title: Vascular anatomy of the subacromial space: a map of bleeding points for the arthroscopic surgeon.
abstract: OBJECTIVE
  Our purpose was to study the vascular anatomy of the subacromial space and to map the major sources of expected bleeding during subacromial arthroscopy surgery.
  
  
  METHODS
  Ten shoulders of five adult cadavers underwent whole-body arterial perfusion with a mixture of lead oxide, gelatin, and water. The tissue specimens were dissected, photographed, radiographed, scanned, and analyzed with a digital software analyzer. Dissection of the arteries of the subacromial space, with their respective anatomic landmarks, was documented. Correlations of bleeding areas during subacromial arthroscopic surgery and cadaveric dissection were carried out. A vascular map of the walls of the subacromial space was created.
  
  
  RESULTS
  The vascularity of the subacromial structures showed consistent patterns of distribution in 60% of the shoulders dissected, and specific sources of bleeding were analyzed. We divided this space into walls with their major arteries as follows: anterior wall, with the acromial branch of the thoracoacromial artery; posterior wall, with the posteromedial acromial branch of the suprascapular artery; and medial wall, with the anterior and posterior arteries of the acromioclavicular joint. The vascular map of the lateral wall, roof, and floor of the subacromial space was also described.
  
  
  CONCLUSIONS
  Vascular maps of the arteries of the walls of the subacromial space were created. The subacromial space is highly vascular, and the pattern of blood supply was found to be constant in 60% of the shoulders dissected. This knowledge of the vascular anatomy may decrease bleeding during surgery.
  
  
  CONCLUSIONS
  Knowledge of the vascular anatomy may decrease vascular damage during subacromial arthroscopy surgery.
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic and Sport Medicine Clinic, Dalhousie University, Halifax, Nova Scotia, Canada. yepeshoracio@yahoo.ca
authors.forename: Horacio
authors.initials: H
authors.lastname: Yepes
authors.forename: Amro
authors.initials: A
authors.lastname: Al-Hibshi
authors.forename: Maolin
authors.initials: M
authors.lastname: Tang
authors.forename: Steven F
authors.initials: SF
authors.lastname: Morris
authors.forename: William D
authors.initials: WD
authors.lastname: Stanish
mesh_terms: D000173:Acromioclavicular Joint / Q000033:anatomy & histology / Q000098:blood supply*; D000174:Acromion / Q000033:anatomy & histology / Q000098:blood supply; D000368:Aged; D000792:Angiography; D001182:Arthroscopy; D002102:Cadaver; D004210:Dissection; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D012785:Shoulder Joint / Q000033:anatomy & histology / Q000098:blood supply*