Playing Create a Lesion:

1
Playing Create a Lesion 

• If you block one artery or vein, the body is full
  of backup routes to get around the blockage!
• Applies to both the arterial aystem and the
  venous system
• Beginning with the
• Arterial System Only one valve in the Arterial
  System Aortic Valve

Pictures below are taken from Netter, I apologize
for not having the corresponding plates for Grant
or Clemente
2
SMA and IMA

• Block the middle colic Artery Will it Die?
• NO! The right colic artery forms an ARCADE and
  anastamoses with the middle colic artery and will
  allow for blood to perfuse the parts of the
  intestine supplied by the blocked right colic
  similarly, the ileocolic artery anastameses with
  the right colic.
• Block the whole SMA
• And the Inferior Mesenteric Artery will
  anastamose with the arcades of the SMA via the
  MARGINAL BRANCH (off the ascending IMA)

Netter, plate 287
3
Celiac Trunk

• Block the Splenic Artery Will the Spleen Die?
• NO! blood can follow the common hepatic trunk-gt
  gastroduodenal a. -gt right gastroepiploic a.-gt
  left gastroepiploic a. -gt splenic a.and the short
  gastric arteries.
• Block the gastroduodenal a. Will the greater
  curvature die?
• NO! Reverse of above.
• Block the gastroduodenal and splenic a. Will the
  greater curvature die?
• NO! Left gastric a. anastamoses at the fundus of
  the stomach with the short gastric arteries off
  the splenic gastroepiploics can then deliver to
  the gastroduodenal.
• If the entire celiac trunk is blocked?
• Pancreatico-duodenal arteries connect the system
  to the SMA!! The Ant. and Post. SUPERIOR
  pancreatico-duodenal arteries branch from the
  gastroduodenal a. and the Ant. and Post. INFERIOR
  pancreatico-duodenal arteries branch off the SMA
  to all anastamose.

Netter, plate 282
4
Connecting the Thorax and the Abdomen

• Assuming the abdominal aorta has been blocked
  there are two routes
• Anterior Wall
•         Aorta feeds the subclavians -gt internal
  thoracic arteries (run in the superficial fascia
  just inferior and lateral to the sternum) -gt
  superior epigastric arteries (simply a name
  change of the internal throacics at the
  diaphragm) -gt inferior epigastrics -gt external
  iliac -gt common iliac -gt abdominal aorta
• Posterior Wall
•         Aorta feeds the subclavians -gt vertebral
  and cervical (ascending and deep) arteries which
  meet in the neck -gt anterior and posterior spinal
  arteries which run down the spine -gt send off
  intercostals branches, lumbar arteries, sacral
  arteries -gt internal iliac arteries -gt common
  iliac arteries -gt abdominal aorta

L. Common Carotid a.
R. Common Carotid a.
L. Subclavian a.
R. Subclavian a.
Internal Thoracic Artery
To the heart
Superior Epigastric Artery
Common Iliac A.
Inferior Epi- Gastric Artery
External Iliac A.
Netter plates 248, 176 may help with A. Netter
218, 219 may help with B.
Internal Iliac a.
Absolutely no credit can be given for this
drawing
5
Venous System 2 flavors -gt Caval and Portal

•  See problems because the lymphatics accompany
  the venous system closely.
• The lymphatics collect the junk out of the blood
  and increase the likelihood of infection, cancer
  etc. Cancerous lymph nodes or inflamed swollen
  lymph nodes will apply pressure to surrounding
  tissue since veins are thin walled they are more
  likely than arteries to be compressed.
• Also, hepatic dysfunction can lead to novel and
  abnormal venous return

6

• 1. caval venous system connections with-in one
  area (abdomen) or between two area (abdomen and
  thorax) mirror the arterial system
• If the IVC is blocked? Will you die?
• NO! you can use vessels of the anterior or
  posterior wall
•  
• 2. Portal Venous system drains the mesentery
  system and filters through the liver
• If blocked before the liver it will follow the
  above
•  
• 3.Portal caval shunts for when the liver is not
  working properly decreased portal venous return,
  increased venous pressure in the mesentery
• a. gastric veins (caval) to esophageal veins
  (portal)
•         pathological presentation esophageal
  verices -gt can result in acute hemorrhage
• b. Recanulization of the ligamentum teres
•         pathological presentation capitas
  medusae
•         ligamentum teres (caval) anastamoses
  with epigastric veins (portal) at umbilicus
• c. Superior Rectal vein (off SMA, portal)
  neovascularizes with Middle and Inferior Rectal
  Veins (off IVC, caval)
•         pathological presentation is hemorrhoids
• d. left splenic vein (of portal system) to left
  renal vein (of caval system )
•         splenorenal ligament recanulizes
• e. lumbar plexus of veins (with cxn to azygous
  and the SVC) neovascularizes to SMV and IMV
•         neovascularization between colonic
  venous plexus and lumbar venous plexus

Netter, Plate 293