґ

teriya; 4 - middle cerebral artery; 5 - posterior lobes penetrating the skull. communicating artery; 6 - posterior cerebral ar- Internal SONNYA artery; 7 - main artery; 8 - vertebral artery (a. carotis interna) sub-terium; 9 - posterior inferior cerebellar artery; taken from the side of the throat

Ш - anterior inferior cerebellar artery; to the base of the skull,

II - superior cerebellar artery

into it through the canal of the temporal bone of the same name and, penetrating the dura mater, gives off a large branch - the ophthalmic artery, and then at the level of the decussation optic nerves is divided into its terminal branches: the anterior and middle cerebral arteries (Fig. 87).

The ophthalmic artery (a. ophthalmica), enters the orbit through the optic canal and supplies blood to the eyeball, its muscles and lacrimal gland, the terminal branches supply blood to the skin and muscles of the forehead, anastomosing with the terminal branches of the external maxillary artery.

The subclavian artery (a. subclavia), starting to the right of the brachial trunk, and to the left of the aortic arch, exits the chest cavity through its upper opening. On the neck, the subclavian artery appears along with the brachial nerve plexus and lies superficially, bending over the first rib and, passing under the clavicle outward, enters the axillary fossa and is called the axillary (Fig. 88). Having passed the fossa, the artery under a new name - the brachial - goes to the shoulder and in the region of the elbow joint is divided into its terminal branches - the ulnar and radial arteries.

A number of large branches depart from the subclavian artery, feeding the organs of the neck, occiput, part of the chest wall, spinal cord and brain. One of them vertebral artery- steam room, departs at the level of the transverse process of the VII cervical vertebra, rises vertically upward through the openings of the transverse processes of the VI-I cervical vertebrae

and through the greater occipital

Rice. 88. Arteries of the axillary region:

the hole enters the skull

o-7h t-g 1 - transverse artery of the neck; 2 - breast acromi-

(Fig. 87). Along the way she gives back,

K1 ‘J al artery; 3 - artery, enveloping the scapula;

branches penetrating through 4 - subscapular artery; 5 - lateral thoracic-intervertebral foramen to the naia artery; 6 - thoracic artery; 7 - intra-spinal cord and its sheathed thoracic artery; 8 - subclavian arte-

kam. Behind the head ria bridge; 9 - common carotid artery; 10 - thyroid

trunk; 11 - vertebral artery

brain, this artery connects with a similar one and forms the basilar artery, which is unpaired, and in turn is divided into two terminal branches - the posterior left and right cerebral arteries. The remaining branches of the subclavian artery feed the body's own muscles (diaphragm, I and II intercostal, upper and lower serratus posterior, rectus abdominis), almost all the muscles of the shoulder girdle, skin of the chest and back, neck organs and mammary glands.

The axillary artery (a. axillaris) is a continuation of the subclavian artery (from the level of the 1st rib), located deep in the axillary fossa and surrounded by trunks of the brachial plexus. It gives branches to the region of the scapula, chest and humerus.

The brachial artery (a. brachialis) is a continuation of the axillary artery and is located on the anterior surface of the brachial muscle, medial to the biceps of the shoulder. In the cubital fossa, at the level of the neck of the radius, the brachial artery divides into the radial and ulnar arteries. A number of branches depart from the brachial artery to the muscles of the shoulder and the elbow joint (Fig. 89).

The radial artery (a. radialis) has arterial branches in the forearm, in the distal forearm it passes to the back of the hand, and then to the palm. Terminal section of the radial artery anastomosis

it is a palmar branch of the ulnar artery, forming a deep palmar arch, from which the palmar metacarpal arteries originate, which flow into the common palmar digital arteries and anastomose with the dorsal metacarpal arteries.

The ulnar artery (a. ul-naris) is one of the branches of the brachial artery, located in the forearm, gives branches to the muscles of the forearm and penetrates into the palm, where it anastomoses with the superficial palmar branch of the radial artery,

forming a superficial laris 89 Arteries of the forearm and hand, right:

bottom arc. IN ADDITION to arcs, A - front view; B - rear view; 1 - shoulder ar-on the BRUSH, lateria is formed; 2 - radial recurrent artery; 3 - radial-bottom and dorsal carpal artery; 4 - front

o 5 - palmar network of the wrist; 6 - own la networks. From last

bottom finger arteries; 7 - common palmar to Interosseous interdigital arteries; 8 - superficial palmar ki the dorsal metacarpal arch departs; 9 - ulnar artery; 10 - ulnar ascending arteries. Each of them is a portal artery; 13 - back network of the wrist; divides into two thin arterial - 14 - dorsal metacarpal arteries; 15 - rear

terii fingers, so the brush

in general, and the fingers in particular, are richly supplied with blood from many sources, which anastomose well with each other due to the presence of arcs and networks.

Branches of the thoracic aorta

The branches of the thoracic aorta are divided into parietal and visceral branches (Fig. 90). Parietal branches:

1. Superior phrenic artery (a. phrenica superior) - steam room, supplies blood to the diaphragm and the pleura covering it.

2. Posterior intercostal arteries (a. a. intercostales posteriores) - paired, supply blood to the intercostal muscles, ribs, chest skin.

1. Bronchial branches (r. r. bronchiales) supply blood to the walls of the bronchi and lung tissue.

2. Esophageal branches (r.r. oesophageales) supply blood to the esophagus.

3. Pericardial branches (r.r. pericardiaci) go to the pericardium

4. Mediastinal branches (r.r. mediastinales) supply blood to the connective tissue of the mediastinum and lymph nodes.

Branches of the abdominal aorta

1. The lower phrenic arteries (a.a. phenicae inferiores) are paired, supply blood to the diaphragm (Fig. 91).

2. Lumbar arteries (a.a. lumbales) (4 pairs) - supply blood to the muscles in the lumbar region and the spinal cord.

1 - aortic arch; 2 - ascending aorta; 3 - bronchial and esophageal branches; 4 - descending part of the aorta; 5 - posterior intercostal arteries; 6 - celiac trunk; 7 - abdominal part of the aorta; 8 - inferior mesenteric artery; 9 - lumbar arteries; 10 - renal artery; 11 - superior mesenteric artery; 12 - thoracic aorta

Rice. 91. Abdominal aorta:

1 - lower phrenic arteries; 2 - celiac trunk; 3 - superior mesenteric artery; 4 - renal artery; 5 - inferior mesenteric artery; 6 - lumbar arteries; 7 - median sacral artery; 8 - common iliac artery; 9 - testicular (ovarian) artery; 10 - lower suprapo-chechnic artery; 11 - middle adrenal artery; 12 - superior adrenal artery

Visceral branches (unpaired):

1. The celiac trunk (truncus coeliacus) has branches: the left ventricular artery, the common hepatic artery, the splenic artery - it supplies blood to the corresponding organs.

2. Superior mesenteric and inferior mesenteric artery(a. mes-enterica superior et a. mesenterica inferior) - supply blood to the small and large intestines.

Visceral branches (paired):

1. Middle adrenal, renal, testicular arteries - supply blood to the corresponding organs.

2. At level IV of the lumbar vertebrae, the abdominal aorta divides into two common iliac arteries, forming an aortic bifurcation, and continues into the median sacral artery.

The common iliac artery (a. iliaca communis) follows the direction of the small pelvis and is divided into the internal and external iliac arteries.

Internal iliac artery (a. iliaca interna).

It has branches - sub-ilio-lumbar lateral sacral arteries, superior gluteal, inferior gluteal, umbilical artery, inferior urinary bladder, uterine middle rectal, internal

pudendal and obturator arte- 92 Arteries of the pelvis:

rii - supply blood to the walls; 1 - the abdominal part of the aorta; 2 - common sub-ki and pelvic organs (Fig. 92). iliac artery; 3 - outer gtodudosh-

TT - - naya artery; 4 - internal iliac

artery; 5 - median sacral artery;

art ^ riYa ((1. iliaca eXtema). 6 - posterior branch of the internal iliac

Serves as a continuation of the ob-artery; 7 - lateral sacral arte-

shchi iliac artery ria; 8 - anterior branch of the internal sub-

in the thigh region it passes into the iliac artery; 9 - middle rectal

renal artery. External artery; 10 - lower rectal

artery; 11 - internal genital artery;

12 - dorsal artery of the penis;

13 - lower vesical artery; 14 - superior vesical artery; 15 - bottom

the iliac artery has branches - the inferior epigastric artery and the deep artery

the circumflex iliac artery is the epigastric artery; 16 - deep artery;

new bone (Fig. 93). 140

iliac circumflex

Arteries of the lower limb

The femoral artery (a. femoralis) is a continuation of the external iliac artery, has branches: superficial epigastric artery, superficial artery, envelope of the ilium, external pudendal, deep artery of the thigh, descending artery - blood supply to the muscles of the abdomen and thigh. The femoral artery passes into the patella artery, which in turn divides into the anterior and posterior tibial arteries.

The anterior tibial artery (a. tibialis anterior) is a continuation of the popliteal artery, goes along the anterior surface of the lower leg and passes to the rear of the foot, has branches: the anterior and posterior tibialis recurrent arteries,

hips; 4 - lateral artery; circumflex femur; 5 - medial artery, enveloping the femur; 6 - perforating arteries; 7 - descending -

Rice. 93. Arteries of the thigh, right: A - front view; B - rear view; 1 - on the lateral and medial ventral iliac artery; 2 - hip arteries, dorsal artrenal artery; 3 - deep artery

teryu foot, supplying blood to the knee joint and the anterior group of muscles of the lower leg.

Posterior tibial artery genicular artery; 8 - superior yagotheria (a. tibialis posterior) - prodative artery; 9 - wide berry

due to the popliteal artery. artery; 10 - popliteal artery Goes along the medial surface of the lower leg and passes to the sole, has branches: muscular; branch around the fibula; peroneal medial and lateral plantar arteries, feeding the muscles of the lateral group of the lower leg.

Veins of the systemic circulation

The veins of the systemic circulation are combined into three systems: the system of the superior vena cava, the system of the inferior vena cava and the system of the veins of the heart. The portal vein with its tributaries is isolated as the portal vein system. Each system has a main trunk, into which veins flow, carrying blood from a certain group of organs. These trunks flow into the right atrium (Fig. 94).

Superior vena cava system

The superior vena cava (v. cava superior) drains blood from the upper half of the body - the head, neck, upper limbs and chest wall. It is formed from the confluence of two brachiocephalic veins (behind the junction of the first rib with the sternum and lies in the upper part of the mediastinum). The inferior end of the superior vena cava empties into the right atrium. The diameter of the superior vena cava is 20-22 mm, the length is 7-8 cm. The unpaired vein flows into it.

Rice. 94. Veins of the head and neck:

I - subcutaneous venous network; 2 - superficial temporal vein; 3 - supraorbital vein; 4 - angular vein; 5 - right labial vein; 6 - mental vein; 7 - facial vein; 8 - anterior jugular vein; 9 - internal jugular vein; 10 - mandibular vein;

II - pterygoid plexus; 12 - posterior ear vein; 13 - occipital vein

Unpaired vein (v. azygos) and its branch (semi-unpaired). These are pathways that drain venous blood away from the walls of the body. The azygous vein lies in the mediastinum and originates from the parietal veins, which penetrate the diaphragm from the abdominal cavity. It takes in the right intercostal veins, veins from the mediastinal organs and the semi-unpaired vein.

Semi-unpaired vein (v. hemiazygos) - lies to the right of the aorta, receives the left intercostal veins and repeats the course of the unpaired vein, into which it flows, which creates the possibility of outflow of venous blood from the walls of the chest cavity.

The brachiocephalic veins (v.v. brachiocephalics) originate behind the sterno-pulmonary articulation, in the so-called venous angle, from the junction of three veins: internal, external jugular and subclavian. The brachiocephalic veins collect blood from the veins accompanying the branches of the subclavian artery, as well as from the veins of the thyroid, thymus, laryngeal, trachea, esophagus, venous plexuses of the spine, deep veins of the neck, veins of the upper intercostal muscles and the mammary gland. The connection between the systems of the superior and inferior vena cava is carried out through the terminal branches of the vein.

The internal jugular vein (v. jugularis interna) begins at the level of the jugular foramen as a direct continuation of the sigmoid sinus of the dura mater and descends along the neck in the same vascular bundle with the carotid artery and vagus nerve. It collects blood from the head and neck, from the sinuses of the dura mater, into which blood enters from the veins of the brain. The common facial vein consists of the anterior and posterior facial veins and is the largest tributary of the internal jugular vein.

The external jugular vein (v. jugularis externa) is formed at the level of the angle of the lower jaw and descends along the outer surface of the sternocleidomastoid muscle, covered by the subcutaneous muscle of the neck. It drains blood from the skin and muscles of the neck and occipital region.

The subclavian vein (v. subclavia) continues the axillary, serves to drain blood from the upper limb and does not have permanent branches. The walls of the vein are firmly connected to the surrounding fascia, which holds the lumen of the vein and increases it with a raised arm, providing an easier outflow of blood from the upper extremities.

Veins of the upper limb

Venous blood from the fingers of the hand enters the dorsal veins of the hand. The superficial veins are larger than the deep ones and form the venous plexuses of the back of the hand. Of the two venous arches of the palm, corresponding to the arterial ones, the deep arch serves as the main venous collector of the hand.

The deep veins of the forearm and shoulder are accompanied by a double number of arteries and bear their name. They repeatedly anastomose with each other. Both brachial veins merge into the axillary vein, which receives all the blood not only from the deep, but also the superficial veins of the upper extremities. One of the branches of the axillary vein, descending along the side wall of the body, anastomoses with the saphenous branch of the femoral vein, forming an anastomosis between the system of the superior and inferior vena cava. The main saphenous veins of the upper limb are the head and main (Fig. 95).

Rice. 95. Superficial veins of the arm, right:

A - rear view; B - front view; 1 - lateral saphenous vein of the arm; 2 - intermediate vein of the elbow; 3 - medial saphenous vein of the arm; 4 - dorsal venous network of the hand

Rice. 96. Deep veins of the upper limb, right:

A - veins of the forearm and hand: 1 - ulnar veins; 2 - radial veins; 3 - superficial palmar venous arch; 4 - palmar fingers veins. B - veins of the shoulder and shoulder girdle: 1 - axillary vein; 2 - brachial veins; 3 - lateral saphenous vein of the arm; 4 - medial saphenous vein of the arm

The lateral saphenous vein of the arm (v. cephalica) originates from the deep palmar arch and superficial venous plexus of the rear of the hand and stretches along the lateral edge of the forearm and shoulder, taking superficial veins along the way. It flows into the axillary vein (Fig. 96).

The medial saphenous vein of the hand (v. basilica) starts from the deep palmar arch and the superficial venous plexus of the back of the hand. Moving to the forearm, the vein is significantly replenished with blood from the head vein through an anastomosis with it in the area of ​​​​the elbow bend - the middle cubital vein (drugs are injected into this vein and blood is taken). The main vein flows into one of the brachial veins.

Inferior vena cava system

The inferior vena cava (v. cava inferior) begins at the level of the V lumbar vertebra from the confluence of the right and left common iliac veins, lies behind the peritoneum to the right of the aorta (Fig. 97). Passing behind the liver, the inferior vena cava sometimes plunges into its tissue, and then through the hole

stia in the tendon center of the diaphragm penetrates into the mediastinum and the pericardial sac, opening into the right atrium. The cross section at its beginning is 20 mm, and near the mouth - 33 mm.

The inferior vena cava receives paired branches both from the walls of the body and from the viscera. The parietal veins include the lumbar veins and the veins of the diaphragm.

Lumbar veins (v.v. lumbales) in the amount of 4 pairs correspond to the lumbar arteries, as well as segmental, as well as intercostal veins. The lumbar veins communicate with each other by vertical anastomoses, due to which thin venous trunks are formed on both sides of the inferior vena cava, which at the top continue into the unpaired (right) and semi-unpaired (left) veins, being one of the anastomoses between the inferior and superior vena cava. The internal branches of the inferior vena cava include: internal testicular and ovarian veins, renal, adrenal and hepatic. The latter through the venous network of the liver are connected with the portal vein.

The testicular vein (v. tecticularis) begins in the testicle and its epididymis, forms a dense plexus inside the spermatic cord and flows to the right into the inferior vena cava, and to the left into the renal vein.

The ovarian vein (v. ovarica) starts from the hilum of the ovary, passing through the wide ligament of the uterus. It accompanies the artery of the same name and further goes like the testicular vein.

The renal vein (v. renalis) begins at the hilum of the kidney with several fairly large branches that lie in front of the renal artery and flow into the inferior vena cava.

Adrenal vein (v. suprarenalis) - on the right flows into the inferior vena cava, and on the left - into the renal.

Rice. 97. Inferior vena cava and its tributaries:

1 - inferior vena cava; 2 - adrenal vein; 3 - renal vein; 4 - testicular veins; 5 - common iliac vein; 6 - femoral vein; 7 - external iliac vein; 8 - internal iliac vein; 9 - lumbar veins; 10 - lower diaphragmatic veins; 11 - hepatic veins

Hepatic veins (v. le-

raisae) - there are 2-3 large ones and several small ones, through which the blood that enters the liver flows. These veins drain into the inferior vena cava.

portal vein system

Portal vein (liver)

(V. robae (heratis)) - collects blood from the walls of the digestive canal, starting from the stomach and up to the upper rectum, as well as from the gallbladder, pancreas and spleen (Fig. 98). This is a short thick trunk, formed behind the head of the pancreas as a result of the confluence of three large veins - the splenic, superior and inferior mesenteric, which branch in the region of the arteries of the same name. The portal vein enters the liver through its gate.

Rice. 98. Portal vein system and inferior vena cava:

1 - anastomoses between the branches of the portal and superior vena cava in the wall of the esophagus; 2 - splenic vein; 3 - superior mesenteric vein; 4 - inferior mesenteric vein; 5 - external iliac vein; 6 - internal iliac vein; 7 - anastomoses between the branches of the portal and inferior vena cava in the wall of the rectum; 8 - common iliac vein; 9 - portal vein; ten - hepatic vein; 11 - inferior vena cava

The common iliac vein (v. iliaca communis) begins at the level of the sacral vertebral articulation from the confluence of the internal and external iliac veins.

The internal iliac vein (v. iliaca interna) lies behind the artery of the same name and has a branching area in common with it. The branches of the vein, carrying blood from the viscera, form abundant plexuses around the organs. These are the hemorrhoidal plexuses surrounding the rectum, especially in its lower section, the plexuses behind the symphysis, which receive blood from the genitals, the venous plexus of the bladder, and in women, the plexuses around the uterus and vagina.

The external iliac vein (v. iliaca externa) starts above the inguinal ligament and serves as a direct continuation of the femoral vein. It carries the blood of all superficial and deep veins of the lower limb.

Veins of the lower limb

On the foot, venous arches of the rear and soles, as well as subcutaneous venous networks, are isolated. The small saphenous vein of the lower leg and the great saphenous vein of the leg begin from the veins of the foot (Fig. 99).

Rice. 99. Deep veins of the lower limb, right:

A - leg veins, medial surface; B - veins of the back surface of the leg; B - veins of the thigh, anteromedial surface; 1 - venous network of the heel region; 2 - venous network in the ankles; 3 - posterior tibial veins; 4 - peroneal veins; 5 - anterior tibial veins; 6 - popliteal vein; 7 - great saphenous vein of the leg; 8 - small saphenous vein of the leg; 9 - femoral vein; 10 - deep vein of the thigh; 11 - perforating veins; 12 - lateral veins enveloping the femur; 13 - external iliac vein

The small saphenous vein of the lower leg (v. saphena parva) passes to the lower leg behind the outer ankle and flows into the popliteal vein.

The great saphenous vein of the leg (v. saphena magna) rises to the lower leg in front of the inner ankle. On the thigh, gradually increasing in diameter, it reaches the inguinal ligament, under which it flows into the femoral vein.

The deep veins of the foot, lower leg and thigh in double quantity accompany the arteries and bear their names. All these veins have many

lazy valves. Deep veins abundantly anastomose with superficial ones, through which a certain amount of blood rises from the deep parts of the limb.

Questions for self-control

1. Describe the importance of the cardiovascular system for the human body.

2. Tell us about the classification of blood vessels, describe their functional significance.

3. Describe the large and small circles of blood circulation.

4. Name the links of the microvasculature, explain the features of their structure.

5. Describe the structure of the walls of blood vessels, differences in the morphology of arteries and veins.

6. List the patterns of the course and branching of blood vessels.

7. What are the boundaries of the heart, their projection on the anterior chest wall?

8. Describe the structure of the chambers of the heart, their features in connection with the function.

9. Give a structural and functional description of the atria.

10. Describe the features of the structure of the ventricles of the heart.

11. Name the valves of the heart, explain their meaning.

12. Describe the structure of the heart wall.

13. Tell us about the blood supply to the heart.

14. Name the parts of the aorta.

15. Describe the thoracic part of the aorta, name its branches and areas of blood supply.

16. Name the branches of the aortic arch.

17. List the branches of the external carotid artery.

18. Name the terminal branches of the external carotid artery, describe the areas of their vascularization.

19. List the branches of the internal carotid artery.

20. Describe the blood supply to the brain.

21. Name the branches of the subclavian artery.

22. What are the features of the branching of the axillary artery?

23. Name the arteries of the shoulder and forearm.

24. What are the features of the blood supply to the hand?

25. List the arteries of the organs of the chest cavity.

26. Tell us about the abdominal part of the aorta, its holotopy, skeletopy and syntopy.

27. Name the parietal branches of the abdominal aorta.

28. List the splanchnic branches of the abdominal aorta, explain the areas of their vascularization.

29. Describe the celiac trunk and its branches.

30. Name the branches of the superior mesenteric artery.

31. Name the branches of the inferior mesenteric artery.

32. List the arteries of the walls and organs of the pelvis.

33. Name the branches of the internal iliac artery.

34. Name the branches of the external iliac artery.

35. Name the arteries of the thigh and leg.

36. What are the features of the blood supply to the foot?

37. Describe the system of the superior vena cava, its roots.

38. Tell us about the internal jugular vein and its ducts.

39. What are the features of blood flow from the brain?

40. How is the blood flow from the head?

41. List the internal tributaries of the internal jugular vein.

42. Name the intracranial tributaries of the internal jugular vein.

43. Describe the blood flow from the upper limb.

44. Describe the system of the inferior vena cava, its roots.

45. List the parietal tributaries of the inferior vena cava.

46. ​​Name the splanchnic tributaries of the inferior vena cava.

47. Describe the portal vein system, its tributaries.

48. Tell us about the tributaries of the internal iliac vein.

49. Describe the blood flow from the walls and organs of the small pelvis.

50. What are the features of blood flow from the lower limb?

Zmist

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Basic concepts and key terms: BLOOD VESSELS. arteries. Vienna. capillaries. Small circle of blood circulation. Great circle of blood circulation.

Remember! What is the cardiovascular system?

Think!

Heraclitus of Ephesus (544-483 BC) is a Greek philosopher who believed that everything is transient and disposable - “everything flows”. These famous words were preserved for history by the philosopher Plato:

“Heraclitus says that everything moves and nothing stands still, and, equating the existing to the flow of a river, he adds that it is impossible to enter the same river twice.” Is it possible to “enter twice” into the “red river”, which is driven by the human cardiovascular system?

What are the structural features of blood vessels?

BLOOD VESSELS - elastic tubes through which blood is transported to all organs and tissues, and then again collected to the heart. The structure of blood vessels is closely related to their functions.

Arteries are blood vessels that carry blood from the heart to organs and tissues. The walls of the arteries have three layers and vary in thickness and elasticity, as they have to withstand great pressure and the speed of blood flow. The outer shell of the walls of the arteries is built from connective tissue. The middle shell consists of smooth muscles and elastic fibers. Thanks to the muscles, the arteries change the diameter and regulate the blood flow, and the elastic fibers give them elasticity. The inner shell is formed by a special connective tissue (endothelium), the cells of which have smooth surfaces, which contributes to the movement of blood. Arteries branch into arterioles, which branch into capillaries.

Capillaries are the smallest blood vessels that connect arteries and veins and provide exchange of substances between blood and tissue fluid. Their walls are formed by one layer of cells, since the blood pressure is insignificant, and the speed of blood movement is the smallest among all vessels. Different organs have different levels of development of the capillary network. For example, in the skin there are 40 capillaries per 1 mm 2, and in the muscles - about 1,000. Blood from the capillaries enters the veins.

Veins are blood vessels that carry blood from organs and tissues to the heart. The walls of the veins have the same structure as the arteries, but with thinner shells. This is due to low blood pressure and slightly higher blood velocity. Another feature of the structure of the veins is the presence of pocket valves that prevent the reverse flow of blood.

So, the structure of blood vessels is associated with their functions and depends mainly on the speed and pressure of the blood.

What is the importance of small and large circles of blood circulation?

Blood vessels form small and large circles of blood circulation. The small (pulmonary) circle of blood circulation begins from the right ventricle with the pulmonary trunk, branches into two pulmonary arteries that carry venous blood to the lungs.

The pulmonary arteries enter the lungs and branch into pulmonary capillaries, in which venous blood is converted into arterial blood. Small veins begin from the capillaries, forming four pulmonary veins. These veins carry arterial blood and empty into the left atrium. In the pulmonary circulation, the pulmonary arteries carry venous blood, and the pulmonary veins carry arterial blood. The movement of blood through the small, or pulmonary, circle of blood circulation is carried out in 4-5 s. The path of blood from the right ventricle through the lungs to the left atrium is called the pulmonary circulation.

The systemic circulation begins from the left ventricle, from where the arterial blood from this chamber of the heart enters the aorta and through the system of arteries and capillaries enters different parts of the body. Capillaries gradually merge into veins. The largest of them - the superior and inferior vena cava - flow into the right atrium. Moving in a large circle, the blood carries oxygen and nutrients to the cells, takes away carbon dioxide and metabolic products from them, and arterial blood is converted into venous blood. In the systemic circulation, arteries carry arterial blood, while veins carry venous blood. The circulation of blood in a large circle of blood circulation is carried out in 20-23 s. The path of blood from the left ventricle through the tissues and organs of the body to the right atrium is called the systemic circulation.

How does blood move through the vessels?

The movement of blood through the vessels in humans is due to the rhythmic work of the four-chamber heart, which provides a pressure difference

leniya at the beginning and at the end of the circles of blood circulation. Auxiliary factors of blood circulation: contraction of skeletal muscles, the presence of valves in the veins along the blood flow, the elastic forces of the vessels that store energy during heart contractions. As it turned out as a result of research, the main factors on which the movement of blood in the vessels depends are blood pressure(P) and blood velocity (V).

Blood pressure is the pressure in the blood vessels due to the rhythmic work of the heart. This is one of the most important parameters characterizing the work of the circulatory system. Depending on the type of vessels, arterial, capillary and venous pressure are distinguished. Easier to measure blood pressure.

The speed of blood movement is defined as the distance that the blood travels per unit of time (in centimeters per second). The movement of blood in different vessels occurs at different speeds. It depends on the pressure difference in a given part of the vascular system and on the total diameter of the vessels. The larger the diameter, the slower the blood moves.

Table 15. BLOOD MOVEMENTS IN THE BLOOD VESSELS

Thus, the indicators of blood movement in different vessels are different. This is due to the functions of arteries, capillaries and veins.

ACTIVITY

Learning to know

Lab Test HEART RATE MEASUREMENT

Purpose: to form practical skills to determine the heart rate.

Equipment: stopwatch.

Theoretical part

Arterial pulse - rhythmic oscillations of the wall of the arteries, due to the work of the heart. The pulse is easily felt under the fingers on large superficially located arteries (temporal, radial arteries). One oscillation corresponds to one heart beat, so the pulse can be used to determine the heart rate in one minute. The arterial pulse provides information about the heart rate, the state of the vessels and the work of the heart. The pulse rate is individual and is 72-85 beats / min in adolescents, and 60-75 beats / min in adults. With age, the elasticity of the arterial walls decreases, so the speed of propagation of the pulse wave increases, and the pulse quickens.

Progress

1. Find the pulse on your left wrist where the radial artery passes. The pulse can also be recorded in areas where the temporal or carotid artery passes.

2. After finding the pulse, turn on the stopwatch and start counting for 30 seconds. Multiply the resulting number by 2. So you determine the number of your own heartbeats in 1 minute. Compare your heart rate with that of your classmates.

Biology + Thinking

Analyze the comparative data of the table and offer your own judgments about the characteristics of blood circulation in the human body.

Table 16

Biology + Medicine

Sergey Bryukhonenko (1890-1960) - an outstanding physiologist and a talented inventor, the author of the first artificial blood circulation apparatus for the whole organism. It was he who became the prototype of Professor Dowell from the science fiction writer A. Belyaev's novel "Professor Dowell's Head". At the end of the 20s of the XX century, a sensational message spread around the world about his experiment - the revival of a dog's head isolated from the body, whose life was supported by a heart-lung machine for 3 hours. What is the importance of a heart-lung machine for medicine?

RESULT

This is textbook material.