22

The Cardiovascular
System: Vessels and
Circulation

© 2012 Pearson Education, Inc.

Introduction

• There are two groups of blood vessels

• Pulmonary circuit
• Blood goes to and from the lungs
• Systemic circuit
• Blood goes to the rest of the body and back to the heart
• Blood goes to both circuits at the same time with
each heartbeat

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Histological Organization of Blood Vessels

• The walls of the vessels consist of three layers

• Intima (innermost layer)
• Media (middle layer)
• Adventitia (outermost layer)
• The layered walls give the vessels tremendous
strength

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Figure 22.1 Histological Comparison of Typical Arteries and Veins

Adventitia
Adventitia
Media
Media
Intima
Intima
Smooth Lumen
muscle of vein
Internal elastic
membrane Smooth
muscle

External
elastic Lumen
membrane of
artery
Endothelium Endothelium

Elastic
fiber
Artery and vein LM  60
ARTERY VEIN

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Histological Organization of Blood Vessels

• Distinguishing Arteries from Veins

• Most arteries and veins run parallel to each other
• Arteries carry blood away from the heart and veins
carry blood toward the heart
• Walls of arteries are thicker than veins
• Arteries maintain their circular shape and veins
typically collapse when cut
• Endothelial lining of an artery has pleated folds

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Figure 22.2 Histological Structure of Blood Vessels

Large Vein Elastic Artery

Internal
elastic layer Intima
Adventitia Endothelium

Media
Media
Endothelium
Intima Adventitia

Medium-Sized Vein Muscular Artery

Adventitia Adventitia
Media
Media
Endothelium Endothelium
Intima Intima

Venule Arteriole

Smooth muscle cells

(Media)
Adventitia
Endothelium Endothelium
Basal lamina

Capillaries
Fenestrated Capillary Continuous Capillary
Pores
Endothelial
Endothelial cells cells

Basal lamina Basal lamina

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Histological Organization of Blood Vessels

• Arteries
• As blood leaves the heart, it travels through:
• Elastic arteries
• Muscular arteries
• Arterioles
• Capillaries
• Capillary beds

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Histological Organization of Blood Vessels

• Capillaries
• Walls are thin enough to permit exchange of gases
between the blood and the interstitial fluid
• The diameter is about 8 microns
• A red blood cell diameter is also about 8 microns
• Fenestrated capillaries contain pores

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Figure 22.3b Structure of Capillaries

Basal lamina
Endothelial cell

Nucleus

This diagrammatic
view of a fenestrated
capillary details the
structure of the wall.
Endosomes

Fenestrations,
or pores

Boundary between Basal

endothelial cells lamina
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Histological Organization of Blood Vessels

• Capillaries (continued)
• There are four mechanisms regarding the passage
of material across the walls of capillaries
• Material can diffuse across the endothelial lining
• Material can diffuse through gaps between adjacent
cells of the lining
• Material can diffuse through pores
• Material can move via endocytosis

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Histological Organization of Blood Vessels

• Capillary Beds
• This is an interconnected network of capillaries
• The capillary bed consists of vessels connecting
arterioles with venules
• There are precapillary sphincters involved in
regulating blood flow through the capillaries

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Figure 22.4a Organization of a Capillary Bed

Vein
Collateral
arteries
Smooth
muscle cells Venule

Arteriole
Thoroughfare
Metarterioles channel Capillaries

Section of
precapillary
sphincter

Small
venule

Precapillary
sphincters

Arteriovenous KEY
anastomosis Consistent
blood flow
Basic organization of a typical capillary bed.
Variable
The pattern of blood flow changes continually blood flow
in response to regional alterations in tissue
oxygen demand.
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Figure 22.4b Organization of a Capillary Bed

Small
artery

Arteriole

Metarterioles

Capillary
Capillary bed LM  125 beds

Capillary bed as seen in living tissue

© 2012 Pearson Education, Inc.
Histological Organization of Blood Vessels

• Capillary Beds (continued)

• In areas such as the brain, heart, and stomach, a
continuous, rich flow of blood is required
• In these areas, more than one artery supplies a
specific area
• These arteries (collateral arteries) typically fuse
forming an arterial anastomosis
• If one arteriole is blocked, the other one will supply
blood to the capillary bed

© 2012 Pearson Education, Inc.

Histological Organization of Blood Vessels

• Capillary Beds (continued)

• In areas such as the joints or visceral organs, blood
flow through some vessels may be hindered due to
body movement
• In order to accommodate this, there must be a
direct connection between arterioles and venules
• This direct connection is called an arteriovenous
anastomosis

© 2012 Pearson Education, Inc.

Histological Organization of Blood Vessels

• Veins
• Veins collect blood from tissues and return the
blood to the heart
• As blood leaves the tissue and travels to the heart,
it travels through the following vessels:
• Capillary beds
• Capillaries
• Venules
• Medium-sized veins
• Large veins

© 2012 Pearson Education, Inc.

Histological Organization of Blood Vessels

• Blood in the veins returning to the heart from

the lower extremities has to go against gravity
• To assist in this process, many veins have valves
(venous valves)
• These valves compartmentalize the blood in the
veins thus acting as one-way valves
• If the venous valves do not close properly, varicose
veins may occur

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Figure 22.5 Function of Valves in the Venous System Valves

Valve
closed

Valve opens above

contracting muscle

Valve
closed

Valve closes below

contracting muscle
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Histological Organization of Blood Vessels

• The total blood volume is distributed unevenly

within the vessels of the body
• Arteries and capillaries contain 30–35% of the
volume
• Veins contain 65–70% of the volume
• Veins are more distensible than arteries
• Based on blood pressure, a vein can expand about 8
times as much as a parallel artery

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Figure 22.6 The Distribution of Blood in the Cardiovascular System

Large veins
18%

Large venous
networks (liver,
bone marrow, skin)
21%

Venules and
medium-sized veins
25%

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Blood Vessel Distribution

• Blood vessels can be divided into two circuits

• Pulmonary circuit
• Composed of arteries and veins that transport blood
between the heart and the lungs
• Arteries and veins travel relatively short distances
• Systemic circuit
• Composed of arteries and veins that transport
oxygenated blood between the heart and all other
tissues
• Arteries and veins travel longer distances

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Blood Vessel Distribution

• There are functional and structural differences

between the vessels in the two circuits
• Blood pressure in the pulmonary circuit is lower
than in the systemic circuit
• Walls of the pulmonary arteries are thinner than
the walls of systemic arteries

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Blood Vessel Distribution Vessel Distribution

• Functional patterns of the pulmonary and

systemic circuits
• The distribution of arteries and veins is the same on
the left side of the body as it is on the right side of
the body except for the venae cavae and the aorta
• A single vessel will have different names according
to specific anatomical boundaries
• Arteries and veins often anastomose

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Blood Vessel Distribution

• The Pulmonary Circuit

• Blood leaves the heart by passing through the
pulmonary valve
• Blood enters the pulmonary trunk
• Blood enters the left and right pulmonary arteries
• Blood arrives at the lungs to drop off carbon dioxide
and pick up oxygen
• Blood returns to the heart via the pulmonary veins
• Blood enters the left atrium of the heart

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Figure 22.8b The Pulmonary Circuit

Superior vena cava Ascending aorta

Left pulmonary artery

Right pulmonary artery
Pulmonary trunk
Left pulmonary veins
Right pulmonary veins

Right coronary artery

Anterior interventricular
Right atrium branch of left coronary
artery

Right ventricle

Left ventricle

Spiral scan of the heart and major vessels [Image rendered with High
Definition Volume Rendering® software provided by Fovia, Inc.]

© 2012 Pearson Education, Inc.

Figure 22.8a The Pulmonary Circuit

Trachea Aortic arch

Ascending aorta Pulmonary trunk

Superior vena cava

Left lung

Right lung Left pulmonary arteries

Right pulmonary Left pulmonary veins

arteries

Right pulmonary
veins
Alveolus

Capillary

O2
Inferior vena cava CO2
Descending aorta
Anatomy of the pulmonary circuit. Blue arrows
indicate the flow of deoxygenated blood; red arrows
indicate the flow of oxygenated blood. The breakout shows the
alveoli of the lung and the routes of gas diffusion into and out of
the bloodstream across the walls of the alveolar capillaries.

© 2012 Pearson Education, Inc.

Blood Vessel Distribution

• The Systemic Circuit

• Blood leaves the heart by passing through the
aortic valve
• Blood enters the ascending aorta and then the
aortic arch and then it branches into:
• Brachiocephalic trunk (then the right common carotid
and right subclavian arteries)
• Left common carotid artery
• Left subclavian artery
• Descending aorta
• Coronary arteries

© 2012 Pearson Education, Inc.

Figure 22.9 An Overview of the Systemic Arterial System

Vertebral
Right common carotid
Right subclavian
Left common carotid
Brachiocephalic Left subclavian
trunk
Aortic arch Axillary
Ascending Pulmonary trunk
aorta Descending aorta

Diaphragm
Celiac trunk
Brachial Renal
Superior mesenteric

Gonadal
Inferior mesenteric

Radial Common iliac

Internal iliac
Ulnar
External
iliac

Palmar
arches Deep
femoral

Femoral

Descending
genicular
Popliteal

Posterior tibial

Anterior tibial

Fibular

Dorsalis pedis

Plantar arch

© 2012 Pearson Education, Inc.

Figure 22.9 An Overview of the Systemic Arterial System (Part 1 of 2)

Vertebral
Right common carotid
Right subclavian
Left common carotid
Brachiocephalic Left subclavian
trunk
Aortic arch Axillary
Ascending Pulmonary trunk
aorta Descending aorta

Diaphragm
Celiac trunk
Brachial Renal
Superior mesenteric
Gonadal
Inferior mesenteric

© 2012 Pearson Education, Inc.

Figure 22.7 An Overview of the General Pattern of Circulation

Brain
Upper limbs

Pulmonary Pulmonary
circuit circuit
(arteries) (veins)

Lungs

LA
RA Systemic
circuit
Left (arteries)
Right ventricle
Systemic ventricle
circuit
(veins)

Kidneys
Spleen

Liver
Digestive
organs

Gonads
Lower limbs
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Blood Vessel Distribution

• The Systemic Circuit (continued)

• Ascending aorta
• Begins at the aortic valve
• Left and right coronary arteries branch off the base of the
ascending aorta
• Aortic arch
• Forms an arch going toward the left and posterior side of
the heart
• Branching off the aortic arch are three elastic arteries

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Blood Vessel Distribution

• The Systemic Circuit (continued)

• Branches of the aortic arch
• Brachiocephalic trunk gives rise to the right
common carotid artery (supplies blood to the right side
of the head and brain) and to the right subclavian artery
(supplies blood to the right arm)
• Left common carotid artery (supplies blood to the left
side of the head and brain)
• Left subclavian artery (supplies blood to the left arm)

© 2012 Pearson Education, Inc.

Figure 22.10 Aortic Angiogram

Right common
carotid artery

Thyrocervical trunk

Right subclavian artery

Left common
carotid artery

Left subclavian artery

Brachiocephalic
trunk

Aortic arch
Internal thoracic artery

Descending aorta
Ascending aorta

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Blood Vessel Distribution

• The Systemic Circuit (continued)

• The subclavian arteries
• Give rise to the vertebral arteries
• Give rise to the axillary arteries
• Prior to forming the axillary arteries, the subclavians
form three branches:
• Thyrocervical trunk (supplies muscles of the neck, head,
and upper back)
• Internal thoracic artery (supplies the pericardium and
anterior wall of the chest)
• Vertebral artery (supplies the brain and spinal cord)

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Blood Vessel Distribution

• The flow of blood from the subclavians

• Axillary artery
• Branches to form the humeral circumflex artery
• Brachial artery
• Branches to form the deep brachial artery
• Divides to form the radial and ulnar arteries
• Arteries anastomose at the wrist forming the superficial
palmar arch and deep palmar arch

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Figure 22.11a Arteries of the Chest and Upper Limb
Thyrocervical trunk
Suprascapular Right common carotid
Left common carotid
Right subclavian
Vertebral
Thoracoacromial
Brachiocephalic trunk
Axillary Left subclavian
Lateral thoracic
Aortic arch
Anterior humeral circumflex
Ascending aorta
Posterior humeral circumflex
Thoracic aorta

Subscapular
Heart

Deep brachial

Intercostal Internal thoracic

Abdominal aorta
Brachial
Superior ulnar
collateral
Inferior ulnar
collateral

Anterior ulnar
recurrent Arteries originating along the aortic
arch shown branching into the chest
Posterior ulnar
recurrent and right upper limb

Radial

Anterior
interosseous

Ulnar

Deep palmar
arch
Superficial
palmar arch

Digital arteries

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Figure 22.11b Arteries of the Chest and Upper Limb

Right vertebral Right Left

Spinal cord, cervical vertebrae common common
(right side); fuses with left vertebral, carotid carotid
forming basilar artery after entering
cranium via foramen magnum
Left
Right thyrocervical vertebral
trunk
Muscles, skin,
Left
tissues of neck, thyroid
gland, shoulders, and thyrocervical
upper back (right side) Right Brachiocephalic Left trunk
subclavian trunk subclavian

Right internal
Left
thoracic
Right axillary AORTIC internal
Skin and muscles of thoracic
Muscles of the chest and abdomen,
ARCH Left
right pectoral mammary gland (right axillary
region and axilla side), pericardium

ASCENDING
Right brachial AORTA Left
To structures brachial
of the arm
A flowchart showing THORACIC
the arterial distribution AORTA
Right radial Right ulnar (see Fig. 22.19)
from the aortic arch. Left Left
Forearm, Forearm,
Thick arrows show radial side ulnar side ulnar radial
major pathways of LEFT
blood flow; thin arrows Connected by anastomoses VENTRICLE
of palmar arches that supply ABDOMINAL
show distribution to AORTA
digital arteries
secondary or terminal (see Fig. 22.19)
pathways.

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Figure 22.11c Arteries of the Chest and Upper Limb

Clavicle
Posterior cord (cut and removed)
of brachial plexus
Axillary artery Medial cord of
brachial plexus
Right subclavian artery
Subscapular artery
Deep brachial
artery Pectoralis major muscle
Brachial (cut and reflected)
artery

Biceps brachii Serratus anterior

muscle muscle
Median nerve

Brachial artery

Anterior view of the right axillary region dissected

to show blood vessels and nerves in this region
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Figure 22.11d Arteries of the Chest and Upper Limb

Biceps brachii
muscle
Brachial artery

Inferior ulnar
collateral artery

Ulnar artery
Brachioradialis
muscle

Flexor carpi
radialis muscle

Radial artery

Ulnar artery

Anterior view of
Superficial
the right forearm palmar arch
dissected to show
the main arteries
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Blood Vessel Distribution

• The Carotid Arteries

• The common carotids ascend the neck
• Divide to form the internal carotids and external
carotids
• The carotid sinus is at the base of the internal carotid
artery consisting of baroreceptors and chemoreceptors

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Figure 22.13a Arteries of the Neck and Head

Superficial temporal

Cerebral arterial circle

Anterior cerebral
Carotid canal Middle cerebral
Ophthalmic

Posterior cerebral Maxillary

Basilar

Occipital Facial

Lingual
Internal carotid
External carotid
Carotid sinus
Vertebral
Inferior thyroid
Thyrocervical
trunk Common carotid
Transverse cervical
Suprascapular
Subclavian
Axillary Brachiocephalic
Internal thoracic trunk

Second rib

General circulation pattern of arteries supplying the

neck and superficial structures of the head; this is
an oblique lateral view from the right side.
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Blood Vessel Distribution

• The internal and external carotid arteries

• External carotids supply the neck and outside of the
skull
• Internal carotids enter the skull to deliver blood to
the brain
• Internal carotid branches to form:
• Ophthalmic artery (supplies the eyes)
• Anterior cerebral artery (supplies frontal and parietal
lobes of the brain)
• Middle cerebral artery (supplies the midbrain and lateral
surfaces of the brain)

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Figure 22.13b Arteries of the Neck and Head

Middle cerebral

Anterior cerebral
Posterior cerebral

Basilar

Vertebral artery Internal carotid artery

after entering skull where it enters the skull

Internal carotid artery

External carotid
Carotid sinus

Facial

Vertebral Common carotid

Spiral 3-D volume rendered scan of the arteries supplying

the neck and head. [Courtesy of TeraRecon, Inc.]

© 2012 Pearson Education, Inc.

Blood Vessel Distribution

• Blood supply to the brain

• Blood in the vertebral arteries go to the brain via:
• Left and right vertebral arteries fuse to form the basilar
artery
• Basilar artery branches many times in the area of the
pons
• Basilar artery eventually forms the vessels of the cerebral
arterial circle (circle of Willis)
• Blood in the internal carotid arteries goes to the
brain via:
• Anastomosing with the cerebral arterial circle

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Figure 22.14a The Arterial Supply to the Brain

Anterior cerebral
Anterior communicating

Internal carotid (cut) Anterior cerebral

Cerebral
Posterior communicating arterial
circle
Middle cerebral
Posterior cerebral
Pituitary gland
Posterior cerebral Superior cerebellar

Basilar Pontine
Labyrinthine
Anterior inferior cerebellar

Vertebral

Posterior inferior cerebellar

Anterior spinal

An inferior view of the brain showing the distribution of

arteries. See Figure 22.21b for a comparable view of
the veins on the inferior surface of the brain.

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Figure 22.14b The Arterial Supply to the Brain
Anterior cerebral
Anterior
communicating

Posterior
communicating

Posterior
cerebral
Left internal
carotid
Superior
cerebellar
Pons
Basilar

Anterior
inferior
cerebellar
Vertebral

Medulla
oblongata

The arteries on the inferior surface of the

brain; the vessels have been injected with
red latex, making them easier to see.
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Figure 22.14c The Arterial Supply to the Brain

Left internal
carotid
Branches of left
middle cerebral artery

Basilar

A lateral view of the arteries supplying the brain. This is a

corrosion cast: The vessels have been injected with latex, and
then the brain tissue was dissolved and removed in an acid bath.
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Blood Vessel Distribution

• The Descending Aorta

• A continuation of the aortic arch
• Divided into thoracic aorta and abdominal aorta

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Figure 22.15 Major Arteries of the Trunk
Vertebral
Thyrocervical trunk

Brachiocephalic trunk Common carotid

Left subclavian
Aortic arch
Axillary

Internal thoracic
Bronchial

Esophageal Mediastinal

Pericardial

Intercostal

THORACIC AORTA

Superior phrenic
Inferior phrenic
Celiac trunk
Diaphragm

Common hepatic Left gastric

Splenic
Suprarenal
Renal Superior
mesenteric
ABDOMINAL
Lumbar AORTA
Gonadal

Right common iliac Inferior mesenteric

Terminal segment
External iliac of the aorta
Median sacral
Internal iliac

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Blood Vessel Distribution

• The Thoracic Aorta

• Branches to form the following vessels:
• Bronchial arteries
• Pericardial arteries
• Mediastinal arteries
• Esophageal arteries
• Intercostal arteries
• Superior phrenic arteries

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Blood Vessel Distribution

• The Abdominal Aorta

• Branches to form the following vessels:
• Celiac trunk
• Superior mesenteric artery
• Inferior mesenteric artery
• Inferior phrenic arteries
• Suprarenal arteries
• Renal arteries
• Gonadal arteries
• Lumbar arteries
• Right and left common iliac arteries
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Blood Vessel Distribution

• The Celiac Trunk

• Branches to form the left gastric artery
• Supplies the stomach
• Branches to form the splenic artery
• Branches to form the left gastroepiploic artery to supply
the stomach
• Branches to form the pancreatic arteries to supply the
pancreas

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Blood Vessel Distribution

• The Celiac Trunk (continued)

• Branches to form the common hepatic artery
• The common hepatic artery branches to form:
• Hepatic artery proper to supply the liver
• Right gastric artery to supply the stomach
• Cystic artery to supply the gallbladder
• Gastroduodenal artery to supply the duodenum

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Figure 22.16 Arteries of the Abdomen
Inferior vena cava
THORACIC AORTA
ABDOMINAL AORTA
Celiac trunk
Liver
Common hepatic Stomach

Hepatic artery proper

Left gastric
Cystic Splenic
Gastroduodenal
Right gastric Spleen

Right gastroepiploic Left gastroepiploic

Superior mesenteric

Superior Pancreatic
Pancreas
pancreaticoduodenal
Inferior mesenteric
Duodenal
Left colic
Inferior
pancreaticoduodenal
Middle colic (cut)
Sigmoid
Ascending colon
Left common iliac
Right colic
Small intestine
Ileocolic
Intestinal Sigmoid colon
Rectal
Right external iliac
Rectum
Right internal iliac

Major arteries supplying the abdominal viscera

Common hepatic Left gastric

Celiac trunk

Superior mesenteric
Left renal
Right kidney

Abdominal aorta

Inferior mesenteric Intestinal arteries

Left iliac crest

Right common iliac Left common iliac

Right internal iliac

Right external iliac
Pubic symphysis

Spiral 3-D volume rendered scan of the abdominal

aorta and its branches. [Courtesy of TeraRecon, Inc.]
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Blood Vessel Distribution

• Inferior Mesenteric Artery

• Branches to form the left colic and sigmoid arteries
• Supply the terminal portions of the large intestine
• Branches to form the rectal arteries
• Supply the rectum

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Figure 22.16a Arteries of the Abdomen

Inferior vena cava

THORACIC AORTA
ABDOMINAL AORTA
Celiac trunk
Liver
Common hepatic Stomach

Hepatic artery proper

Left gastric
Cystic Splenic
Gastroduodenal
Right gastric Spleen

Right gastroepiploic Left gastroepiploic

Superior mesenteric

Superior Pancreatic
Pancreas
pancreaticoduodenal
Inferior mesenteric
Duodenal
Left colic
Inferior
pancreaticoduodenal
Middle colic (cut)
Sigmoid
Ascending colon
Left common iliac
Right colic
Small intestine
Ileocolic
Intestinal Sigmoid colon
Rectal
Right external iliac
Rectum
Right internal iliac

Major arteries supplying the abdominal viscera

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Figure 22.16b Arteries of the Abdomen

Common hepatic Left gastric

Celiac trunk

Superior mesenteric
Left renal
Right kidney

Abdominal aorta

Inferior mesenteric Intestinal arteries

Left iliac crest

Right common iliac Left common iliac

Right internal iliac

Right external iliac
Pubic symphysis

Spiral 3-D volume rendered scan of the abdominal

aorta and its branches. [Courtesy of TeraRecon, Inc.]

© 2012 Pearson Education, Inc.

Blood Vessel Distribution

• Arteries of the Pelvis

• The common iliac arteries
• Branch to form the internal iliac artery
• Supplies the urinary bladder, walls of the pelvis, external
genitalia, and the medial side of the thigh
• Branches to form the external iliac artery
• Supplies blood to the legs

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Figure 22.9 An Overview of the Systemic Arterial System (Part 2 of 2)

Radial Common iliac

Internal iliac
Ulnar
External
iliac

Palmar
arches Deep
femoral

Femoral

Descending
genicular
Popliteal

Posterior tibial

Anterior tibial

Fibular

Dorsalis pedis

Plantar arch

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 Iliolumbar Common iliac

Internal iliac
Superior
Figure 22.17a Major Arteries of the Lower gluteal
Limb, Part I External iliac
Inguinal Lateral sacral
ligament Internal pudendal
Obturator

Medial femoral
Deep femoral circumflex

• Arteries of the Leg Lateral femoral

circumflex

– External iliac Femoral

arteries form the:

– Femoral artery
– The femoral artery Popliteal Descending
genicular

continues to form
the popliteal artery,
Posterior tibial
and then splits to
form the anterior Anterior tibial

tibial artery and

posterior tibial Fibular

artery
• Deep femoral artery
Dorsalis pedis

Lateral plantar Medial plantar

Dorsal arch
Plantar arch

Anterior view of the arteries supplying the right

lower limb
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Figure 22.17b Major Arteries of the Lower Limb, Part I

Inguinal
ligament

Iliacus
muscle
Femoral artery
Sartorius Femoral nerve
muscle Femoral vein
Pectineus
muscle
Fascia overlying
Great
tensor fasciae
saphenous
latae
vein
Lateral femoral Adductor
circumflex brevis muscle
artery

Adductor
longus muscle

Rectus Deep femoral

femoris artery
muscle

Saphenous
nerve overlying
femoral artery

Major arteries of the right thigh

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Blood Vessel Distribution

• Arteries of the Foot

• The anterior tibial artery forms the dorsalis pedis
artery
• The posterior tibial artery forms the medial and
lateral plantar arteries

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Blood Vessel Distribution

• Systemic Veins
• Veins collect blood from the body tissues and return
it to the heart
• Blood returns to the heart from the lower
extremities via the inferior vena cava to the right
atrium
• Blood returns to the heart from the upper
extremities via the superior vena cava to the right
atrium
• Blood returns to the heart from the lungs via the
pulmonary veins to the left atrium
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Blood Vessel Distribution

• Venous Return from the Cranium

• The superficial cerebral veins drain into:
• Superior and inferior sagittal sinuses
• Petrosal sinuses
• Occipital sinus
• Left and right transverse sinuses
• Straight sinus
• All of the venous sinuses drain into the internal
jugular vein
• The internal jugular drains into the brachiocephalic
veins
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Figure 22.21a Major Veins of the Head and Neck

Superior
sagittal sinus

Superficial
cerebral veins
Temporal
Inferior
sagittal sinus Deep cerebral
Great cerebral
Cavernous sinus
Straight sinus Maxillary
Petrosal sinuses
Right
transverse sinus
Occipital sinus Facial

Sigmoid
sinus
Occipital

Vertebral
External Internal jugular
jugular

Right
subclavian
Clavicle
Right brachiocephalic
Axillary Left brachiocephalic

Superior vena cava

Internal thoracic

An oblique lateral view of the head and neck

showing the major superficial and deep veins
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Blood Vessel Distribution

• Venous Return from the Cranium (continued)

• The vertebral veins drain into the brachiocephalic
veins

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Blood Vessel Distribution

• Venous Return from the Head

• Veins from the head converge to form the:
• Temporal vein
• Facial vein
• Maxillary veins
• The temporal and maxillary veins drain into the
external jugular vein
• The facial vein drains into the internal jugular vein

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Blood Vessel Distribution

• Venous Return from the Neck

• Vessels in the neck drain into the external jugular
vein
• The external jugular vein drains into the subclavian
vein

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 Blood Vessel Distribution
• Venous Return from the
Upper Limb
• Blood returns to the heart
from the hands in the
following sequence:
• Digital veins
• Superficial and deep palmar
veins
• The superficial palmar veins
drain into the cephalic vein
• Subclavian vein
• Brachiocephalic vein
• Superior vena cava
• Right atrium
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• Venous Return from the Upper
Limb
– Blood can also return to the heart
from the hands in the following
sequence:
– The superficial palmar veins drain
into the cephalic vein
– Median cubital vein
– Basilic vein
– Axillary vein
– Subclavian vein
– Brachiocephalic vein
– Superior vena cava
– Right atrium
 Blood Vessel Distribution
• Venous Return from the
Upper Limb
• Blood can also return to the
heart from the hands in the
following sequence:
• The superficial palmar veins
drain into the basilic vein
• Axillary vein
• Subclavian vein
• Brachiocephalic vein
• Superior vena cava
• Right atrium
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• Blood can also return to the heart
from the hands in the following
sequence:
• The deep palmar veins drain into the
radial and ulnar vein
• Those veins will unite to form the
brachial vein
• Axillary vein
• Subclavian vein
• Brachiocephalic vein
• Superior vena cava
• Right atrium
Blood Vessel Distribution

• Venous Return from the Upper Limb

• Blood can also return to the heart from the hands in
the following sequence:
• The deep palmar veins drain into the radial and ulnar
vein
• Those veins will unite to form the brachial vein
• Axillary vein
• Subclavian vein
• Brachiocephalic vein
• Superior vena cava
• Right atrium

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Figure 22.22 The Venous Drainage of the Trunk and Upper Limb
Vertebral
Internal jugular
SUPERIOR External jugular
VENA CAVA
Subclavian
Mediastinal Highest intercostal
Brachiocephalic
Esophageal Axillary
Cephalic

Azygos
Accessory hemiazygos

Hemiazygos
Internal Brachial
thoracic
Intercostal
INFERIOR VENA CAVA
Hepatic
Basilic
Phrenic
Suprarenal

Renal KEY
Superficial veins
Gonadal
Deep veins

Lumbar Median cubital

Common
iliac
Cephalic

Internal iliac Medial Anterior

sacral interosseous
External iliac
Radial
Basilic
Median antebrachial

Ulnar

Palmar venous
arches

Digital

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Figure 22.22 The Venous Drainage of the Trunk and Upper Limb (Part 1 of 2)

Vertebral
Internal jugular
SUPERIOR External jugular
VENA CAVA
Subclavian
Mediastinal Highest intercostal
Brachiocephalic
Esophageal Axillary
Cephalic
Azygos
Accessory hemiazygos
Hemiazygos
Internal Brachial
thoracic
Intercostal
INFERIOR VENA CAVA

KEY
Superficial veins
Deep veins

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Blood Vessel Distribution

• Venous Return from the Abdominal Area

• The following veins drain into the inferior vena cava
or the superior vena cava, which drains into the
right atrium
• Lumbar veins go superior and drain into the superior
vena cava
• Gonadal veins: the right gonadal vein drains into the
inferior vena cava, the left gonadal vein drains into the
left renal vein and then into the inferior vena cava
• Hepatic veins drain into the inferior vena cava

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Figure 22.22 The Venous Drainage of the Trunk and Upper Limb (Part 2 of 2)

Hepatic
Basilic
Phrenic
Suprarenal
Renal

Gonadal

Lumbar Median cubital

Common
iliac
Cephalic
Internal iliac Medial Anterior
sacral interosseous
External iliac
Radial
Basilic
Median antebrachial

Ulnar

KEY
Superficial veins Palmar venous
Deep veins arches
Digital

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 Blood Vessel Distribution
• Venous Return from the
Lower Limb
• Blood leaves the foot and
returns to the heart via the
following veins
• Plantar veins
• Drain into the anterior tibial,
posterior tibial, and fibular
veins
• Popliteal vein
• Femoral vein
• Common iliac vein
• Inferior vena cava
• Right atrium
• Blood also leaves the foot and
returns to the heart via the
following veins
• Dorsal venous arch
• Great saphenous vein
• Femoral vein
• External iliac vein
• Common iliac vein
• Inferior vena cava
• Right atrium

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 Figure 22.24b The Venous Drainage of the Lower Limb
Right common
iliac Internal iliac
Superior gluteal Inferior gluteal

External iliac Internal pudendal

Lateral sacral
Obturator

Femoral
Femoral circumflex

• Venous Return from Deep femoral

the Lower Limb

– Blood also leaves the
foot and returns to the
Great saphenous
heart via the following
veins
– Dorsal venous arch
Popliteal
– Great saphenous vein
– Femoral vein
Small saphenous
– External iliac vein
– Common iliac vein Anterior tibial

Posterior tibial
– Inferior vena cava Fibular

– Right atrium KEY

Superficial veins
Deep veins

Dorsal venous arch

Plantar venous arch

Digital

Anterior view showing the veins of the

right lower limb
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Figure 22.24c The Venous Drainage of the Lower Limb

Right external
iliac

Superior gluteal
Internal pudendal Inferior gluteal
Obturator
Femoral

Femoral
circumflex
Deep femoral

Femoral

Great saphenous

Popliteal

Small
saphenous
Anterior tibial

Fibular
Posterior tibial

KEY
Superficial veins
Deep veins

Posterior view showing the veins of the

right lower limb
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Blood Vessel Distribution

• Venous Return from the Hepatic Portal System

• Blood in the inferior mesenteric, splenic, and
superior mesenteric veins drains into the hepatic
portal system
• Liver sinusoids
• Hepatic veins
• Inferior vena cava
• Right atrium

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Figure 22.26 The Hepatic Portal System
Esophagus
Inferior vena cava
Aorta

Hepatic Left gastric

Liver Stomach

Right gastric
Cystic
Hepatic portal
Left gastroepiploic
Spleen
Right gastroepiploic
Pancreaticoduodenal

Pancreas Splenic

Middle colic Pancreatic

(from transverse colon)
Superior mesenteric Left colic

Inferior mesenteric
Right colic

Ascending colon Descending colon

Ileocolic
Sigmoid
Intestinal

Small intestine

Superior rectal

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Cardiovascular Changes at Birth

• The fetal cardiovascular system differs from the

adult cardiovascular system
• The fetal lungs are nonfunctional
• The fetal digestive system is nonfunctional
• All fetal nutritional and respiratory needs are
provided by diffusion across the placenta
• Blood in the fetal internal iliacs enters the umbilical
arteries
• Enters the umbilical cord
• Enters the placenta

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Cardiovascular Changes at Birth

• All fetal nutritional and respiratory needs are

provided by diffusion across the placenta
(continued)
• Blood leaves the placenta
• Enters the umbilical vein
• Enters the ductus venosus
• Enters the fetal liver
• Enters the inferior vena cava
• Enters the fetal right atrium

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Cardiovascular Changes at Birth

• All fetal nutritional and respiratory needs are

provided by diffusion across the placenta
(continued)
• Blood in the right atrium can pass through the
heart via the following methods:
• Through the tricuspid valve to the right ventricle
• Through the foramen ovale to the left atrium
• From the pulmonary trunk through the ductus arteriosus
to the aortic arch

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Figure 22.27a Changes in Fetal Circulation at Birth

Foramen ovale (open)

Aorta

Ductus
arteriosus
(open)
Pulmonary
trunk

Liver Inferior vena cava

Umbilical vein

Ductus venosus

Placenta
Umbilical
cord Umbilical
Circulation pathways in a arteries
full-term fetus. Red indicates
oxygenated blood, blue indicates
deoxygenated blood, and violet
indicates a mixture of oxygenated
and deoxygenated blood.
© 2012 Pearson Education, Inc.
Figure 22.27b Changes in Fetal Circulation at Birth

Ductus arteriosus
(closed)

Pulmonary
trunk

Foramen ovale
(closed) Left
atrium
Right
atrium
Left
ventricle
Inferior
vena cava

Right ventricle

Blood flows
through the heart
of the newborn.
© 2012 Pearson Education, Inc.
Figure 22.27c Changes in Fetal Circulation at Birth

An opening in interatrial
RIGHT Foramen septum that permits some
blood to flow directly
ATRIUM ovale into the left atrium

INFERIOR FETAL LEFT

VENA HEART ATRIUM
CAVA

RIGHT LEFT
Lungs VENTRICLE VENTRICLE
A shunt that permits most Minimal
Ductus blood to bypass the fetal blood flow
liver so as to directly enter
venosus the inferior vena cava and
then the right atrium A vessel that shunts blood
Ductus from the pulmonary trunk, AORTA
arteriosus away from the pulmonary
circuit, into the aortic arch General
Transports oxygenated, systemic
Umbilical nutrient-rich blood from circulation
vein placenta to fetal liver
Internal
iliac
arteries
PLACENTA Umbilical
arteries

Flowchart shows the circulatory patterns in the fetus and newborn infant.
© 2012 Pearson Education, Inc.
Cardiovascular Changes at Birth

• Upon birth:
• Smooth muscles of the ductus arteriosus contract
forming the ligamentum arteriosum found in the
adult heart
• Pressure in the left atrium increases, thus closing
the valvular flap of the foramen ovale, forming the
fossa ovalis found in the adult heart

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Aging and the Cardiovascular System

• Age-related changes in the cardiovascular system

• Blood changes
• Decreased hematocrit
• Thrombi and emboli form more easily
• Pooling of blood in veins of the leg
• Heart changes
• Reduced efficiency and elasticity
• Atherosclerosis of coronary vessels
• Scar tissue forms
• Blood vessel changes
• Loss of elasticity
• Calcium deposits damage vessel walls

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