Anatomy of the Vessels and Nerves of the Trunk (Angioneurology) - Chornokulskyi S. T. 2011

Vessels of the Systemic Circulation. Arteries of the Trunk
Abdominal Aorta

The abdominal part of the aorta (pars abdominalis aortae) or abdominal aorta (aorta abdominalis) (Fig. 23)

It is the direct continuation of the Thoracic Aorta at the level of Th_XII–L_IV, terminating in the bifurcation into the right and left common iliac Arteries as the terminal Branches of the Abdominal Aorta. The abdominal aorta lies anterior to THE Vertebral Column in the retroperitoneal space. To its right lies the INFERIOR VENA CAVA; anteriorly, the Pancreas, the horizontal part of the duodenum, and the ROOT of the mesentery of the Small Intestine; and posteriorly, the cisterna chyli of the Thoracic duct.

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Fig. 23. The aorta, its branches, and topography

A. 1 - right common carotid artery (a. carotis communis dextra);

2 - right Subclavian Artery (a. subclavia dextra);

3 - brachiocephalic trunk (truncus brachiocephalicus);

4 - internal thoracic artery (a. thoracica interna);

5 - supreme intercostal artery (a. intercostalis suprema);

6 - aortic arch (arcus aortae);

7 - ascending aorta (aorta ascendens);

8 - left main bronchus (bronchus principalis sinister);

9 - Esophagus (oesophagus);

10 - descending aorta (aorta descendens), its thoracic part (aorta thoracica);

11 - posterior intercostal artery (a. intercostalis posterior)

12 - Adrenal gland (glandula suprarenalis)

13 - Kidney (rеn)

B - relation of the pleural cavity along the upper border of the rib.

14 - rib (costa)

15 - Muscles of the chest wall

16 - Skin and subcutaneous tissue (cutis et tela subcutanea)

C - abdominal aorta and its branches (schematic diagram).

17 - superior mesenteric artery (a. mesenterica superior)

18 - right renal artery (a. renalis dextra)

19 - right testicular (ovarian) artery (a. testicularis (ovarica) dextra)

20 - right common iliac artery (a. iliaca communis dextra)

21 - external iliac artery (a. iliaca externa)

22 - internal iliac artery (a. iliaca interna)

23 - median sacral artery (a. sacralis mediana)

24 - inferior phrenic artery (a. phrenica inferior)

25 - celiac trunk (truncus coeliacus)

26 - left middle suprarenal artery (a. suprarenalis media sinistra)

27 - inferior mesenteric artery (a. mesenterica inferior)

The branches of the abdominal aorta are subdivided into parietal (wall-related) and visceral (organ-related) branches. The visceral branches include paired and unpaired branches.

The inferior phrenic artery (a. phrenica inferior) is a paired vessel that arises near the aortic hiatus, supplies the Diaphragm, and gives off superior suprarenal arteries (aa. suprarenales superiores) to the adrenal gland.

1. The lumbar arteries (aa. lumbales) occur in four pairs on either side and resemble the posterior intercostal arteries. Each lumbar artery gives off a dorsal branch (r. dorsalis) to the muscles and skin of the lumbar region, which in turn sends a spinal branch to supply the Spinal Cord and its Meninges.

Fig. 24. Topography of the celiac trunk, its branches, and the superior and inferior mesenteric arteries:

1 - abdominal part of aorta (pars abdominalis aortae);

2 - splenic artery (a. lienalis); 3 - pancreas (pancreas);

4 (18) - left (right) suprarenal gland (glandula suprarenalis sinistra (dextra));

5 - Spleen (lien (splen)); 6 (17) - left (right) kidney (ren sinister (dexter));

7 (8) - superior mesenteric artery (vein) (a. (v.) mesenterica superior);

9 - inferior mesenteric artery (a. mesenterica inferior);

10(11) - left testicular (ovarian) vein (artery) (v. (a.) testicularis (ovarica) sinistra);

12(14) - left (right) Ureter (ureter sinister (dexter));

13 - duodenum (duodenum);

15, (16) - right testicular (ovarian) artery (vein) (a. (v.) testicularis (ovarica) dextra))/

19 - Bile duct (ductus choledochus);

20 - HEPATIC PORTAL VEIN (v. portae hepatis);

21 - gastroduodenal artery (a. gastro-duodenalis);

22 - inferior vena cava (v. cava inferior);

23 - common hepatic artery (a. hepatica communis);

24 - celiac trunk (truncus coeliacus)

Fig. 25. Arteries of the Stomach, anterior view:

1 - abdominal part of the aorta (pars abdominalis aortae);

2 - celiac trunk (truncus coeliacus);

3 - left gastric artery (a. gastrica sinistra);

4 - splenic artery (a. lienalis);

5 - common hepatic artery (a. hepatica communis);

6 - short gastric arteries (aa. gastricae breves);

7 - left gastro-omental artery (a. gastroomentalis sinistra);

8 - right gastro-omental artery (a. gastroomentalis dextra);

9 - gastroduodenal artery (a. gastroduodenalis);

10 - right gastric artery (a. gastrica dextra);

11 - proper hepatic artery (a. hepatica propria)

3. The median sacral artery (a. sacralis mediana) branches off from just below the aortic bifurcation and courses down to the coccyx, terminating in the coccygeal body (glomus coccygeum). It gives rise to the lowest lumbar arteries (aa. lumbales имае) and lateral sacral branches (rr. sacrales laterales).

4. Visceral Branches of the abdominal aorta (Figs. 23–29)

A. Unpaired Visceral Branches.

These consist of three branches:

- celiac trunk (truncus coeliacus);

- superior mesenteric artery (a. mesenterica superior);

- inferior mesenteric artery (a. mesenterica inferior).

1. Celiac trunk (truncus coeliacus)

about 2 cm long, a thick artery branching into three parts ("Haller's tripod", tripus Halleri):

— left gastric artery (a. gastrica sinistra);

— splenic artery [a. splenica (lienalis)];

— common hepatic artery (a. hepatica communis).

The left gastric artery (a. gastrica sinistra) runs along the lesser curvature of The Stomach, supplying branches to both the stomach and the abdominal part of the esophagus (rr. oesophageales).

Splenic artery [a. splenica (lienalis)] (Fig. 24, 25).

This is the thickest branch of the coeliac trunk (tr. coeliacus), which runs along the upper border of the pancreas toward the splenic hilum and penetrates its parenchyma via several branches (5–8).

Before reaching the spleen, it gives off the following branches:

— pancreatic branches (rr. pancreatici), 4–5 small vessels;

— left gastro-omental artery (a. gastroomentalis sinistra), which runs along the greater curvature of the stomach from left to right and anastomoses with the right gastro-omental artery;

— short gastric arteries (aa. gastricae breves).

Common hepatic artery (a. hepatica communis) (Fig. 24–26)

at the level of the superior part of the duodenum (pars superior duodeni) gives off the gastroduodenal artery, after which, as the proper hepatic artery (a. hepatica propria), it ascends between the layers of the hepatoduodenal ligament (lig. hepatoduodenale) (as part of the portal triad) to the porta hepatis. Here it divides into right (r. dexter) and left (r. sinister) branches supplying the respective lobes of the organ. The proper hepatic artery gives off the right gastric artery (a. gastrica dextra), which anastomoses with the left gastric artery along the lesser curvature of the stomach, completing the arterial circle around it (Fig. 25). The right branch of the proper hepatic artery gives off the cystic artery (a. cystica).

The gastroduodenal artery (a. gastroduodenalis) passes behind the duodenum and divides into:

✵the right gastro-omental artery (a. gastroomentalis dextra), which anastomoses with the corresponding left artery, and

✵the superior pancreaticoduodenal artery (a. pancreaticoduodenalis superior), whose numerous branches (rr. pancreatici, rr. duodenales) supply the pancreas and duodenum.

2. Superior mesenteric artery (a. mesenterica superior) (Fig. 27, 28)

originates 1 cm below the celiac trunk behind the body of the pancreas, runs inferiorly, and reaches the right iliac fossa between the leaves of the mesentery of the small intestine.

Branches:

— Inferior pancreaticoduodenal artery (a. pancreaticoduodenalis inferior), whose branches anastomose with the superior artery of the same name, thus completing the Blood supply to the pancreas and duodenum;

— Jejunal arteries (aa. jejunales);

— Ileal arteries (aa. ileales), numbering 12–18 in total, branch out within the mesentery and loops of the mesenteric part of the small intestine. Here they form

arterial arcades—three-tiered in the jejunum and two-tiered in the ileum—serving as adaptive structures for the uninterrupted blood supply to the intestine during its peristalsis;

— Ileocolic artery (a. ileocolica), which supplies the distal segment of the ileum and the cecum, giving off the appendicular artery (a. appendicularis) (Fig. 27);

— Right colic artery (a. colica dextra), which runs retroperitoneally toward the ascending colon (colon ascendens), forming arterial arches and anastomoses in front of it [with the artery of the right flexure (a. flexurae dextrae) via the right branch of the middle colic artery (a. colica media)].

— The middle colic artery (a. colica media) divides between the layers of the transverse mesocolon into right and left branches. The left branch anastomoses with the ascending artery (a. ascendens) from the inferior mesenteric artery system, forming a clinically significant intersystemic anastomosis known as the arc of Riolan (arcus Riolani).

Fig. 26 COMPOSITION OF THE "portal triad" (and associated structures), from right to left (3-4-5) (within the hepatoduodenal ligament):

1 - common hepatic duct

(ductus hepaticus communis);

2 - cystic duct (ductus cysticus);

3 - common bile duct

(ductus choledochus);

4 - hepatic portal vein (v. portae hepatis).

5 - proper hepatic artery

(a. hepatica propria);

6 - celiac trunk (truncus coeliacus).

Inferior mesenteric artery (a. mesenterica inferior) (Fig. 29)

arises from the abdominal aorta at the level of the IIIrd lumbar vertebra, runs retroperitoneally, and gives off the following branches:

— Ascending artery (a. ascendens) — see above;

— Left colic artery (a. colica sinistra) supplying the descending colon;

— Sigmoid arteries (aa. sigmoideae), which are 2–3 branches running between the layers of the sigmoid mesocolon to supply this organ;

— Superior rectal artery (a. rectalis superior), representing the direct continuation of the inferior mesenteric artery. It supplies the upper third of the rectum and anastomoses with the middle rectal artery (from the internal iliac artery) and the sigmoid arteries.

B. Paired visceral branches (Figs. 23, 29, a)

1. Middle suprarenal artery (a. suprarenalis media) branches off below the superior rectal artery, penetrates the parenchyma of the adrenal gland, and anastomoses with the superior and inferior suprarenal arteries of the same name.

2. Renal artery (a. renalis) (Figs. 23, 29, a) originates at the level of the 1st lumbar vertebra as a thick vessel. The right renal artery lies posterior to the inferior vena cava, while the left lies posterior to the pancreas. The pre-organ branching of these arteries may follow either a main or a distributed (scattered) pattern.

Each renal artery also supplies the renal capsule, ureter, and adrenal gland via a branch known as the inferior suprarenal artery (a. suprarenalis inferior).

3. Testicular artery (a. testicularis), or ovarian artery (a. ovarica) in females, originates at the level of the IInd lumbar vertebra as slender, long vessels that reach the Gonads. The testicular artery passes through the Inguinal Canal as a component of the Spermatic Cord structures, whereas the ovarian artery runs within the suspensory ligament of the Ovary.

Pelvic arteries (Figs. 30, 31)

* Common iliac artery (a. iliac communis) on each side extends to the level of the sacroiliac joint, where it divides into the external and internal iliac arteries (aa. iliacae externa et interna).

The external iliac artery (a. iliaca externa) runs along the medial border of the psoas major Muscle and continues into the femoral artery (a. femoralis) at the level of the inguinal ligament. After giving off small branches to the psoas major muscle, the external iliac artery branches into:

I. The inferior epigastric artery (a. epigastrica inferior), which lies within the lateral umbilical fold and anastomoses with the superior epigastric artery. Near the inguinal ligament, it gives off:

— the pubic branch (r. pubicus), and

— the cremasteric artery (a. cremasterica), or in females, the artery of the round ligament of the Uterus (a. ligamenti teretis uteri).

* Also discussed in the section "Arteries of the Lower Limb".

Fig. 27. Arteries of the small and large intestines:

1 - abdominal part of the aorta (pars abdominalis aortae);

2 - celiac trunk (truncus coeliacus);

3 - superior mesenteric artery (a. mesenterica superior);

4 - inferior mesenteric artery (a. mesenterica inferior);

5 - jejunal arteries (aa. jejunales);

6 - left colic artery (a. colica sinistra);

7 - sigmoid arteries (aa. sigmoideae);

8 - superior rectal artery (a. rectalis superior);

9 - ileal arteries (aa. ileales);

10 - ileocolic artery (a. ileocolica);

11 - right colic artery (a. colica dextra);

12 - middle colic artery (a. colica media);

13 - appendicular artery and vein (a. et v. appendiculares);

14 - mesoappendix (mesoappendix)

Fig. 28. Superior mesenteric artery.

A. Superior mesenteric artery and vein (Peritoneum of the region removed);

A, B. Superior mesenteric artery (schematic):

1 - middle colic artery (a. colica media);

2 - transverse mesocolon (mesocolon transversum);

3 - right colic artery (a. colica dextra);

4 - ileocolic artery (a. ileocolica);

5 - appendicular artery (a. appendicularis);

6 - superior mesenteric artery (a. mesenterica superior);

7 - supraduodenal artery (a. supraduodenalis);

8 - inferior pancreaticoduodenal artery (a. pancreaticoduodenalis inferior);

9 - jejunal and ileal arteries (aa. jejunales et ileales)

The pubic branch (r. pubicus) supplies the pyramidal muscle, the lower part of the rectus abdominis muscle, and the Pubic Symphysis. Through its obturator branch (r. obturatorius), it anastomoses with the pubic branch of the obturator artery (from the internal iliac artery), forming an intersystemic anastomosis known by the ominous name "corona mortis" (the "crown of death").

The cremasteric artery (a. cremasterica) enters the structures of the spermatic cord, supplying its coverings and the coverings of the Testis (specifically the cremaster muscle).

Fig. 29. Inferior mesenteric artery.

A. Topography and vascularization area (peritoneum removed);

B. Branches (schematic).

1 - duodenojejunal flexure (flexura duodenojejunalis);

2 - inferior mesenteric vein (v. mesenterica inferior);

3 - inferior mesenteric artery (a. mesenterica inferior);

4 - left colic artery (a. colica sinistra);

4a - middle colic artery (a. colica media);

4b - intersystemic anastomosis: superior mesenteric artery – inferior mesenteric artery, Riolan's arch (arcus arteriosus Riolani);

5 - sigmoid arteries (aa. sigmoideae);

6 - superior rectal artery (a. rectalis superior);

Intersystemic anastomosis with the middle rectal arteries

Fig. 29a. Arteries of the right kidney, anterior view:

1 - abdominal part of aorta (pars abdominalis aortae);

2 - middle suprarenal artery (a. suprarenalis media);

3 - inferior suprarenal artery (a. suprarenalis inferior);

4 - renal artery (branching within the renal sinus) (a. renalis);

5 - testicular (ovarian) artery (a. testicularis (ovarica));

6 - interlobar artery (a. interlobaris);

7 - arcuate artery (a. arcuata);

8 - interlobular artery (interlobularis)

The artery of the round ligament of the uterus (a. ligamenti teretis uteri) supplies blood to the uterine wall, its round ligament, and the Labia Majora.

2. The deep circumflex iliac artery (a. circumflexa ilium profunda) runs parallel to the inguinal ligament and the iliac crest, supplying the iliacus muscle (m. iliacus) and the transverse abdominis muscle (m. transversus abdominis).

Fig. 30. Arteries of the pelvis.

1 - muscular lacuna (lacuna musculorum); 2 - inguinal ligament (lig. inguinale); 3 - vascular lacuna (lacuna vasorum); 4 - suprapiriform foramen (for. suprapirifarmis); 5 - piriformis muscle (m. piriformis); 6 - Sacral Plexus (plexus sacralis); 7 - infrapiriform foramen (for. infrapiriformis); 8 - sacrospinous ligament (lig. sacrospinale); 9 - lesser sciatic foramen (for. ischiadicum minus); 10 - sacrotuberous ligament (lig. sacrotuberale); 11 - pudendal nerve (n. ischiadicus); 12 - sciatic nerve (n. ischiadicus); 13 - aorta (aorta); 14 - common iliac artery (a. iliaca communis); 15 - external iliac artery (a. iliaca externa); 16 - internal iliac artery (a. iliaca interna); 17, 19 - anterior branch (r. anterior); 18 - posterior branch (r. posterior); 20 - obturator artery (a. obturatoria); 21 - umbilical artery (a. umbilicalis); 22 - uterine artery (a. uterina); 23 - middle rectal artery (a. rectalis media); 24 - internal pudendal artery (a. pudenda interna); 25 - inferior gluteal artery (a. glutea inferior); 26 - superior gluteal artery (a. glutea superior); 27 - median sacral artery (a. sacralis mediana); 28 - iliolumbar artery (a. iliolumbalis); 29 - lateral sacral arteries (aa. sacrales laterales)

Fig. 30a. Blood supply to the FEMALE REPRODUCTIVE Organs

(diagram, anterior view):

1 - ovarian artery (a. ovarica);

2 - uterine artery (a. uterina);

3 - internal pudendal artery (a. pudenda interna);

4 - external pudendal artery (a. pudenda externa);

5 - internal iliac artery (a. iliaca interna);

6 - ureter (ureter)

Fig. 30b. Intraorgan: A - uterine arteries; B - arteries (1) and Veins (2) of the uterus on a transverse section

Internal iliac artery (a. iliaca interna) (Fig. 30)

at the level of the upper margin of the greater sciatic foramen divides into two trunks — anterior and posterior, which give rise to the visceral and parietal branches, respectively.

The posterior trunk continues as the superior gluteal artery (a. glutea superior), which exits the lesser pelvis cavity through the suprapiriformis foramen.

I. Parietal branches of the a. iliaca interna:

1. Iliolumbar artery (a. iliolumbalis): its lumbar branch (r. lumbalis) supplies the psoas major and quadratus lumborum muscles, while its iliac branch (r. iliacus) supplies the iliac bone and muscle. The spinal branch (r. spinalis) enters the vertebral canal and supplies the spinal meninges. The a. iliolumbalis anastomoses with the deep circumflex iliac artery (a. circumflexa ilium profunda).

2. Lateral sacral arteries (aa. sacrales laterales) supply the sacrum, levator ani and piriformis muscles, and the trunks of the sacral plexus.

3. Superior gluteal artery (a. glutea superior) via its superficial (r. superficialis) and deep branches (r. profundus) supplies the gluteal muscles and the hip joint.

4. Inferior gluteal artery (a. gluteal inferior) passes through the infrapiriformis foramen accompanied by the sciatic nerve and internal pudendal artery. It gives off the companion artery of the sciatic nerve (a. comitans n. schiadici) and supplies the gluteus maximus muscle.

5. Obturator artery (a. obturator), after branching off the pubic branch (r. pubicus), passes through the obturator canal and supplies the m. obturatorius externus and adductors. Through its acetabular branch (r. acetabularis), it penetrates the substance of the ligament of the HEAD of the Femur, supplying it and the femoral head.

As noted above, the pubic branch forms a clinically significant anastomosis with the obturator branch (from the inferior epigastric artery, a. epigastrica inferior) — the "corona mortis" — which is located medial to the femoral ring. Hemostasis in case of injury to this anastomosis is difficult (femoral herniotomy).

II. Visceral branches of the a. iliaca interna:

1. Umbilical artery (a. umbilicalis) in adults Functions only up to the Water/144.html">Origin of the superior vesical arteries (aa. vesicales superiores). This is the patent part (pars patens). The obliterated (closed) part (pars occlusa) of the umbilical artery is located within the medial umbilical fold of the peritoneum. Its ureteric branches (rr. ureterici) and the artery of the Ductus deferens (a. ductus deferentis) supply the respective organs.

2. Inferior vesical artery (a. vesicalis inferior) supplies the lower part of the Urinary Bladder, Prostate Gland, and Seminal Vesicles, anastomosing with the superior vesical artery.

Uterine artery (a. uterina) (Figs. 30, 30a, 30b) runs medially, crosses the ureter, and reaches the cervix of the uterus. Here it gives off the vaginal artery (a. vaginalis) and ascends between the layers of the broad ligament lateral to the uterus. Through its terminal branches — ovarian (r. ovaricus) and tubal (r. tubarius) — it anastomoses with the ovarian artery. Intrauterine arteries have a spiral and corkscrew-like shape — coiled branches (helicini). The crossing of the artery and the ureter requires special attention during surgeries.

4. Unpaired vaginal artery (a. azygos vaginae) consists of 2 vaginal arteries (anterior, posterior) that run anteriorly and posteriorly along the midline of the vaginal wall as direct branches of the uterine artery.

5. Middle rectal artery (a. rectalis media) supplies the rectum, prostate gland, seminal vesicles, and Vagina.

6. Internal pudendal artery (a. pudenda interna) exits the pelvic cavity through the infrapiriformis foramen, hooks around the ischial spine, and enters the ischioanal fossa via the lesser sciatic foramen. Here, as part of the neurovascular bundle, it runs forward within Alcock's canal and continues as the dorsal artery of the Penis/Clitoris.

Branches of the a. pudenda interna:

— Inferior rectal artery (a. rectalis inferior) supplies the anal canal and the fat pad of the ischioanal fossa (paraproctium);

— perineal artery (a. perinealis) supplies the urogenital diaphragm;

— posterior scrotal/labial branches (rr. scrotales/labiales posteriores);

— urethral artery (a. urethralis);

— artery of the bulb of the penis/Vestibule of the vagina (a. bulbi penis/vestibuli vaginae);

— deep artery of the penis/clitoris (a. profunda penis/clitoridis). Flanking the unpaired dorsal vein of the penis/clitoris is the paired dorsal artery of the penis/clitoris (a. dorsalis penis/clitoridis). The deep and dorsal arteries anastomose with each other via perforating branches of the penis/clitoris (aa. perforantes penis/clitoridis).

Fig. 31. Arteries of the rectum (4, 5, 7 — right side):

1 — inferior mesenteric artery (a. mesenterica inferior);

2 — internal iliac artery (a. iliaca interna);

3 — internal pudendal artery (a. pudenda interna);

4 — superior rectal artery (a. rectalis superior);

5 — middle rectal artery (a. rectalis media);

6 — perineal line;

7 — inferior rectal artery (a. rectalis inferior)

Fig. 31a. Histotopographic cross-section of Blood and Lymphatic vessels in an intestinal villus and the wall of the small intestine.