AORTA AND PERIPHERAL ARTERIES ANATOMY

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AORTA AND PERIPHERAL ARTERIES ANATOMY
VISUALIZATION

• Presented By Dr Rakesh Jain

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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 aorta
• Ascending aorta
• Arch of the aorta and
• Descending aorta (thoracic and abdominal aorta)

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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

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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

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Branches of arch of aorta

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

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LEFT ANTERIOR OBLIQUE VIEW
CCA common carotid artery VA vertebral
artery SCA subclavian artery
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Variations of the supraaortic vessel origins
Vertibral
Lt CC
Rt CC
Lt CC
Lt Subclavian
Rt Subclavian
Vertibral
Inominate A
Lt Subclavian
Rt CC
Rt Subclavian
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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

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Branches of the Thoracic Aorta

• Visceral
• Pericardial
• Bronchial
• Esophageal
• Mediastinal
• Parietal 
• Intercostal.- usually 9 pairs
• Subcostal.
• Superior Phrenic.

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LEFT ANTERIOR OBLIQUE VIEW
LCC
RCC
Lt Subclavian
Rt Subclavian
Brachiocephalic A
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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

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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.

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• 1.Abdo Aorta
• 2.Coeliac trunk
• Lt gastric A
• Splenic A
• Hepatic A
• 3. S M A
• 4. I M A
• 5. Lt Renal A
• 6. Rt Renal A

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b
AP VIEW
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LATERAL VIEW
Catheter
Celiac trunk
Superior mesenteric artery
Abdominal aorta
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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

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1.Coeliac A 2.Lt gastric A 3.Hepatic
A 4.Splenic A 5.Gastroduodenal A
ANTERIO-POSTERIOR VIEW
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4
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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

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SMA-Branches

• Inferior Pancreatico-duodenal
• Middle Colic
• Right Colic
• Ileocolic
• Intestinal

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1.Abd Aorta 2.S M A 3.Middle colic A 4.Rt
colic A 5.Ileocolic A 6. Intestinal
A 7.Appendicular
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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

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Inferior Mesenteric Artery branches

• Left Colic A
• Sigmoid branches
• Superior Hemorrhoidal A

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1.Inf mesentric A 2.Lt colic A 3.Marginal
A 4.Sigmoid A 5.Superior hemorrhoidal A
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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)

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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

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AP VIEW
Lt Renal arteries
Rt Renal arteries
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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 )

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

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EIA-Branches

• 2 branches
• Inferior epigastric
• Deep iliac circumflex
• Continues as femoral A

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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

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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

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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)

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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)

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AP VIEW
Catheter
Common femoral artery
Superficial femoral artery
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1.Profnda F A 2.Femoral artery
AP VIEW
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2
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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

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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
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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

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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.  

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AP VIEW
Tibioperoneal Trunk Anterior
Tibial Peroneal Posterior Tibial
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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
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Foot arteries front view
A. tibialis anterior
A. dorsalis pedis
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Foot arteriesdown view
Arcus plantaris profundus
A. plantaris medialis
A. plantaris lateralis
A. tibialis posterior
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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.

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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

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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

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branches of the subclavian artery

• Vertebral.
• Internal mammary
• Thyrocervical
• Costocervical

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LEFT ANTERIOR OBLIQUE VIEW
LCC
RCC
Lt Subclavian
Rt Subclavian
Brachiocephalic A
Rt Axillary A
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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

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ANTERIO-POSTERIOR VIEW
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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

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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

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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

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ANTERIO-POSTERIOR VIEW
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POSTERIO-ANTERIOR VIEW
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Thanks