AORTA AND PERIPHERAL ARTERIES ANATOMY & VISUALIZATION

Presented By; Dr Rakesh Jain

The Aorta

1. 2. 3.

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 aorta
Ascending aorta Arch of the aorta and 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

LEFT ANTERIOR OBLIQUE VIEW

CCA= common carotid artery VA= vertebral artery SCA= subclavian artery

Variations of the supraaortic vessel origins

Vertibral Rt CC Rt Subclavian Inominate A

Lt CC Lt Subclavian Lt CC Vertibral

Lt Subclavian
Rt CC Rt 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

1.
2. 3.

Visceral
Pericardial Bronchial Esophageal Mediastinal

4.

1.

Parietal
Intercostal.- usually 9 pairs Subcostal. Superior Phrenic.

2.
3.

LEFT ANTERIOR OBLIQUE VIEW

RCC

LCC

Lt Subclavian

Rt Subclavian

Brachiocephalic A

Abdominal aorta
Begins

at aortic hiatus of diaphragm In front of lower border of T12 Descending in front of the vertebral column Ends on L4-body, a little to Left of midline Summit 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.

AP VIEW

a c
2

1.Abdo Aorta 2.Coeliac trunk a.Lt gastric A b.Splenic A c.Hepatic A

6 1 3

3. S M A
4. I M A 5. Lt Renal A 6. Rt Renal A

LATERAL VIEW

Catheter

Celiac trunk

Superior mesenteric artery

Abdominal aorta

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

ANTERIO-POSTERIOR VIEW

1.Coeliac A 2.Lt gastric A 3.Hepatic A 4.Splenic A 5.Gastroduo denal A

2
3 4 1

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 Transverse Colon

SMA-Branches

Inferior Pancreatico-duodenal Middle Colic Right Colic Ileocolic Intestinal

1
1.Abd Aorta 2.S M A 3.Middle colic A 4.Rt colic A

3
4

5
5.Ileocolic A 6. Intestinal A

7.Appendicular

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 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 4 1 2

5.Superior hemorrhoidal A

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 arteries
1. Two large arteries 2. 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

AP VIEW

Lt Renal arteries
Rt Renal arteries

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 )

AP VIEW

1.Abd Aorta
2.Common iliac A 3.External iliac A 4.Internal iliac A
3 4 2

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 A

Anterior 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 & lower of thigh, to become Popliteal A First 4 cm -enclosed, together with Femoral V, in a fibrous sheaththe Femoral Sheath In the upper of thigh Femoral A is contained in the Femoral Triangle (Scarpas triangle) In the middle of thigh, in the Adductor Canal (Hunters canal)

Profunda Femoris A

Large vessel arising from lateral & back part of Femoral A, 2-5 cm below inguinal ligament Ends at the lower 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 Common femoral artery

Superficial femoral artery

AP VIEW

1
1.Profnda F A

2.Femoral artery

Popliteal Artery

Continuation of Femoral A Extends from the opening in the Adductor magnus, at the junction of middle & lower 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

Superficial femoral artery

Popliteal artery

Anterior tibial artery

Posterior tibial artery Peroneal artery

Popliteal artery

Anterior tibial artery

Posterior tibial artery Peroneal 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.

AP VIEW

Tibioperoneal Trunk

Anterior Tibial
Peroneal

Posterior Tibial

Ankle and Foot Vascular Anatomy

Lateral view

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

Peroneal
Anterior Tibial

Posterior Tibial

Dorsalis Pedis

Foot arteries front view

A. tibialis anterior A. dorsalis pedis

Foot arteries down view

Arcus plantaris profundus A. plantaris medialis A. plantaris lateralis A. tibialis posterior

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

LEFT ANTERIOR OBLIQUE VIEW

RCC

LCC

Lt Subclavian

Rt Subclavian

Brachiocephalic A 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