Transcript AORTA AND PERIPHERAL ARTERIES ANATOMY

AORTA AND PERIPHERAL
ARTERIES
ANATOMY & VISUALIZATION
Presented By; Dr Rakesh Jain
The Aorta
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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)
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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
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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
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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
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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
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Visceral
1.
4.
Pericardial
Bronchial
Esophageal
Mediastinal
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Parietal
1.
2.
Intercostal.- usually 9 pairs
Subcostal.
3.
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.
b
a
AP VIEW
c
1.Abdo Aorta
2.Coeliac trunk
a.Lt gastric A
b.Splenic A
c.Hepatic A
3. S M A
5
2
6
1
3
4. I M A
5. Lt Renal A
6. Rt Renal A
4
LATERAL VIEW
Catheter
Celiac trunk
Superior mesenteric artery
Abdominal aorta
Coeliac Artery
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Short thick trunk
≈1.25 cm length
Arises from the front of the aorta, just below the aortic
hiatus of the diaphragm
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Between T12 & L1
Passing nearly horizontally forward
3 large branches
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Left gastric A - smallest
Hepatic A
Splenic A - largest
ANTERIO-POSTERIOR VIEW
2
1.Coeliac A
3
2.Lt gastric
A
3.Hepatic A
4.Splenic A
5.Gastroduo
denal A
4
1
4
Superior Mesenteric Artery
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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
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Inferior Pancreatico-duodenal
Middle Colic
Right Colic
Ileocolic
Intestinal
1
2
1.Abd Aorta
3
2.S M A
3.Middle colic A
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4.Rt colic A
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6
5.Ileocolic A
6. Intestinal A
7.Appendicular
7
Inferior Mesenteric Artery
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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
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Left Colic A
Sigmoid branches
Superior Hemorrhoidal A
3
1.Inf mesentric A
2.Lt colic A
1
2
3.Marginal A
4.Sigmoid A
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5.Superior
hemorrhoidal A
4
Superior Hemorrhoidal Artery
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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)
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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
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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
1.Abd Aorta
2.Common iliac A
3.External iliac A
4.Internal iliac A
2
3
4
The External Iliac Artery
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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
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2 branches
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Inferior epigastric
Deep iliac circumflex
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Continues as femoral A
The Internal Iliac A
(Hypogastric A )
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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
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Iliolumbar
Lateral Sacral
Superior Gluteal
Femoral Artery
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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
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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.—
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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
2
Popliteal Artery
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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
Superficial femoral
artery
Popliteal artery
Popliteal artery
Anterior tibial artery
Anterior tibial artery
Posterior tibial artery
Posterior tibial artery
Peroneal artery
Peroneal artery
Tibioperoneal trunk
Posterior Tibial A
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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
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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
Peroneal
Anterior Tibial
Posterior
Tibial
Medial & lateral
Plantar A
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
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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
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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
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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
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Vertebral.
Internal mammary
Thyrocervical
Costocervical
LEFT ANTERIOR OBLIQUE VIEW
RCC
LCC
Lt Subclavian
Rt Subclavian
Brachiocephalic A
Rt Axillary A
Axillary Artery
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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
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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
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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
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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