AORTA AND PERIPHERAL ARTERIES ANATOMY & VISUALIZATION

1. AORTA AND PERIPHERAL ARTERIES ANATOMY & VISUALIZATION Presented By; Dr Rakesh Jain

2. 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)

4. 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

5. 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

6. Branches of arch of aorta Three in number- • Innominate artery • Left common carotid artery • Left subclavian artery

8. LEFT ANTERIOR OBLIQUE VIEW CCA= common carotid artery VA= vertebral artery SCA= subclavian artery

9. 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

10. 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

11. Branches of the Thoracic Aorta • Visceral • Pericardial • Bronchial • Esophageal • Mediastinal • Parietal • Intercostal.- usually 9 pairs • Subcostal. • Superior Phrenic.

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

13. 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

14. 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.

15. 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 a b AP VIEW c 2 5 6 1 3 4

16. LATERAL VIEW Catheter Celiac trunk Superior mesenteric artery Abdominal aorta

17. 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

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

21. 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

22. SMA-Branches Inferior Pancreatico-duodenal Middle Colic Right Colic Ileocolic Intestinal

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

25. 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

26. Inferior Mesenteric Artery branches Left Colic A Sigmoid branches Superior Hemorrhoidal A

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

29. 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)

30. Renal arteries • Two large arteries • Arises from side of aorta, immediately below SMA • Nearly a right angle with the aorta • Right is longer than left • Before reaching hilus of the kidney, each artery divides into four or five branches • Left is somewhat higher than the right

31. AP VIEW Lt Renal arteries Rt Renal arteries

32. 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 )

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

34. 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

35. EIA-Branches • 2 branches • Inferior epigastric • Deep iliac circumflex • Continues as femoral A

36. 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

37. 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

38. 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)

40. 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)

42. AP VIEW Catheter Common femoral artery Superficial femoral artery

43. 1.Profnda F A 2.Femoral artery AP VIEW 1 2

44. 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

46. 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

47. 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

49. 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.