The Abdominal Aorta

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    The Abdominal Aorta

    (Aorta Abdominalis)

    The abdominal aorta begins at the aortic hiatus of the diaphragm, in front of the lower border of the body of the last thoracic vertebra,

    and, descending in front of the vertebral column, ends on the body of the fourth lumbar vertebra, commonly a little to the left of the

    middle line, by dividing into the two common iliac arteries. It diminishes rapidly in size, in consequence of the many large branches

    which it gives off. As it lies upon the bodies of the vertebr, the curve which it describes is convex forward, the summit of the convexitycorresponding to the third lumbar vertebra.

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    I!. "#$% The abdominal aorta and its branches. &'ee enlarged image(

    Relations.)The abdominal aorta is covered, anteriorly,by the lesser omentum and stomach, behind which are the branches of the celiac

    artery and the celiac plexus* below these, by the lienal vein, the pancreas, the left renal vein, the inferior part of the duodenum, the

    mesentery, and aortic plexus.Posteriorly,it is separated from the lumbar vertebr and intervertebral fibrocartilages by the anterior

    longitudinal ligament and left lumbar veins. +n the right sideit is in relation above with the azygos vein, cisterna chyli, thoracic duct,

    and the right crus of the diaphragm)the last separating it from the upper part of the inferior vena cava, and from the right celiacganglion* the inferior vena cava is in contact with the aorta below. +n the left sideare the left crus of the diaphragm, the left celiac

    ganglion, the ascending part of the duodenum, and some coils of the small intestine.

    Collateral Circulation.)The collateral circulation would be carried on by the anastomoses between the internal mammary and the

    inferior epigastric* by the free communication between the superior and inferior mesenterics, if the ligature were placed between thesevessels* or by the anastomosis between the inferior mesenteric and the internal pudendal, when &as is more common( the point of ligature

    is below the origin of the inferior mesenteric* and possibly by the anastomoses of the lumbar arteries with the branches of the

    hypogastric.

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    Branches.)The branches of the abdominal aorta may be divided into three sets visceral, parietal, and terminal.

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    Visceral Branches: -eliac,., superior esenteric., inferior esenteric, middle 'uprarenals, renals and internal 'permatics or ovarian &in

    the female(.Parietal Branches:inferior /hrenics, lumbars, middle 'acral

    Terminal Branches. -ommon Iliacs.

    +f the visceral branches, the celiac artery and the superior and inferior mesenteric arteries are unpaired, while the suprarenals, renals,

    internal spermatics, and ovarian are paired. +f the parietal branches the inferior phrenics and lumbars are paired* the middle sacral isunpaired. The terminal branches are paired.

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    The celiac artery&a. cliaca; celiac axis( is a short thic0 trun0, about $.1" cm. in length, which arisesfrom the front of the aorta, 2ust

    below the aortic hiatus of the diaphragm, and, passing nearly horizontally forward, divides into three large branches, the left gastric,the

    hepatic,and the splenic;it occasionally gives off one of the inferior phrenic arteries.

    Relations.)The celiac artery is covered by the lesser omentum. +n the right sideit is in relation with the right celiac ganglion and the

    caudate process of the liver* on the left side,with the left celiac ganglion and the cardiac end of the stomach. Belo!,it is in relation to the

    upper border of the pancreas, and the lienal vein.

    "

    $. The Left astric Artery&a. gastrica sinistra; gastric or coronary artery(, the smallest of the three branches of the celiac artery,passes upward and to the left, posterior to the omental bursa, to the cardiac orifice of the stomach. 3ere it distributes branches to the

    esophagus, which anastomose with the aortic esophageal arteries* others supply the cardiac part of the stomach, anastomosing with

    branches of the lienal artery. It then runs from left to right, along the lesser curvature of the stomach to the pylorus, between the layers of

    the lesser omentum* it gives branches to both surfaces of the stomach and anastomoses with the right gastric artery.

    1. The !epatic Artery&a. he#atica( in the adult is intermediate in size between the left gastric and lienal* in the fetus, it is the largest of

    the three branches of the celiac artery. It is first directed forward and to the right, to the upper margin of the superior part of the

    duodenum, forming the lower boundary of the epiploic foramen &foramen of $inslo!(. It then crosses the portal vein anteriorly and

    ascends between the layers of the lesser omentum, and in front of the epiploic foramen, to the porta hepatis, where it divides into two

    branches, right and left, which supply the corresponding lobes of the liver, accompanying the ramifications of the portal vein and hepaticducts. The hepatic artery, in its course along the right border of the lesser omentum, is in relation with the common bile4duct and portal

    vein, the duct lying to the right of the artery, and the vein behind.

    %

    Its branches are

    1&5ight !astric, gastroduodenal &right gastroepiploic and superior /ancreaticoduodenal( and cystic.

    I!. "#1% The celiac artery and its branches* the liver has been raised, and the lesser omentum and anterior layer of the greater omentumremoved.

    The right gastric artery&a. gastrica dextra; #yloric artery( arisesfrom the hepatic, above the pylorus, descends to the pyloric end of

    the stomach, and passes from right to left along its lesser curvature, supplying it with branches, and anastomosing with the left gastric

    artery.

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    The gastroduodenal artery&a. gastrod'odenalis( is a short but large branch, which descends, near the pylorus, between the superiorpart of the duodenum and the nec0 of the pancreas, and divides at the lower border of the duodenum into two branches, the right

    gastroepiploicand the superior pancreaticoduodenal./revious to its division it gives off two or three small branches to the pyloric end

    of the stomach and to the pancreas.

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    The right gastroepiploic artery&a. gastroe#i#loica dextra( runs from right to left along the greater curvature of the stomach, between

    the layers of the greater omentum, anastomosing with the left gastroepiploic branch of the lienal artery. 6xcept at the pylorus where it is

    in contact with the stomach, it lies about a finger7s breadth from the greater curvature. This vessel gives off numerous branches, some of

    which ascend to supply both surfaces of the stomach, while others descend to supply the greater omentum and anastomose with branchesof the middle colic.

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    The superior pancreaticoduodenal artery&a. #ancreaticod'odenalis s'#erior( descends between the contiguous margins of the

    duodenum and pancreas. It supplies both these organs, and anastomoses with the inferior pancreaticoduodenal branch of the superior

    mesenteric artery, and with the pancreatic branches of the lienal artery. 14

    I!. "##% The celiac artery and its branches* the stomach has been raised and the peritoneum removed.

    The cystic artery&a. cystica(,usually a branch of the right hepatic, passes downward and forward along the nec0 of the gall4bladder, and

    divides into two branches, one of which ramifies on the free surface, the other on the attached surface of the gall4bladder.

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    #. The Lienalor "plenic Artery&a. lienalis(, the largest branch of the celiac artery, is remar0able for the tortuosity of its course. Itpasses horizontally to the left side, behind the stomach and the omental bursa of the peritoneum, and along the upper border of the

    pancreas, accompanied by the lienal vein, which lies below it* it crosses in front of the upper part of the left 0idney, and, on arriving near

    the spleen, divides into branches, some of which enter the hilus of that organ between the two layers of the phrenicolienal ligament to be

    distributed to the tissues of the spleen* some are given to the pancreas, while others pass to the greater curvature of the stomach between

    the layers of the gastrolienal ligament. Its branches are#pancreatic, short gastric and left gastroepiploic.

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    The pancreatic branches&rami #ancreatici( are numerous small vessels derived from the lienal as it runs behind the upper border of

    the pancreas, supplying its body and tail. +ne of these, larger than the rest, is sometimes given off near the tail of the pancreas* it runs

    from left to right near the posterior surface of the gland, following the course of the pancreatic duct, and is called the arteria pancreaticamagna.These vessels anastomose with the pancreatic branches of the pancreaticoduodenal and superior mesenteric arteries.

    1"

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    I!. "#9% The superior mesenteric artery and its branches.

    The short gastric arteries&aa. gastric )re*es; *asa )re*ia( consist of from five to seven small branches, which arisefrom the end ofthe lienal artery, and from its terminal divisions. They pass from left to right, between the layers of the gastrolienal ligament, and are

    distributed to the greater curvature of the stomach, anastomosing with branches of the left gastric and left gastroepiploic arteries.

    1+

    The left gastroepiploic artery&a. gastroe#i#loica sinistra( the largest branch of the lienal, runs from left to right about a finger:s

    breadth or more from the greater curvature of the stomach, between the layers of the greater omentum, and anastomoses with the rightgastroepiploic. In its course it distributes several ascending branches to both surfaces of the stomach* others descend to supply the greater

    omentum and anastomose with branches of the middle colic.

    1%

    The superior mesenteric artery&a. mesenterica s'#erior( is a large vessel which supplies the whole length of the small intestine,

    except the superior part of the duodenum* it also supplies the cecum and the ascending part of the colon and about one4half of thetransverse part of the colon. It arises from the front of the aorta, about $.1" cm. below the celiac artery, and is crossed at its origin by the

    lienal vein and the nec0 of the pancreas. It passes downward and forward, anterior to the processus uncinatus of the head of the pancreas

    and inferior part of the duodenum, and descends between the layers of the mesentery to the right iliac fossa, where, considerablydiminished in size, it anastomoses with one of its own branches, viz., the ileocolic. In its course it crosses in front of the inferior vena

    cava, the right ureter and /soas ma2or, and forms an arch, the convexity of which is directed foward and downward to the left side, theconcavity bac0ward and upward to the right. It is accompanied by the superior mesenteric vein, which lies to its right side, and it is

    surrounded by the superior mesenteric plexus of nerves.

    Branches.)Its branches are Inferior /ancreaticoduodenal, ileocolic, right colic and middle -olic.

    (1

    The $nferior %ancreaticoduodenal Artery&a. #ancreaticod'odenalis inferior( is given off from the superior mesenteric or from its

    first intestinal branch, opposite the upper border of the inferior part of the duodenum. It courses to the right between the head of the

    pancreas and duodenum, and then ascends to anastomose with the superior pancreaticoduodenal artery. It distributes branches to the head

    of the pancreas and to the descending and inferior parts of the duodenum. ((

    The $ntestinal Arteries&aa. intestinales; *asa intestini ten'is( arisefrom the convex side of the superior mesenteric artery. They are

    usually from twelve to fifteen in number, and are distributed to the 2e2unum and ileum. They run nearly parallel with one another between

    the layers of the mesentery, each vessel dividing into two branches, which unite with ad2acent branches, forming a series of arches, theconvexities of which are directed toward the intestine&ig. "#"(.rom this first set of arches branches arise, which unite with similarbranches from above and below and thus a second series of arches is formed* from the lower branches of the artery, a third, a fourth, or

    even a fifth series of arches may be formed, diminishing in size the nearer they approach the intestine. In the short, upper part of the

    mesentery only one set of arches exists, but as the depth of the mesentery increases, second, third, fourth, or even fifth groups are

    developed. rom the terminal arches numerous small straight vessels arise which encircle the intestine, upon which they are distributed,

    ramifying between its coats. rom the intestinal arteries small branches are given off to the lymph glands and other structures between thelayers of the mesentery.

    (3

    The $leocolic Artery&a. ileocolica( is the lowest branch arising from the concavity of the superior mesenteric artery. It passes

    downward and to the right behind the peritoneum toward the right iliac fossa, where it divides into a superior and an inferior branch* the

    inferior anastomoses with the end of the superior mesenteric artery, the superior with the right colic artery.

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    I!. "#=% The inferior mesenteric artery and its branches. &'ee enlarged image(

    The &iddle Colic Artery&a. colica media( arisesfrom the superior mesenteric 2ust below the pancreas and, passing downward and

    forward between the layers of the transverse mesocolon, divides into two branches, right and left* the former anastomoses with the right

    colic* the latter with the left colic, a branch of the inferior mesenteric. The arches thus formed are placed about two fingers: breadth from

    the transverse colon, to which they distribute branches. (+

    The inferior mesenteric artery&a. mesenterica inferior( supplies the left half of the transverse part of the colon, the whole of the

    descending and iliac parts of the colon, the sigmoid colon, and the greater part of the rectum. It is smaller than the superior mesenteric,

    and arisesfrom the aorta, about # or 9 cm. above its division into the common iliacs and close to the lower border of the inferior part of

    the duodenum. It passes downward posterior to the peritoneum, lying at first anterior to and then on the left side of the aorta. It crosses

    the left common iliac artery and is continued into the lesser pelvis under the name of the superior hemorrhoidal artery,which descendsbetween the two layers of the sigmoid mesocolon and ends on the upper part of the rectum.

    (%

    Branches.)Its branches are left -olic. , sigmoid and superior 3emorrhoidal.

    3&

    The Left Colic Artery&a. colica sinistra( runs to the left behind the peritoneum and in front of the /soas ma2or, and after a short, but

    variable, course divides into an ascending and a descending branch* the stem of the artery or its branches cross the left ureter and left

    internal spermatic vessels. The ascending branch crosses in front of the left 0idney and ends, between the two layers of the transversemesocolon, by anastomosing with the middle colic artery* the descending branch anastomoses with the highest sigmoid artery. rom the

    arches formed by these anastomoses branches are distributed to the descending colon and the left part of the transverse colon.

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    The "igmoid Arteries&aa. sigmoide(,two or three in number, run obliquely downward and to the left behind the peritoneum and in

    front of the /soas ma2or, ureter, and internal spermatic vessels. Their branches supply the lower part of the descending colon, the iliaccolon, and the sigmoid or pelvic colon* anastomosing above with the left colic, and below with the superior hemorrhoidal artery.

    3(

    The "uperior !emorrhoidal Artery&a. hmorrhoidalis s'#erior(,the continuation of the inferior mesenteric, descends into the pelvisbetween the layers of the mesentery of the sigmoid colon, crossing, in its course, the left common iliac vessels. It divides, opposite the

    third sacral vertebra, into two branches, which descend one on either side of the rectum, and about $> or $1 cm. from the anus brea0 upinto several small branches. These pierce the muscular coat of the bowel and run downward, as straight vessels, placed at regular

    intervals from each other in the wall of the gut between its muscular and mucous coats, to the level of the 'phincter ani internus* here

    they form a series of loops around the lower end of the rectum, and communicate with the middle hemorrhoidal branches of the

    hypogastric, and with the inferior hemorrhoidal branches of the internal pudendal.

    33 The middle suprarenal arteries&aa. s'#rarenales media; middle ca#s'lar arteries; s'#rarenal arteries( are two small vessels which

    arise,one from either side of the aorta, opposite the superior mesenteric artery. They pass lateralward and slightly upward, over the crura

    of the diaphragm, to the suprarenal glands, where they anastomose with suprarenal branches of the inferior phrenic and renal arteries. In

    the fetus these arteries are of large size.

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    34

    The renal arteries&aa. renales(,are two large trun0s, which arisefrom the side of the aorta, immediately below the superior

    mesenteric artery. 6ach is directed across the crus of the diaphragm, so as to form nearly a right angle with the aorta. The right is longer

    than the left, on account of the position of the aorta* it passes behind the inferior vena cava, the right renal vein, the head of the pancreas,and the descending part of the duodenum. The left is somewhat higher than the right* it lies behind the left renal vein, the body of the

    pancreas and the lienal vein, and is crossed by the inferior mesenteric vein. ?efore reaching the hilus of the 0idney, each artery divides

    into four or five branches* the greater number of these lie between the renal vein and ureter, the vein being in front, the ureter behind, but

    one or more branches are usually situated behind the ureter. 6ach vessel gives off some small inferior suprarenal branchesto the

    suprarenal gland, the ureter, and the surrounding cellular tissue and muscles. +ne or two accessory renal arteries are frequently found,more especially on the left side they usually arise from the aorta, and may come off above or below the main artery, the former being the

    more common position. Instead of entering the 0idney at the hilus, they usually pierce the upper or lower part of the gland.

    35

    The internal spermatic arteries&aa. s#ermatic intern; s#ermatic arteries( are distributed to the testes. They are two slender vessels

    of considerable length, and arisefrom the front of the aorta a little below the renal arteries. 6ach passes obliquely downward andlateralward behind the peritoneum, resting on the /soas ma2or, the right spermatic lying in front of the inferior vena cava and behind the

    middle colic and ileocolic arteries and the terminal part of the ileum, the left behind the left colic and sigmoid arteries and the iliac colon.

    6ach crosses obliquely over the ureter and the lower part of the external iliac artery to reach the abdominal inguinal ring, through which it

    passes, and accompanies the other constituents of the spermatic cord along the inguinal canal to the scrotum, where it becomes tortuous,

    and divides into several branches. Two or three of these accompany the ductus deferens, and supply the epididymis, anastomosing withthe artery of the ductus deferens* others pierce the bac0 part of the tunica albuginea, and supply the substance of the testis. The internal

    spermatic artery supplies one or two small branches to the ureter, and in the inguinal canal gives one or two twigs to the -remaster.

    3

    I!. "#@% 'igmoid colon and rectum, showing distribution of branches of inferior mesenteric artery and their anastomoses. &rom a

    preparation by r. 3amilton

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    transmits that vein. ear the bac0 part of the central tendon each vessel divides into a medial and a lateral branch. The medial branch

    curves forward, and anastomoses with its fellow of the opposite side, and with the musculophrenic and pericardiacophrenic arteries. The

    lateral branchpasses toward the side of the thorax, and anastomoses with the lower intercostal arteries, and with the musculophrenic.

    The lateral branch of the right phrenic gives off a few vessels to the inferior vena cava* and the left one, some branches to the esophagus.6ach vessel gives off superior suprarenal branchesto the suprarenal gland of its own side. The spleen and the liver also receive a few

    twigs from the left and right vessels respectively.

    3%

    The lumbar arteries&aa. l'm)ales( are in series with the intercostals. They are usually four in number on either side, and arisefrom

    the bac0 of the aorta, opposite the bodies of the upper four lumbar vertebr. A fifth pair, small in size, is occasionally present they arisefrom the middle sacral artery. They run lateralward and bac0ward on the bodies of the lumbar vertebr, behind the sympathetic trun0, to

    the intervals between the ad2acent transverse processes, and are then continued into the abdominal wall. The arteries of the right side pass

    behind the inferior vena cava, and the upper two on each side run behind the corresponding crus of the diaphragm. The arteries of both

    sides pass beneath the tendinous arches which give origin to the /soas ma2or, and are then continued behind this muscle and the lumbar

    plexus. They now cross the Buadratus lumborum, the upper three arteries running behind, the last usually in front of the muscle. At thelateral border of the Buadratus lumborum they pierce the posterior aponeurosis of the Transversus abdominis and are carried forward

    between this muscle and the +bliquus internus. They anastomose with the lower intercostal, the subcostal, the iliolumbar, the deep iliac

    circumflex, and the inferior epigastric arteries.

    4&

    Branches.)In the interval between the ad2acent transverse processes each lumbar artery gives off a posterior ramuswhich is continued

    bac0ward between the transverse processes and is distributed to the muscles and s0in of the bac0* it furnishes a spinal branchwhich

    enters the vertebral canal and is distributed in a manner similar to the spinal branches of the posterior rami of the intercostal arteries &page

    8>$(. &uscular branchesare supplied from each lumbar artery and from its posterior ramus to the neighboring muscles. 41

    The middle sacral artery&a. sacralis media( is a small vessel, which arisesfrom the bac0 of the aorta, a little above its bifurcation. Itdescends in the middle l ine in front of the fourth and fifth lumbar vertebr, the sacrum and coccyx, and ends in the glomus coccygeum

    &coccygeal gland(. rom it, minute branches are said to pass to the posterior surface of the rectum. +n the last lumbar vertebra it

    anastomoses with the lumbar branch of the iliolumbar artery* in front of the sacrum it anastomoses with the lateral sacral arteries, andsends offsets into the anterior sacral foramina. It is crossed by the left common iliac vein, and is accompanied by a pair of ven

    comitantes* these unite to form a single vessel, which opens into the left common iliac vein.

    4(

    I!. "#C% The arteries of the pelvis.

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