Human Anatomy, Part 2 - K. A. Dyubenko, A. K. Kolomiysev, Yu. B. Chaykovsky 2008

Special Part
Cardiovascular system, systema cardiovasculare - Special Part
Blood vessels of the systemic circulation - Unpaired visceral branches of the abdominal aorta

1. Truncus coeliacus;

2. A.mesenterica superior;

3. A.mesenterica inferior.

The celiac trunk, truncus coeliacus (Fig. 43, 43 A), is a short, unpaired trunk measuring 1–2 cm in length and 4 to 7 mm in diameter. It originates from the anterior surface of the Abdominal Aorta at the level of the 12th thoracic vertebra, immediately below the aortic hiatus. The celiac trunk courses anteriorly and divides into three terminal branches: the left gastric artery, the common hepatic artery, and the splenic artery.

Branching of the celiac trunk via a dispersed pattern, forming the "Halller's tripod", occurs in 85% of cases (V. A. Vendrykh). Anatomical variants are observed in which the left gastric, common hepatic, and splenic Arteries arise directly from the abdominal aorta (M. A. Tikhomirov, 1900). Alongside the typical celiac trunk, various anatomical variants exist, which is of significant clinical importance (F. Netter, 1989) (Fig. 43 B).

a) The left gastric artery, a.gastrica sinistra* (Fig. 43, 43 A), is the slenderest branch of the celiac trunk. It courses to the left and anteriorly along the lesser curvature toward the esophagogastric junction. Subsequently, the artery runs along the left half of the lesser curvature of The Stomach toward the right gastric artery.

Passing between the peritoneal folds of the lesser omentum, a.gastrica sinistra gives off branches to the anterior and posterior walls of the stomach, the lesser omentum, and the cardiac part of the Esophagus. The Branches of the left gastric artery anastomose with esophageal arteries and the right gastric artery.

б) The common hepatic artery, a.hepatica communis (Fig. 43, 43 A), 4–5 cm in length, originates from the celiac trunk and courses to the right. It is located inferior to the caudate lobe of The Liver and posterior to the Vestibule of the omental bursa. At the level of the duodenum, the common hepatic artery divides into the gastroduodenal artery, a.gastroduodenalis, and the proper hepatic artery, a.hepatica propria. Frequently, it divides into three branches, the third being a specific branch for the caudate lobe. The classical form of the hepatic artery occurs in 50–55% of cases (A. O. Voitenko), while the remainder represent anatomical variants (Netter, 1989) (Fig. 43 B). The latter gives rise to the right gastric artery, a.gastrica dextra, which runs from right to left between the folds of the lesser omentum. It anastomoses with the left gastric artery, resulting in The formation of an anastomotic arterial arch along the lesser curvature, from which branches supply the stomach wall.

* The left gastric artery, a.gastrica sinistra, frequently gives off an additional branch, a.hepatica accessoria, to the left lobe of the liver (W. Krause, M. A. Tikhomirov). This variant occurs when the a.hepatica communis or its branches are insufficiently developed (M. A. Tikhomirov). Additional hepatic arteries may also arise from the superior mesenteric artery, the aorta, and the right renal artery (V. V. Kupriyanov, N. V. Voskresensky, 1970).

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Fig. 43. Celiac trunk, truncus coeliacus, and its branches (after Toldt)

Fig. 43 A. Arteries of the Abdominal cavity (anterior view). The stomach is reflected upward

The proper hepatic artery courses within the thickness of the hepatoduodenal ligament, anterior to the portal vein and to the left of the Bile duct*, which must be considered in clinical (surgical) practice during operations on Extrahepatic bile ducts. Subsequently, it reaches the porta hepatis, where it divides into right and left branches, r.dexter and r.sinister. The cystic artery, a.cystica, arises from the right branch to supply the Gallbladder. This origin is observed in 85% of cases: to the right of the common hepatic duct (61%) or to the left of it (24%). Occasionally, a.cystica originates from the common hepatic artery (10%) (H. P. Filimonov, 1975), or from the left branch of the proper hepatic artery, or the gastroduodenal artery (Fig. 46 A). At the level of the neck of the gallbladder, a.cystica divides into two branches: one runs along the superior (hepatic) surface of the gallbladder, and the larger second branch runs along the inferior surface, which is covered by Peritoneum. These anatomical Variants of the cystic artery require heightened surgical attention during Operations on the bile ducts and gallbladder.

The gastroduodenal artery, a.gastroduodenalis, passes between the Cytology/practical/109.html">Pyloric part of the stomach and the HEAD of the Pancreas, where it divides into two arteries: the superior pancreaticoduodenal artery, a.pancreaticoduodenalis superior, and the right gastroepiploic artery, a.gastroepiploica dextra. The right gastroepiploic artery runs along the right half of the greater curvature of the stomach between the peritoneal folds, where it anastomoses with the corresponding artery from the left side (intrasystemic anastomosis) and sends branches to the stomach and greater omentum.

в) The splenic artery, a.splenica [lienalis] (Fig. 43 A), follows a tortuous course along the superior border of the pancreas and reaches the splenic hilum, where it branches into 5–6 terminal branches**. Along its path, it sends branches to the pancreas, the stomach, and along the greater curvature of the stomach as the left gastroepiploic artery, a.gastroepiploica sinistra, which anastomoses with a.gastroepiploica dextra (a branch of a.gastroduodenalis). Through this anastomosis, an arterial arch is formed along the greater curvature of the stomach, giving off branches to the anterior and posterior walls of the stomach and the greater omentum.

2. The superior mesenteric artery, a.mesenterica superior (Fig. 44), originates from the anterior surface of the abdominal aorta at the level of the 1st lumbar vertebra***. Initially, the artery passes between the inferior border of the pancreas and the horizontal part of the duodenum, and then, at the level of the 2nd lumbar vertebra, enters the mesentery of the Small Intestine, where it forms an arcuate bend directed to the left before reaching the iliac fossa. Along its course, it is related to four Veins: superiorly by the splenic vein, inferiorly by the left renal vein, to the left by the inferior mesenteric vein, and to the right by the superior mesenteric vein. The arch of the superior mesenteric artery gives off the following branches:

* According to the anatomical abbreviation DVA (ductus, vena, arteria).

** The following anatomical variants are observed: two splenic arteries, or occasionally, a short distance from its origin, the splenic artery divides into two branches (J. Hyrtl).

*** Information (anatomical variants) regarding the participation of the superior mesenteric artery in the Blood supply to the liver is of practical interest. According to K. Suslov, it gives off accessory branches to the liver in 12% of cases, whereas according to Rio Branco, variants were encountered in 14% of cases where the superior mesenteric artery was the sole source of blood supply to the liver, or a right hepatic artery arose from it while the left hepatic artery originated from the celiac trunk, or an accessory right hepatic artery arose while the main hepatic artery originated from a typical source (A. O. Voitenko, 1970).

Fig. 43 B. Anatomical variants of the celiac trunk (after F. Netter)

Fig. 43 C. Anatomical variants of the hepatic artery (after F. Netter)

1. The inferior pancreaticoduodenal artery, a.pancreaticoduodenalis inferior, originates from the concave side of the arch of the superior mesenteric artery posterior to the pancreas. The inferior pancreaticoduodenal artery anastomoses with the superior pancreaticoduodenal artery (a branch of a.gastroduodenalis) and supplies the pancreas and duodenum.

2. Jejunal and ileal arteries, aa. jejunales et ilei (18–24 branches), originate from the arch of the superior mesenteric artery and course toward the mesenteric border of the small intestine, where they divide dichotomously. These branches anastomose to form three rows of arcades around the jejunum and two around the ileum. The number of arcade rows can reach up to five (I. Ye. Kefeli). Branches arising from the final row encircle the small intestine, penetrate its wall, and supply it with blood.

3. Ileocolic artery, a. ileocolica (Fig. 44), originates from the concave side of the superior mesenteric artery arch, courses retroperitoneally to the right iliac fossa, where it supplies the cecum and gives off a branch to the Appendix—a. appendicularis, which serves as its primary blood supply*.

4. Right colic artery, a. colica dextra (Fig. 44), arises from the concave surface of the superior mesenteric artery arch, passes retroperitoneally, and reaches the ascending colon, where it divides into ascending and descending branches. The ascending branch anastomoses with the a. colica media, while the descending branch anastomoses with the a. ileocolica.

5. Middle colic artery, a. colica media (Fig. 44), originates from the arch of the superior mesenteric artery, runs forward and upward within the transverse mesocolon, and reaches the right colic flexure. It subsequently divides into a right descending and a left ascending branch. The right branch anastomoses with the a. colica dextra, and the left with the a. colica sinistra (a branch of the a. mesenterica inferior). The a. mesenterica superior supplies the pancreas; the duodenum, jejunum, ileum, cecum, ascending colon, and transverse colon; as well as the transverse mesocolon, the mesentery of the small intestine, and the mesenteric Lymph Nodes.

The inferior mesenteric artery, a. mesenterica inferior (Fig. 45), originates from the anterior wall of the abdominal aorta at the level of the third lumbar vertebra. The artery runs downward and to the left within the retroperitoneal space, reaching the left iliac fossa. It supplies the descending colon, sigmoid colon, and rectum. The inferior mesenteric artery gives rise to the following branches:

1. Left colic artery, a. colica sinistra (Fig. 45), runs retroperitoneally anterior to the left testicular (or ovarian) artery and the left Ureter. It then proceeds toward the descending colon, branching into ascending and descending segments. The ascending branch, r. ascendens, courses upward along the left half of the transverse colon, where it anastomoses with the middle colic artery; this anastomosis is known as Riolan's arch, or arcus Riolani.

2. Sigmoid arteries, aa. sigmoideae (Fig. 45)—most commonly two branches*—descend downward and to the left within the sigmoid mesocolon, anastomosing with branches of the a. colica sinistra and a. rectalis superior.

3. Superior rectal artery, a. rectalis superior (Fig. 45), is the terminal branch of the inferior mesenteric artery. It runs within the ROOT of the sigmoid mesocolon, crosses anterior to the left common iliac artery (a. iliaca communis sinistra), and reaches the rectum, where it divides into lateral branches. These branches anastomose with the aa. sigmoideae and the middle rectal artery, a. rectalis media (a branch of the internal iliac artery, a. iliaca interna).

Thus, the a. mesenterica inferior supplies the descending colon, the sigmoid colon, and the upper two-thirds of the rectum.

* The appendix is supplied by two arteries in 7.8% of cases or three in 2.3% (A. P. Didkivsky, 1970).