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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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
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2
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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