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