Week 5: Anatomical Considerations, Vessel Sites and Selections

Anatomical Considerations, Embalming Vessel Sites and Selections

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Week 5:

Key Considerations for Vessel Selection

• Accessibility

  • Is the vessel superficial or deep?

  • What surrounding structures may complicate access?

  • How close is it to the aorta?

  • These factors determine condition and usability.

• Size (Diameter)

  • Influences fluid volume and distribution.

  • Impacts effectiveness of embalming and body positioning.

Key Considerations for Vessel Selection

• Location & Exposure

  • Will the incision be visible or need to be concealed?

  • How does the vessel’s location relate to exposed body areas?

• Practicality

  • Is drainage feasible through the corresponding veins?

Key Considerations

Organ and Tissue Procurement

• Multiple Injection Sites: Several access points may be required

• Vessel Exposure: Many vessels may be exposed during the procurement process

Key Considerations

• Invasive Medical Devices

  • Devices such as ports, catheters, or medication pumps may limit or prevent the use of certain vessels

  Medico-Legal Factors

  • Must adhere to autopsy protocols

  • Follow requirements set by the Medical Examiner or Coroner

  • Cause and manner of death may affect vessel selection and procedure

Selection of vessels

• Definitions

  • Linear Guide: A line drawn or visualized on the skin to indicate the approximate location of an underlying structure

  • Anatomical Guide: Descriptive reference using identifiable anatomical structures to locate arteries and veins

  • Anatomical Limits: Points of origin and termination of a vessel, defined in relation to adjacent structures

Technique for raising vessels

Prepare the Area

• Shave the area as needed.

• Select appropriate instruments and prepare the ligature.

Locate Incision Site

• Identify the proper location for the incision using anatomical landmarks.

Make the Incision

• Carefully incise through the skin, superficial fascia, and deep fascia.

Technique for raising vessels

Dissect to Expose Vessels

• Perform blunt dissection through the superficial fascia, fat, and deep fascia.

• Use anatomical guides to locate the vessels.

Prepare Vessels for Ligation

• Clean the vessels using blunt dissection.

• Loosely ligate the vessels as needed.

Technique for raising vessels

• Incision Types for Vessel Access

  • Transverse

  • Diagonal

  • Longitudinal

  • T-incision

  • Wedge (triangular)

Technique for raising vessels

• ​Types of vessel incisions:

Technique for raising vessels

• Common Arteries Used in Embalming

  • Common carotid artery

  • Femoral artery (or external iliac at the inguinal ligament)

  • Axillary artery (or brachial artery)

Arteries of the head and neck

• Common Carotid Artery (Right & Left)

  Linear Guide

  • Visualize a line from the sternoclavicular articulation
    → to the anterior surface of the base of the earlobe

Common Carotid Artery

• Anatomical Guide

  • Located posterior to the medial border of the sternocleidomastoid (SCM) on each side of the neck

  Anatomical Limits

  • Right Common Carotid: Extends from the right sternoclavicular articulation → superior border of the thyroid cartilage

  • Left Common Carotid: Extends from the level of the second costal cartilage → superior border of the thyroid cartilage

Common Carotid Artery

• Places of Incision

  • Supraclavicular (anterior-lateral)

  • Anterior vertical (parallel)

  • Posterior vertical (parallel)

  • Anterior horizontal

  • Semilunar (flap incision)

  • Strap line

Common Carotid Artery

• Proximity & Distance Considerations

  • Direct distribution to the face

  • Close to the center of arterial solution distribution

  • Close to the center of venous drainage

  Branches of the Carotid Arteries

  • External Carotid: Ascending pharyngeal, superior thyroid, lingual, facial, occipital, posterior auricular, maxillary, superficial temporal

  • Internal Carotid: Carotid canal, ophthalmic, anterior cerebral, middle cerebral, posterior communicating, choroidal

Common Carotid Artery

• Precautions

  • Incision may be visible after dressing

  • Tubes may leave mark on face

  • Face may be over-injected

    • because you will need to inject the left and right separately.

  • Accompanying vein - internal jugular, relative location

    • Superficial to the Common Carotid

Facial Artery

• Alternative vessel for embalming the frontal structures of the face

  • Especially useful for lips and superficial tissues

• Incision: Along the inferior border of the mandible, just anterior to the angle of the jaw

Arteries of trunk

• Subclavian Artery

  • Right: Begins at the right sternoclavicular articulation → lateral border of the first rib

  • Left: Begins at the level of the second left costal cartilage → lateral border of the first rib

  • Commonly used in autopsy cases

  Brachiocephalic Artery

  • One of three branches from the aorta

  • Divides into the right subclavian and right common carotid arteries

Arteries of trunk

• Aorta

  • Ascending Aorta: Originates from the left ventricle of the heart

  • Arch of the Aorta: Curved portion giving rise to major arteries supplying the head, neck, and upper limbs

  • Descending Aorta: Continues from the arch into the thorax and abdomen

    • Thoracic Aorta: Portion within the thoracic cavity

    • Abdominal Aorta: Portion within the abdominal cavity, terminating at the common iliac arteries

Arteries of trunk

• Accompanying Veins for Drainage

  • Superior Vena Cava: Drains blood from the head, neck, and upper extremities into the right atrium

  • Inferior Vena Cava: Drains blood from the lower extremities, pelvis, and abdomen into the right atrium

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Arteries of trunk

• Common Iliac Artery

  • Terminal branches of the abdominal aorta

  • Divides into:

    • External Iliac Artery

      • Anatomical Guide: Follows the pelvic brim toward the inguinal ligament

      • Accompanying Vein: External iliac vein

    • Internal Iliac Artery

      • Supplies the pelvic organs, gluteal region, and perineum

Arteries of the Upper Extremity – Considerations & Precautions

• Considerations

  • Close proximity to the face can affect distribution of arterial solution

  • Near the center of arterial solution distribution

  • Close to the center of venous drainage

  • Vessels are relatively superficial, making them accessible for injection

  • Numerous branches increase the complexity of injection

Arteries of the Upper Extremity – Considerations & Precautions

• Precautions

  • Risk of over-injecting the face if left and right sides are injected separately

  • Anatomical variations and anomalies of both arteries and veins are common

  • Proper positioning of the upper extremity is important to ensure uniform distribution

Arteries of upper extremity

• Axillary Artery

  Linear Guide

  • Follow the center of the lateral border of the axillary space (armpit)

Arteries of upper extremity

• Anatomical Guide

  • Located just behind the medial border of the coracobrachialis muscle

  Anatomical Limits

  • Extends from the lateral border of the first rib → inferior border of the teres major tendon

Arteries of upper extremity

• Axillary Artery – Place of Incision

  • Midaxillary incision along the anterior margin of the axillary hairline

  • Perform with the arm abducted for better access

Arteries of upper extremity

• Axillary Artery – Accompanying Vein

  • Vein: Axillary vein

  • Relative Location: Axillary artery lies lateral and deep to the axillary vein

Arteries of upper extremity

• Brachial Artery

  Linear Guide

  • From the center of the lateral border of the axillary space

  • To a point approximately 1 inch below and anterior to the elbow joint

Arteries of upper extremity

• Brachial Artery

  Anatomical Guide

  • Located in the bicipital groove, along the posterior margin of the medial border of the biceps brachii muscle

  Anatomical Limits

  • Extends from the inferior border of the teres major tendon → a point just below the antecubital fossa

Arteries of upper extremity

• Brachial Artery – Place of Incision

  • Incision may be made anywhere along the upper half of the linear guide

  • Preferred site: Proximal third, approximately 1 inch above and parallel to the linear guide

Arteries of upper extremity

• Brachial Artery – Accompanying Vein

  • Vein for Drainage: Basilic vein

  • Relative Location: Medial and superficial to the brachial artery

  • Note: Brachial vein exists but is smaller and has multiple branches

Arteries of upper extremity

• Radial Artery

  Linear Guide

  • From the center of the antecubital fossa

  • To the center of the base of the index finger

Arteries of upper extremity

Radial Artery

Anatomical Guide

• Lies lateral to the tendon of the flexor carpi radialis

• Lies medial to the tendon of the brachioradialis

Place of Incision

• Made parallel to the artery along the linear guide

• Preferred site: Approximately 1 inch above the base of the thumb

Arteries of upper extremity

• Radial Artery – Place of Incision

  • Incision parallel to the artery along the linear guide

  • Location: About 1 inch above the base of the thumb

Arteries of upper extremity

• Ulnar Artery

  Linear Guide

  • From the center of the antecubital fossa

  • To a point between the fourth and fifth fingers

Arteries of upper extremity

• Ulnar Artery

  Anatomical Guide

  • Located just lateral to the tendon of the flexor carpi ulnaris

  Place of Incision

  • Made parallel to the artery directly over the linear guide

Arteries of lower extremity

• Femoral Artery

  Linear Guide

  • From the center of the inguinal ligament

  • To the center of the medial prominence of the knee (medial condyle of the femur)

Arteries of lower extremity

Femoral Artery

Anatomical Guide

• Passes through the center of the femoral triangle

• Boundaries:

  • Lateral: Medial border of the sartorius muscle

  • Medial: Adductor longus muscle

Anatomical Limits

• Extends from behind the center of the inguinal ligament → opening of the adductor magnus muscle

Arteries of lower extremity

Femoral Artery – Place of Incision

• Incision made along the medial edge of the linear guide

• Relative location: Femoral artery lies lateral and slightly superficial to the femoral vein

• Helpful mnemonic – VAN: From medial to lateral → Vein, Artery, Nerve

​Arteries of the Lower Extremity – Considerations & Precautions

Considerations

• Large diameter, allowing for greater solution flow

• Potential for even distribution to both sides of the face

• Incisions are easier to conceal

• Many embalmers prefer the femoral artery over the carotid for these reasons

​Arteries of the Lower Extremity – Considerations & Precautions

Precautions

• Vessels may be deep-seated in obese individuals

• Condition of the vessel: Femoral artery is commonly sclerotic

• Drainage may be difficult to establish and maintain

Arteries of lower extremity

Femoral Artery – Accompanying Vein

• Vein: Femoral vein

• Relative Position: Femoral artery lies lateral and superficial to the femoral vein

Arteries of lower extremity

• Popliteal Artery

Arteries of lower extremity

• Popliteal Artery – Linear Guide

  • From the center of the superior border of the popliteal space

  • Parallel to the long axis of the lower extremity

  • To the center of the inferior border of the popliteal space

Arteries of lower extremity-Popliteal Artery

• Anatomical Limits

  • Located between the popliteal surface of the femur and the oblique popliteal ligament

  • Continuation of the femoral artery

  Place of Incision

  • Option 1: Roll the decedent to one side and make an incision down the center of the popliteal space, parallel to the artery

  • Option 2: Flex the knee slightly and make a longitudinal incision along the posterior-medial aspect of the lower third of the thigh, just superior to the popliteal space

Arteries of lower extremity

• Anterior Tibial Artery – Linear Guide

  • Draw or visualize a line from the lateral border of the patella → anterior surface of the ankle joint

  Posterior Tibial Artery – Linear Guide

  • Draw or visualize a line from the center of the popliteal space → midway between the medial malleolus and calcaneus

Arteries of lower extremity

• Anterior Tibial Artery – Place of Incision

  • Incision made along the lateral margin of the inferior third of the tibial crest

  • In the distal leg, the artery lies at the superficial margin of the tibia

Arteries of lower extremity

• Dorsalis Pedis Artery – Linear Guide

  • Draw or visualize a line from the center of the anterior surface of the ankle joint → a point between the first and second toes

Arteries of lower extremity

• Dorsalis Pedis Artery – Place of Incision

  • Incision made from a point midway between the medial and lateral malleoli → interosseous space

  • Note: May require supplemental hypodermic fluid injection