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Atlas of Vascular Anatomy An Angiographic Approach THIRD EDITION Andre Uflacker, MD Assistant Professor Vascular and Interventional Radiology Medical University of South Carolina Charleston, South Carolina Marcelo Guimaraes, MD, MBA, FSIR Director, Vascular & Interventional Radiology Professor Surgery and Radiology Medical University of South Carolina Charleston, South Carolina Acquisitions Editor: Sharon Zinner Development Editor: Liz Schaeffer Editorial Coordinator: Ashley Pfeiffer Editorial Assistant: Nicole Dunn Marketing Manager: Julie Sikora Senior Production Project Manager: Alicia Jackson Design Coordinator: Holly McLaughlin Manufacturing Coordinator: Beth Welsh Prepress Vendor: TNQ Technologies 3rd edition Copyright © 2021 Wolters Kluwer. Copyright © 2007 Lippincott Williams & Wilkins. Copyright © 1997 Williams & Wilkins. All rights reserved. This book is protected by copyright. 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To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. shop.lww.com “Variability is the law of life,” Sir William Osler To Curry and Hugo, with all my gratitude and To my parents, Helena and Renan, and to Barbara and Duke, for these gifts Andre To Julia and Mateus: life is a wonderful journey. You have the opportunity to live it meaningfully with integrity, creativity, courage, dedication, passion, persistency, and patience. As you cannot predict the future, dare to create it! It is your choice! To my wife Rossana: many thanks for your unconditional love and support. To my parents Marilene and Allan: thanks for being outstanding parents. Marcelo Contributors Illustrations by José Falcetti Director, Center for Medical Arts, Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo Functional Neurosurgery São Paulo, SP, Brazil Body Scientific International Grayslake, Illinois Andre Uflacker, MD Assistant Professor Vascular and Interventional Radiology Medical University of South Carolina Charleston, South Carolina With Contributions by Arindam Chatterjee, MD Assistant Professor of Radiology Division of Neuroradiology Medical University of South Carolina —Arteries of the Head and Neck —Veins of the Head and Neck Pal Spruill Suranyi, MD, PhD, FNASCI Professor of Radiology and Medicine Department of Radiology and Radiological Science Divisions of Cardiovascular and Thoracic Imaging Department of Medicine, Division of Cardiology Medical University of South Carolina —The Heart and Coronary Arteries —The Heart Venous Circulation Preface to Third Edition We are pleased to provide an update to the Atlas of Vascular Anatomy in the form of its third edition. This work has its roots in the stacks of type-written pages, cut film, and the original illustrations of José Falcetti, which were painstainkingly labeled by my father, Renan Uflacker, using cut pieces of paper, tape, and glue. Ever grateful to stand on the shoulders of this giant, we are lucky that technology has continued to evolve and that we are able to add to this work. The development of 3D cinematic volume-rendered reconstructions would have shocked Renan and José with their beauty, as they allowed only the most accurate and highest quality material to go on print. We hope that the cinematic reconstructions provided herein are a useful adjunct to the understanding and teaching of vascular anatomy, and that they help kindle the love for the discipline in the coming generations of students, clinicians, researchers, and academics. These images would not have been possible without the assistance of my colleagues at the University of Virginia, who took the time to teach me the intricacies of the software used to create them, and without the dedication of that institution to scholarship, which allowed me the required time and resources. As our understanding of anatomy and technical expertise evolve, the clinical application of this knowledge presents itself in sometimes surprising areas. One of the best examples of this is the advent of Prostatic Artery Embolization, which has reignited interest in pelvic vascular anatomy. We have provided an updated discussion of the pelvic arteries, with a fresh understanding of the incredible complexity of this territory, where variability truly is law. The evolution of imaging technology now allows the appreciation of a multitude of variants outside of the cadaver lab or the operating room. Cinematic reconstructions have been added to several chapters, but particularly in the neurovascular and cardiac anatomy chapters. We hope that these images provide the reader with an enhanced understanding of the often-- complex anatomy of those systems with renderings that are often akin to virtual cadaveric dissections. This preface would not be complete without acknowledging the two people who made it possible, Renan Uflacker and José Falcetti. Renan’s death in 2011 left us in uncharted territory, and it was only through the guidance of his love of medicine and anatomy that we were able to get back on the course that landed us here. He will be forever missed and remembered. José was a tremendous artist and medical illustrator who created the color plates for the first edition of the Atlas, which we maintain as an essential part of this work. I approached José with a proposal to create new illustrations for this edition in 2017 and found him genuinely elated to see this project still alive. Unfortunately, José succumbed to leukemia in May of 2018, before we could complete our work. His original illustrations provide the perfect standard for the art found in this book. His artistic genius thus lives on, guiding every decision we have made with regards to art in this volume. We would like to thank the staff of Lippincott Williams & Wilkins for their patience and attention to detail in producing this work. We would also like to thank you, our reader, whether you are a student, trainee, seasoned clinician, researcher, or artist. Finally, we would like to thank our patients, for whom this book was ultimately made, and without whom its creation would have been impossible. Andre Uflacker, MD Co-Editor Renan Uflacker has trained directly or indirectly hundreds of Vascular Interventionalists around the world. The Atlas of Vascular Anatomy is one of many contributions that he left in 2011 to future generations of interventionalists to come. Considering Renan as an intellectual father, to whom I will be always grateful, I felt the urge to give continuity to his work on vascular anatomy. I believe that one of our tasks in life is to demonstrate gratitude in a genuine way, so it was a natural choice to include Andre Uflacker (his son) on this humbling task. It is important to recognize that Andre not only worked as a co-editor but was fundamental for the completeness and quality of the third edition. Andre is also a talented artist. Several drawings of this edition were created by him. This project was only possible with Andre’s dedication and hard work and after the incredible LWW staff support. I am grateful that we were able to give continuity to Renan’s vascular anatomy project and to keep his intellectual and scientific spirit strong amongst ourselves. Marcelo Guimaraes, MD, MBA, FSIR Co-Editor Acknowledgment of Prior Contributors The authors would like to acknowledge the contributions of prior authors who have worked in the first and second editions of this text. These authors set the standards against which we measured the quality of our material. It was an honor to build upon their work, and we will be forever grateful. Carlos Jader Feldman, MD Chief, Department of Radiology Hospital Hernesto Dornelles Porto Alegre, RS, Brazil —Vascular Anatomy of the Lower Genital Tract Ronie L. Piske, MD Interventional Neuroradiologist Med–Imagem Hospital Beneficência Poruguesa, São Paulo, SP, Brazil —Arteries of the Head and Neck —Veins of the Head and Neck Francisco J.B. Sampaio, MD, PhD Professor of Anatomy and Urology Head, Department of Anatomy State University of Rio de Janeiro Rio de Janeiro, RJ, Brazil —Kidney Arterial Vascularization —Kidney Venous Drainage —Lymphatic Drainage of the Kidney —Periprostatic Venous Plexus J. Bayne Selby, MD Professor of Radiology Medical University of South Carolina Charleston, SC —The Heart and Coronary Arteries —The Heart Venous Circulation —Pulmonary Arterial Circulation —Pulmonary Venous Circulation Luiz Maria Yordi, MD Chief, Department of Hemodynamic and Cardiovascular Radiology Hospital São Francisco Porto Alegre, RS, Brazil —The Heart and Coronary Arteries —The Heart Venous Circulation Contents Chapter 1 The Fetal Circulation and Vascular Embryology Development of the Systemic Arterial Circulation Development of the Systemic Venous Circulation Development of the Portal Venous Circulation Chapter 2 Arteries of the Head and Neck Common Carotid Artery External Carotid Artery Internal Carotid Artery Vertebral Artery Basilar Artery Collateral Circulation Circle of Willis Embryonic Communications Chapter 3 Veins of the Head and Neck External Veins of the Head and Face Veins of the Neck Cranial and Intracranial Veins and Dural Venous Sinuses Chapter 4 Lymphatic System of the Head and Neck Deep Cervical Lymph Nodes Lymphatic Drainage of the Deeper Tissues of the Neck Chapter 5 Arteries of the Spinal Cord and Spine Chapter 6 Veins of the Spinal Cord and Spine Veins of the Spine Chapter 7 Thoracic Aorta and Arteries of the Trunk Thoracic Aorta Segments of the Thoracic Aorta Chapter 8 Veins of the Thorax Brachiocephalic Veins Internal Thoracic Veins (Mammary) Inferior Thyroid Veins Superior Vena Cava Pericardiophrenic Vein Thymic Veins Left Superior Intercostal Vein Azygos Vein Hemiazygos Vein Accessory Hemiazygos Vein Posterior Intercostal Veins Esophageal Veins Veins of the Vertebral Spine External Venous Plexuses Chapter 9 Lymphatic System of the Thorax Thoracic Lymphatic Drainage Chapter 10 Pulmonary Arterial Circulation Pulmonary Trunk Right Pulmonary Artery Left Pulmonary Artery Computerized Tomographic Appearance Pulmonary Microcirculation Pulmonary Artery Variants Chapter 11 Pulmonary Venous Circulation Pulmonary Veins Anomalous Pulmonary Venous Drainage Chapter 12 Pulmonary and Mediastinal Lymphatic System Lymphatics of the Lungs and Pleura Thoracic Duct and Right Lymphatic Duct Lymph Nodes of the Mediastinum Chapter 13 Heart and Coronary Arteries Cardiac Chambers Coronary Arteries Chapter 14 Cardiac Veins Chapter 15 Arteries of the Upper Extremity Subclavian Artery Axillary Artery Brachial Artery Arteries of the Hand Chapter 16 Veins of the Upper Extremity Superficial Veins of the Upper Extremity Deep Veins of the Upper Extremity Chapter 17 Lymphatic Drainage of the Upper Extremity Lymphatics of the Superficial Tissues Lymphatics of the Deep Tissues Axillary Lymph Nodes Chapter 18 Abdominal Aorta and Branches Abdominal Aorta Ventral Branches Lateral Branches of the Abdominal Aorta Dorsal Branches of the Aorta Terminal Branches Chapter 19 Arteries of the Pelvis Common Iliac Arteries Internal Iliac Arteries (Hypogastric Arteries) External Iliac Arteries Collateral Pathways (Fig. 19.31) Chapter 20 Veins of the Abdomen and Pelvis Veins of the Pelvis