AORTA AND PERIPHERAL ARTERIES ANATOMY & VISUALIZATION

AORTA AND PERIPHERAL ARTERIES

ANATOMY & VISUALIZATION

Presented By; Dr Rakesh Jain

The Aorta After originating from LV (about 3 cm in

diameter ), it ascending for a short distance, arches backward and to the left side, descends within the thorax on the left side of the vertebral column

Portions of aorta1. Ascending aorta 2. Arch of the aorta and3. Descending aorta (thoracic and abdominal aorta)

Ascending Aorta (Aorta Ascendens)

About 5 cm. in length Passes obliquely upward, forward, and to the

right, as high as the upper border of the second right costal cartilage

At its origin, three small dilatations called the aortic sinuses

At the union of the ascending aorta with the aortic arch, the caliber of the vessel is increased, owing to a bulging of its right wall. This dilatation is termed the bulb of the aorta

Only branches of the ascending aorta are the two coronary arteries

Arch of the Aorta

Begins at the level of the upper border of the Rt 2nd sternocostal joint

First runs upward, backward, and to the left, infront of the trachea, then directed backward on the left side of the trachea and finally passes downward on the left side of the body of T4, at lower border of which it becomes continuous with the descending aorta

Forms two curvatures: one with its convexity upward, the other with its convexity forward and to the left

Branches of arch of aorta

Three in number- Innominate artery Left common carotid artery Left subclavian artery

CCA= common carotid artery

VA= vertebral artery

SCA= subclavian artery

LEFT ANTERIOR OBLIQUE VIEW

Variations of the supraaortic vessel

origins

Inominate ARt SubclavianRt CC

Vertibral Lt CC

Lt Subclavian

Rt Subclavian

Rt CC

Lt CCVertibral

Lt Subclavian

Descending Aorta Thoracic Aorta

Contained in the posterior mediastinal cavity

Begins at the lower border of the T4 Ends in front of the lower border of

the T12 vertebra, at the aortic hiatus in the diaphragm

Branches of the Thoracic Aorta

Visceral 1. Pericardial2. Bronchial3. Esophageal4. Mediastinal

Parietal  1. Intercostal.- usually 9 pairs2. Subcostal.

3. Superior Phrenic.

RCCLCC

Lt Subclavian

Rt Subclavian

Brachiocephalic A

LEFT ANTERIOR OBLIQUE VIEW

Abdominal aorta

Begins at aortic hiatus of diaphragmIn front of lower border of T12 Descending in front of the vertebral column Ends on L4-body, a little to Left of midlineSummit of the convexity corresponding to the L3

Branches of the abdominal aorta

Visceral Branches Celiac. Superior Mesenteric. Inferior Mesenteric. Middle Suprarenals. Renals. Internal Spermatics. Ovarian (in the female)Parietal Branches Inferior Phrenics. Lumbars. Middle Sacral.Terminal Branches Common Iliacs.

1.Abdo Aorta

2.Coeliac trunk

a. Lt gastric Ab. Splenic Ac. Hepatic A

3. S M A

4. I M A

5. Lt Renal A

6. Rt Renal A

2

c

a b

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31

4

AP VIEW

Catheter

Abdominal aorta

Celiac trunk

Superior mesenteric artery

LATERAL VIEW

Coeliac Artery Short thick trunk ≈1.25 cm length Arises from the front of the aorta, just below

the aortic hiatus of the diaphragm Between T12 & L1 Passing nearly horizontally forward 3 large branches

Left gastric A - smallest Hepatic A Splenic A - largest

1.Coeliac A

2.Lt gastric A

3.Hepatic A

4.Splenic A

5.Gastroduodenal

A

13

2

44

ANTERIO-POSTERIOR VIEW

Superior Mesenteric Artery

Large vessel Arises from front of aorta, at L1,

~1.25 cm below Coeliac A Passes downward and forward, to

the right iliac fossa Supply small intestine (expt superior

Duo),

Cecum, Asc Colon & Rt ½ Transverse Colon

SMA-Branches

Inferior Pancreatico-duodenal Middle Colic Right Colic Ileocolic Intestinal

1.Abd Aorta

2.S M A

3.Middle colic A 4.Rt colic A

5.Ileocolic A

6. Intestinal A

7.Appendicular

5

7

4

1

6

2

3

Inferior Mesenteric Artery Smaller than SMA Arises from aorta at L3, about 3 or 4 cm

above its division Passes downward, posterior to the

peritoneum Continued into pelvis as Superior

hemorrhoidal artery & ends on the upper rectum

Supply Lt ½ transverse colon, descending & sigmoid colon, and most of the rectum

Inferior Mesenteric Artery branches

Left Colic A Sigmoid branches Superior Hemorrhoidal A

1.Inf mesentric A

2.Lt colic A

3.Marginal A

4.Sigmoid A

5.Superior hemorrhoidal A

1

2

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3

Superior Hemorrhoidal Artery

Form a series of loops around lower rectum

Communicate with Middle hemorrhoidal branches of

Internal Iliac A and Inferior hemorrhoidal branches of

Internal pudendal A (branch of Internal Iliac A)

Renal arteries1.Two large arteries2.Arises from side of

aorta, immediately below SMA

3.Nearly a right angle with the aorta

4.Right is longer than left

5.Before reaching hilus of the kidney, each artery divides into four or five branches

6.Left is somewhat higher than the right

Rt Renal arteries

Lt Renal arteries

AP VIEW

Common Iliac Arteries

Abdominal Aorta divides, on Lt side of L4 Each about 5 cm length Rt Common Iliac A -somewhat longer than

the Lt Each divide, opposite the intervertebral

fibrocartilage between L5 & S1 2 branches→

External Iliac A & Internal Iliac A (Hypogastric A )

1.Abd Aorta

2.Common iliac A 3.External iliac A

4.Internal iliac A

1

2

3

4

AP VIEW

The External Iliac Artery

Larger than Internal Iliac A Passes obliquely downward and

lateralward along the medial border of the Psoas major

Beneath the inguinal ligament, midway between anterior superior iliac spine and symphysis pubis entering the thigh & becomes Femoral A

EIA-Branches

2 branches Inferior epigastric Deep iliac circumflex

Continues as femoral A

The Internal Iliac A(Hypogastric A )

Short, thick vessel, smaller than EIA Arises at the bifurcation of the common

iliac, opposite the lumbosacral articulation

Abt 4 cm length, on medial side of the thigh

The lengths of the CIA & IIA bear an inverse proportion to each other→ IIA being long when CIA is short, and vice versa.

Divides into 2 large trunks at upper margin of the greater sciatic foramen → anterior & posterior

Branches of Internal Iliac AAnterior Trunk

Superior Vesical Middle Vesical Inferior Vesical Vaginal (in females) Middle Hemorrhoidal Obturator Inferior Gluteal Internal Pudendal Inf Hemorrhoidal A Uterine

Posterior Trunk Iliolumbar Lateral Sacral Superior Gluteal

Femoral Artery Begins behind inguinal ligament, midway

between ASIS & symphysis pubis, Ends at junction of upper ⅔ & lower ⅓ of

thigh, to become Popliteal A First 4 cm -enclosed, together with

Femoral V, in a fibrous sheath—the Femoral Sheath

In the upper ⅓ of thigh Femoral A is contained in the Femoral Triangle (Scarpa’s triangle)

In the middle ⅓ of thigh, in the Adductor Canal (Hunter’s canal)

Profunda Femoris A

Large vessel arising from lateral & back part of Femoral A, 2-5 cm below inguinal ligament

Ends at the lower ⅓ of thigh PFA provides an important source of

collateral flow to the leg and foot in patients with significant SFA stenoses or occlusion

Branches.— Lateral Femoral Circumflex, Medial Femoral Circumflex, Perforating branches (4 no.s)

AP VIEW

Catheter

Superficial femoralartery

Common femoralartery

1.Profnda F A

2.Femoral artery

1

2

AP VIEW

Popliteal Artery Continuation of Femoral A Extends from the opening in the Adductor

magnus, at the junction of middle ⅔ & lower ⅓ of thigh

Courses downward and lateralward to the intercondyloid Popliteal fossa of the femur, then vertically downward to the lower border of the Popliteus

Divides into Anterior tibial A and tibioperoneal trunk.

Tibioperoneal trunk is the direct continuation of the popliteal artey, arises distal to the anterior tibial artery, bifurcates just beyond its origin into the posterior tibial and peroneal arteries

Popliteal artery Anterior tibial artery

Posterior tibial artery

Peroneal artery

Popliteal artery

Anterior tibial artery

Posterior tibial artery

Peroneal artery

Superficial femoral artery

Tibioperoneal trunk

Posterior Tibial A

Begins at lower border of Popliteus, opposite the interval betw tibia & fibula

Descends, approaching tibial side of leg In the lower part, situated midway betw

med malleolus & med process of calcaneal tuberosity

Divides into Medial & Lateral plantar A

Anterior Tibial A

Begins at bifurcation of Popliteal A, at the lower border of Popliteus

Passes forward through aperture above upper border of interosseous memb

Descends on anterior surface of interosseous memb, gradually approaching the tibia

On the front of ankle-joint (more superficial), becomes Dorsalis Pedis Artery.  

Tibioperoneal Trunk

Anterior Tibial

Peroneal

Posterior Tibial

AP VIEW

Ankle and Foot Vascular Anatomy

Dorsalis Pedis

Anterior Tibial

Peroneal

Posterior Tibial

To resolve ischemic rest pain or heal an ulcer, one continuously patent infrapopliteal vessel to the foot is necessary

Medial & lateralPlantar A

Lateral view

Foot arteries front view

A. tibialis anterior

A. dorsalis pedis

Foot arteriesdown view

A. tibialis posterior

A. plantaris lateralis

A. plantaris medialis

Arcus plantaris profundus

Innominate Artery

Largest branch of arch of the aorta 4 to 5 cm. in length Arises, on a level with the upper

border of the second right costal cartilage

Ascends obliquely upward, backward, and to the right to the level of the upper border of the right sternoclavicular articulation, where it divides into the right common carotid and right subclavian arteries.

Common Carotid Artery 2 in number (Rt & Lt) Differ in length and mode of origin The right begins at bifurcation of

innominate A, behind sternoclavicular joint and is confined to the neck.

The left springs from the highest part of arch of the aorta to the left of, on a plane posterior to the innominate artery

Each vessel passes obliquely upward Divides into the ECA & ICA, at the level of

upper border of the thyroid cartilage

The Subclavian Artery

Right side: arises from the innominate artery behind right sternoclavicular articulation

Left side: arises directly from the arch of the aorta

Extends to the outer border of the first rib, where it becomes the axillary artery

branches of the subclavian artery

Vertebral. Internal mammary Thyrocervical Costocervical

RCCLCC

Lt Subclavian

Rt Subclavian

Brachiocephalic A

LEFT ANTERIOR OBLIQUE VIEW

Rt Axillary A

Axillary Artery

Commences at the outer border of the first rib

Ends at lower border of the tendon of the Teres major, where it takes the name of brachial

At its origin the artery is very deeply situated, but near its termination is superficial

ANTERIO-POSTERIOR VIEW

Brachial Artery

Commences at the lower margin of the tendon of the Teres major

Passing down the arm Ends about 1 cm. below the bend of the

elbow, where it divides into the radial and ulnar arteries

Course; At first the brachial artery lies medial to the humerus; as it runs down the arm it gradually gets in front of the bone, and at the bend of the elbow it lies midway between its two epicondyles

Radial Artery

Continuation of the brachial Smaller in caliber than ulnar. Commences at bifurcation of the brachial,

just below the bend of the elbow Passes along the radial side of the

forearm to the wrist Then winds backward, around the lateral

side of the carpus, forward toward thumb and index finger into the palm of the hand and unite with the deep volar branch of the ulnar artery to form the deep volar arch

Ulnar Artery

Larger than radial A. Begins a little below the bend of the

elbow Passing obliquely downward, reaches

ulnar side of the forearm, midway between the elbow and the wrist. It then runs along the ulnar border to the wrist

Immediately beyond pisiform bone, it divides into two branches, which enter into the formation of the superficial and deep volar arches

ANTERIO-POSTERIOR VIEW

POSTERIO-ANTERIOR VIEW