AORTA AND PERIPHERAL AORTA AND PERIPHERAL ARTERIES ARTERIES

ANATOMY & ANATOMY & VISUALIZATIONVISUALIZATION

Presented By; Dr Rakesh JainPresented By; Dr Rakesh Jain

The Aorta The Aorta After originating from LV After originating from LV (about 3 cm in (about 3 cm in

diameter )diameter ), it ascending for a short , it ascending for a short distance, arches backward and to the left distance, arches backward and to the left side, descends within the thorax on the side, descends within the thorax on the left side of the vertebral columnleft side of the vertebral column

Portions of aortaPortions of aorta1.1. Ascending aorta Ascending aorta

2.2. Arch of the aorta andArch of the aorta and

3.3. Descending aorta Descending aorta (thoracic and abdominal aorta)(thoracic and abdominal aorta)

Ascending Aorta (Aorta Ascending Aorta (Aorta Ascendens) Ascendens)

About 5 cm. in lengthAbout 5 cm. in length Passes obliquely upward, forward, and to the Passes obliquely upward, forward, and to the

right, as high as the upper border of the second right, as high as the upper border of the second right costal cartilageright costal cartilage

At its origin, three small dilatations called the At its origin, three small dilatations called the aortic sinusesaortic sinuses

At the union of the ascending aorta with the At the union of the ascending aorta with the aortic arch, the caliber of the vessel is increased, aortic arch, the caliber of the vessel is increased, owing to a bulging of its right wall. This owing to a bulging of its right wall. This dilatation is termed the dilatation is termed the bulb of the aortabulb of the aorta

Only branches of the ascending aorta are the two Only branches of the ascending aorta are the two coronary arteries coronary arteries

Arch of the Aorta Arch of the Aorta

Begins at the level of the upper border of the Begins at the level of the upper border of the Rt 2nd sternocostal jointRt 2nd sternocostal joint

First runs upward, backward, and to the left, First runs upward, backward, and to the left, infront of the trachea, then directed backward infront of the trachea, then directed backward on the left side of the trachea and finally on the left side of the trachea and finally passes downward on the left side of the body passes downward on the left side of the body of T4, at lower border of which it becomes of T4, at lower border of which it becomes continuous with the descending aorta continuous with the descending aorta

Forms two curvatures: one with its convexity Forms two curvatures: one with its convexity upward, the other with its convexity forward upward, the other with its convexity forward and to the left and to the left

Branches of arch of aorta Branches of arch of aorta

Three in number-Three in number- Innominate arteryInnominate artery Left common carotid arteryLeft common carotid artery Left subclavian arteryLeft subclavian artery

CCA= common carotid artery

VA= vertebral artery

SCA= subclavian artery

LEFT ANTERIOR OBLIQUE VIEW

Variations of the Variations of the supraaortic vessel supraaortic vessel

originsorigins

Inominate ARt SubclavianRt CC

Vertibral Lt CC

Lt Subclavian

Rt Subclavian

Rt CC

Lt CCVertibral

Lt Subclavian

Descending Aorta Descending Aorta Thoracic Aorta Thoracic Aorta

Contained in the posterior Contained in the posterior mediastinal cavity mediastinal cavity

Begins at the lower border of the T4Begins at the lower border of the T4 Ends in front of the lower border of Ends in front of the lower border of

the T12 vertebra, at the aortic hiatus the T12 vertebra, at the aortic hiatus in the diaphragm in the diaphragm

Branches of the Thoracic Branches of the Thoracic Aorta Aorta

VisceralVisceral 1.1. PericardialPericardial

2.2. BronchialBronchial

3.3. EsophagealEsophageal

4.4. MediastinalMediastinal

ParietalParietal    1.1. Intercostal.- usually 9 pairsIntercostal.- usually 9 pairs

2.2. Subcostal.Subcostal.

3.3. Superior PhrenicSuperior Phrenic..

RCCLCC

Lt Subclavian

Rt Subclavian

Brachiocephalic A

LEFT ANTERIOR OBLIQUE VIEW

Abdominal Abdominal aortaaorta

Begins at aortic Begins at aortic hiatus of diaphragmhiatus of diaphragmIn front of lower In front of lower border of Tborder of T1212 Descending in front Descending in front of the vertebral column of the vertebral column Ends on LEnds on L4-4-body, body, a little to Left of midlinea little to Left of midlineSummit of the convexity Summit of the convexity corresponding to the L3corresponding to the L3

Branches of the Branches of the abdominal aorta abdominal aorta

Visceral BranchesVisceral Branches Celiac.Celiac. Superior Mesenteric.Superior Mesenteric. Inferior Mesenteric.Inferior Mesenteric. Middle Suprarenals.Middle Suprarenals. Renals.Renals. Internal Spermatics.Internal Spermatics. Ovarian (in the female)Ovarian (in the female)Parietal BranchesParietal Branches Inferior Phrenics.Inferior Phrenics. Lumbars.Lumbars. Middle Sacral.Middle Sacral.

Terminal BranchesTerminal Branches Common Iliacs.Common Iliacs.

1.Abdo Aorta

2.Coeliac trunk

a.Lt gastric Ab.Splenic Ac.Hepatic A

3. S M A

4. I M A

5. Lt Renal A

6. Rt Renal A

2

c

a b

65

31

4

AP VIEW

Catheter

Abdominal aorta

Celiac trunk

Superior mesenteric artery

LATERAL VIEW

Coeliac ArteryCoeliac Artery Short thick trunkShort thick trunk ≈≈1.25 cm length1.25 cm length Arises from the front of the aorta, Arises from the front of the aorta, just below just below

the aortic hiatus of the diaphragm the aortic hiatus of the diaphragm Between Between TT1212 & & LL11 Passing nearly horizontally forwardPassing nearly horizontally forward 3 large branches3 large branches

Left gastric A - smallestLeft gastric A - smallest Hepatic AHepatic A Splenic A - largestSplenic A - largest

1.Coeliac A

2.Lt gastric A

3.Hepatic A

4.Splenic A

5.Gastroduodenal

A

13

2

44

ANTERIO-POSTERIOR VIEW

Superior Mesenteric ArterySuperior Mesenteric Artery

Large vessel Large vessel Arises from front of aorta, at Arises from front of aorta, at LL11, ~1.25 , ~1.25

cm below Coeliac A cm below Coeliac A Passes downward and forward, to the Passes downward and forward, to the

right iliac fossaright iliac fossa Supply small intestine (expt superior Supply small intestine (expt superior

Duo),Duo),

Cecum, Asc Colon & Rt Cecum, Asc Colon & Rt ½½ Transverse Transverse ColonColon

SMA-BranchesSMA-Branches

Inferior Pancreatico-duodenalInferior Pancreatico-duodenal Middle ColicMiddle Colic Right ColicRight Colic IleocolicIleocolic IntestinalIntestinal

1.Abd Aorta

2.S M A

3.Middle colic A 4.Rt colic A

5.Ileocolic A

6. Intestinal A

7.Appendicular

5

7

4

1

6

2

3

Inferior Mesenteric ArteryInferior Mesenteric Artery Smaller than SMASmaller than SMA Arises from aorta at L3, about 3 or 4 cm Arises from aorta at L3, about 3 or 4 cm

above its division above its division Passes downward, posterior to the Passes downward, posterior to the

peritoneumperitoneum Continued into pelvis as Superior Continued into pelvis as Superior

hemorrhoidal artery &hemorrhoidal artery & ends on the upper ends on the upper rectum rectum

Supply Lt ½ transverse colon, descending Supply Lt ½ transverse colon, descending & sigmoid colon, and most of the rectum& sigmoid colon, and most of the rectum

Inferior Mesenteric Artery Inferior Mesenteric Artery branchesbranches

Left Colic ALeft Colic A Sigmoid branchesSigmoid branches Superior Hemorrhoidal ASuperior Hemorrhoidal A

1.Inf mesentric A

2.Lt colic A

3.Marginal A

4.Sigmoid A

5.Superior hemorrhoidal A

1

2

45

3

Superior Hemorrhoidal Superior Hemorrhoidal ArteryArtery

Form a series of loops around lower Form a series of loops around lower rectumrectum

Communicate with Communicate with Middle hemorrhoidal branches of Middle hemorrhoidal branches of

Internal Iliac AInternal Iliac A

and and Inferior hemorrhoidal branches of Inferior hemorrhoidal branches of

Internal pudendal A (branch of Internal Internal pudendal A (branch of Internal Iliac A)Iliac A)

Renal arteriesRenal arteries1.Two large arteries2.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

Rt Renal arteries

Lt Renal arteries

AP VIEW

Common Iliac ArteriesCommon Iliac Arteries

Abdominal Aorta divides, on Lt side of L4 Abdominal Aorta divides, on Lt side of L4 Each about 5 cm lengthEach about 5 cm length Rt Common Iliac A -somewhat longer than Rt Common Iliac A -somewhat longer than

the Ltthe Lt Each divide, opposite the intervertebral Each divide, opposite the intervertebral

fibrocartilage between L5 & S1fibrocartilage between L5 & S1 2 branches→ 2 branches→

External Iliac A External Iliac A

& & Internal Iliac A (Hypogastric A )Internal Iliac A (Hypogastric A )

1.Abd Aorta

2.Common iliac A 3.External iliac A

4.Internal iliac A

1

2

3

4

AP VIEW

The External Iliac ArteryThe External Iliac Artery

Larger than Internal Iliac A Larger than Internal Iliac A Passes obliquely downward and Passes obliquely downward and

lateralward along the medial border lateralward along the medial border of the Psoas major of the Psoas major

Beneath the inguinal ligament, Beneath the inguinal ligament, midway between anterior superior midway between anterior superior iliac spine and symphysis pubis iliac spine and symphysis pubis entering the thigh & becomes entering the thigh & becomes Femoral AFemoral A

EIA-BranchesEIA-Branches

2 branches2 branches Inferior epigastricInferior epigastric Deep iliac circumflexDeep iliac circumflex

Continues as femoral AContinues as femoral A

The Internal Iliac AThe Internal Iliac A(Hypogastric A(Hypogastric A ))

Short, thick vessel, smaller than EIAShort, thick vessel, smaller than EIA ArisesArises at the bifurcation of the common at the bifurcation of the common

iliac, opposite the lumbosacral articulation iliac, opposite the lumbosacral articulation Abt 4 cm length, on medial side of the thigh Abt 4 cm length, on medial side of the thigh The lengths of the CIA & IIA bear an The lengths of the CIA & IIA bear an

inverse proportion to each other→ IIA being inverse proportion to each other→ IIA being long when CIA is short, and long when CIA is short, and vice versa.vice versa.

Divides into 2 large trunks at upper margin Divides into 2 large trunks at upper margin of the greater sciatic foramen → of the greater sciatic foramen → anterioranterior & & posteriorposterior

Branches of Internal Branches of Internal Iliac AIliac AAnterior TrunkAnterior Trunk

Superior VesicalSuperior Vesical Middle Vesical Middle Vesical Inferior Vesical Inferior Vesical Vaginal Vaginal (in females)(in females) Middle HemorrhoidalMiddle Hemorrhoidal Obturator Obturator Inferior Gluteal Inferior Gluteal Internal Pudendal Internal Pudendal Inf Hemorrhoidal AInf Hemorrhoidal A UterineUterine

Posterior TrunkPosterior Trunk IliolumbarIliolumbar Lateral SacralLateral Sacral Superior Gluteal Superior Gluteal

Femoral ArteryFemoral Artery Begins behind inguinal ligament, midway Begins behind inguinal ligament, midway

between ASIS & symphysis pubis, between ASIS & symphysis pubis, Ends at junction of upper Ends at junction of upper ⅔ & ⅔ & lower lower ⅓⅓ of of

thigh, to become Popliteal Athigh, to become Popliteal A First 4 cm -enclosed, together with First 4 cm -enclosed, together with

Femoral V, in a fibrous sheath—the Femoral V, in a fibrous sheath—the Femoral SheathFemoral Sheath

In the upper In the upper ⅓⅓ of thigh Femoral A is of thigh Femoral A is contained in the contained in the Femoral TriangleFemoral Triangle ((Scarpa’s triangleScarpa’s triangle) )

IIn the middle n the middle ⅓⅓ of thigh, in the of thigh, in the Adductor Adductor CanalCanal ( (Hunter’s canal)Hunter’s canal)

Profunda Femoris AProfunda Femoris A

Large vessel Large vessel arisingarising from lateral & back part from lateral & back part of Femoral A, 2-5 cm below inguinal ligamentof Femoral A, 2-5 cm below inguinal ligament

Ends at the lower Ends at the lower ⅓⅓ of thigh of thigh PFA provides an important source of PFA provides an important source of

collateral flow to the leg and foot in patients collateral flow to the leg and foot in patients with significant SFA stenoses or occlusionwith significant SFA stenoses or occlusion

Branches.Branches.—— Lateral Femoral Circumflex, Lateral Femoral Circumflex, Medial Femoral Circumflex, Medial Femoral Circumflex, Perforating branches (4 no.s)Perforating branches (4 no.s)

AP VIEW

Catheter

Superficial femoralartery

Common femoralartery

1.Profnda F A

2.Femoral artery

1

2

AP VIEW

Popliteal ArteryPopliteal Artery Continuation of Femoral AContinuation of Femoral A Extends from the opening in the Adductor Extends from the opening in the Adductor

magnus, at the junction of middle magnus, at the junction of middle ⅔ ⅔ & lower & lower ⅓⅓ of thighof thigh

Courses downward and lateralward to the Courses downward and lateralward to the intercondyloid Popliteal fossa of the femur, then intercondyloid Popliteal fossa of the femur, then vertically downward to the lower border of the vertically downward to the lower border of the Popliteus Popliteus

Divides into Anterior tibial A and Divides into Anterior tibial A and tibioperoneal tibioperoneal trunk.trunk.

Tibioperoneal trunk is the direct continuation of Tibioperoneal trunk is the direct continuation of the popliteal arteythe popliteal artey, arises distal to the anterior , arises distal to the anterior tibial artery, bifurcates just beyond its origin into tibial artery, bifurcates just beyond its origin into the posterior tibial and peroneal arteriesthe posterior tibial and peroneal arteries

Popliteal artery Anterior tibial artery

Posterior tibial artery

Peroneal artery

Popliteal artery

Anterior tibial artery

Posterior tibial artery

Peroneal artery

Superficial femoral artery

Tibioperoneal trunk

Posterior Tibial APosterior Tibial A

Begins at lower border of Popliteus, Begins at lower border of Popliteus, opposite the interval betw tibia & fibula opposite the interval betw tibia & fibula

Descends, approaching tibial side of legDescends, approaching tibial side of leg In the lower part, situated midway betw In the lower part, situated midway betw

med malleolus & med process of calcaneal med malleolus & med process of calcaneal tuberositytuberosity

Divides into Medial & Lateral plantar ADivides into Medial & Lateral plantar A

Anterior Tibial AAnterior Tibial A

Begins at bifurcation of Popliteal A, at the Begins at bifurcation of Popliteal A, at the lower border of Popliteuslower border of Popliteus

Passes forward through aperture above Passes forward through aperture above upper border of interosseous membupper border of interosseous memb

Descends on anterior surface of Descends on anterior surface of interosseous memb, gradually interosseous memb, gradually approaching the tibiaapproaching the tibia

On the front of ankle-joint (more On the front of ankle-joint (more superficial), becomes superficial), becomes Dorsalis Pedis Artery.Dorsalis Pedis Artery.   

Tibioperoneal Trunk

Anterior Tibial

Peroneal

Posterior Tibial

AP VIEW

Ankle and Foot Vascular Ankle and Foot Vascular AnatomyAnatomy

Dorsalis Pedis

Anterior Tibial

Peroneal

Posterior Tibial

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

Medial & lateralPlantar A

Lateral view

Foot arteries Foot arteries front view front view

A. tibialis anterior

A. dorsalis pedis

Foot arteriesFoot arteriesdown view down view

A. tibialis posterior

A. plantaris lateralis

A. plantaris medialis

Arcus plantaris profundus

Innominate Artery Innominate Artery

Largest branch of arch of the aortaLargest branch of arch of the aorta 4 to 5 cm. in length4 to 5 cm. in length Arises,Arises, on a level with the upper border on a level with the upper border

of the second right costal cartilageof the second right costal cartilage Ascends obliquely upward, backward, Ascends obliquely upward, backward,

and to the right to the level of the and to the right to the level of the upper border of the right upper border of the right sternoclavicular articulation, where it sternoclavicular articulation, where it divides into the right common carotid divides into the right common carotid and right subclavian arteries. and right subclavian arteries.

Common Carotid Artery Common Carotid Artery 2 in number (Rt & Lt)2 in number (Rt & Lt) Differ in length and mode of origin Differ in length and mode of origin The rightThe right begins at bifurcation of begins at bifurcation of

innominate A, behind sternoclavicular joint innominate A, behind sternoclavicular joint and is confined to the neck. and is confined to the neck.

The The leftleft springs from the highest part of springs from the highest part of arch of the aorta to the left of, on a plane arch of the aorta to the left of, on a plane posterior to the innominate artery posterior to the innominate artery

Each vessel passes obliquely upward Each vessel passes obliquely upward Divides into the ECA & ICA, at the level of Divides into the ECA & ICA, at the level of

upper border of the thyroid cartilage upper border of the thyroid cartilage

The Subclavian Artery The Subclavian Artery

Right side: Right side: arisesarises from the from the innominate artery behind right innominate artery behind right sternoclavicular articulationsternoclavicular articulation

Left side: Left side: arisesarises directly from the directly from the arch of the aortaarch of the aorta

Extends to the outer border of the Extends to the outer border of the first rib, where it becomes the first rib, where it becomes the axillary arteryaxillary artery

branches of the branches of the subclavian artery subclavian artery

Vertebral.Vertebral. Internal mammaryInternal mammary ThyrocervicalThyrocervical CostocervicalCostocervical

RCCLCC

Lt Subclavian

Rt Subclavian

Brachiocephalic A

LEFT ANTERIOR OBLIQUE VIEW

Rt Axillary A

Axillary Artery Axillary Artery

Commences at the outer border of Commences at the outer border of the first ribthe first rib

Ends at lower border of the tendon Ends at lower border of the tendon of the Teres major, where it takes of the Teres major, where it takes the name of brachial the name of brachial

At its origin the artery is very deeply At its origin the artery is very deeply situated, but near its termination is situated, but near its termination is superficial superficial

ANTERIO-POSTERIOR VIEW

Brachial Artery Brachial Artery

Commences at the lower margin of the tendon Commences at the lower margin of the tendon of the Teres majorof the Teres major

Passing down the arm Passing down the arm Ends about 1 cm. below the bend of the Ends about 1 cm. below the bend of the

elbow, where it divides into the elbow, where it divides into the radialradial and and ulnar arteriesulnar arteries

Course;Course; At first the brachial artery lies medial At first the brachial artery lies medial to the humerus; as it runs down the arm it to the humerus; as it runs down the arm it gradually gets in front of the bone, and at the gradually gets in front of the bone, and at the bend of the elbow it lies midway between its bend of the elbow it lies midway between its two epicondyles two epicondyles

Radial Artery Radial Artery

Continuation of the brachialContinuation of the brachial Smaller in caliber than ulnar. Smaller in caliber than ulnar. Commences at bifurcation of the brachial, just Commences at bifurcation of the brachial, just

below the bend of the elbowbelow the bend of the elbow Passes along the radial side of the forearm to Passes along the radial side of the forearm to

the wristthe wrist Then winds backward, around the lateral side Then winds backward, around the lateral side

of the carpus, forward toward thumb and index of the carpus, forward toward thumb and index finger into the palm of the hand and unite with finger into the palm of the hand and unite with the deep volar branch of the ulnar artery to the deep volar branch of the ulnar artery to form the deep volar arch form the deep volar arch

Ulnar Artery Ulnar Artery

Larger than radial A.Larger than radial A. Begins a little below the bend of the elbow Begins a little below the bend of the elbow Passing obliquely downward, reaches ulnar Passing obliquely downward, reaches ulnar

side of the forearm, midway between the side of the forearm, midway between the elbow and the wrist. It then runs along the elbow and the wrist. It then runs along the ulnar border to the wristulnar border to the wrist

Immediately beyond pisiform bone, it Immediately beyond pisiform bone, it divides into two branches, which enter into divides into two branches, which enter into the formation of the superficial and deep the formation of the superficial and deep volar arches volar arches

ANTERIO-POSTERIOR VIEW

POSTERIO-ANTERIOR VIEW