ARTERIAL SUPPLY OF ORGANS David Kachlík

Organs with complicated supply 5 supplying vessels: stomach 4 supplying vessels : vagina 3 supplying vessels : pancreas, duodenum, rectum, suprarenal gland… many small branches: oesophagus, trachea, ureter… lungs and liver (functional and nutritive circulation)

Brain

Pharynx a. carotis externa a. subclavia a. maxillaris  r. pharyngeus, a. canalis pterygoidei, a. palatina descendens a. pharyngea ascendens a. facialis  a. palatina ascendends. rr. tonsillares a. lingualis  rr. dorsales linguae a. subclavia a. thyroidea inferior

Tonsillae Tonsilla pharyngea Tonsilla palatina a. maxillaris  r. pharyngeus, a. canalis pterygoidei, a. palatina descendens a. facialis a. palatina ascendens a. pharyngea ascendens Tonsilla palatina r. tonsillaris a. facialis / sometimes from a. pharyngea ascendens additional branches from all surrounding arteries a. pharyngea asc.  r. tonsillaris a. lingualis  rr. dorsales linguae a. maxillaris  a. palatina major a. facialis  a. palatina ascendens

Oesophagus a. thyroidea inferior  pars cervicalis (arcus aortae) aorta thoracica  4-5 branches pars thoracica a. gastrica sinistra  pars abdominalis a. phrenica inferior sinistra  pars abdominalis

Stomach truncus coeliacus  aa. gastrica sin.  a. hepatica communis  a. hepatica propria  a. gastrica dx.  a. gastroduodenalis  a. gastroomentalis dx.  a. splenica  a. gastroomentalis sin., aa. gastricae breves (fundus), a. gastrica posterior (80 %)

Duodeum + pancreas truncus coeliacus  a. hepatica communis  a. gastroduodenalis  a. pancreaticoduodenalis sup. post. + sup. ant. + aa. retroduodenales a. mesenterica sup.  a. pancreaticoduodenalis inf.  ramus ant. + r. post. Body and tail of pancreas: truncus coelicacus  a. splenica  rr. pancreatici a. pancreatica magna, posterior et inferior, a. caudae pancreatis, a. prepancreratica

Small intestine a. mesenterica superior  aa. jejunales + ileales + aa. ileocolica  arcades (parallel artery of Dwight)  arteriolae rectae

Colon a. mesenterica sup.  a. ileocolica  a. ceacalis ant. + post., a. appendicularis  a. colica dx. (colon ascendens)  a. colica media (colon transversum) a. mesenterica inf.  a. colica sin. (colon descendens)  aa. sigmoideae (3-4) arteria marginalis Drummondi anastomosis magna Halleri = arcus Riolani

Rectum a. mesenterica sup.  a. rectalis sup. a. iliaca int.  a. rectalis media (tunica adventitia only) a. iliaca int.  a. pudenda int.  a. rectalis inf.

Liver and gallbladder truncus coeliacus  a. hepatica communis  a. hepatica propria  r. dx.+sin.  aa. interlobulares a. hepatica accessoria/aberrans Gallbladder truncus coelicacus  a. hepatica communis  a. hepatica propria  r. dx.  a. cystica

CONTENT: BORDERS: border of the liver ductus cysticus ductus hepaticus communis CONTENT: a. cystica ligation

Kidneys arteria renalis arteria renalis accessoria (30%) paired visceral branch of the abdominal aorta, at the level of the intervertebral disc L1/L2 the left artery is slightly higher arteria renalis accessoria (30%) branch of the abdominal aorta / a. iliaca communis / a. iliaca interna flow rate: 1,2-1,3 l blood/min the arteries are terminal = no arterio-arterial anastomosis  segments (r. ant + post)

Suprarenal gland from aorta abdominalis a. phrenica inferior → a. suprarenalis superior a. suprarenalis media – branch of the abdominal aorta a. renalis → a. suprarenalis inferior vena suprarenalis – only one vein on the left into v. renalis sinistra on the right directly into do v. cava inferior

Ureter a. renalis aorta abdominalis a. testicularis ♂ / ovarica ♀ a. ductus deferentis ♂ / uterina ♀ a. vesicalis inferior  rr. ureterici

Urinary bladder a. iliaca interna a. umbilicalis  aa. vesicales superiores a. vesicalis inferior (a. obturatoria, a. glutea inf., a. uterina, a. vaginalis)  rr. vesicales

Ovaries and uterine tubes aorta abdominalis → a. ovarica / r. tubarius a. iliaca int. → r. ovaricus / r. tubarius both rami ovarici anastomose to form the ovarian arcade

Uterus a. iliaca interna → a. uterina ventral to the ureter = „water under the bridge“ approaching the cervix laterally, then courses superiorly on the lateral aspect of the uterus sinusoid course bleeding in rupture

Vagina a. iliaca interna → a. vaginalis (sometimes missing) → a. uterina → r. vaginalis → a. rectalis media → r. vaginalis → a. pudenda interna → r. vaginalis

Testes + epididymis aorta abdominalis a. iliaca interna a. testicularis the branches enter the lobules in the periphery, not from the center ! a. iliaca interna a. umbilicalis  a. ductus deferentis a. iliaca externa a. epigastrica inferior  a . cremasterica mutual anastomoses

Prostate + vesiculous glands a. iliaca interna a. ductus deferentis a. vesicalis inferior a. rectalis media

Penis / clitoris a. pudenda interna  a. dorsalis penis / clitoridis a. profunda penis / clitoridis a. urethralis a. bulbi penis / vestibuli 3 last  aa. helicinae (+ Ebner‘s cushions)  vv. cavernosae

Nasal cavity arteria carotis interna a. ophthalmica  a. ethmoidalis ant. + post. arteria carotis externa a. maxillaris  a. sphenopalatina  rr. nasales posteriores lat. + rr. septales posteriores a. maxillaris  a. palatina descendens  a. palatina major  větev přes canalis incisivus a. facialis  a. labialis superior (vestibulum)

Thyroid gland and larynx a. carotis ext.  a. thyroidea sup.  a. laryngea sup. a. subclavia  a. thyroidea inf. (crossing n. laryngeus recurrens)  a. laryngea inf. r. cricothyroideus of both sides anastomose under the cricoid cartilage (! tracheotomia superior !) a. thyroidea ima (2 %) - !! tracheotomia superior !! from arcus aortae (70 %) truncus brachiocephalicus, a. carotis communis, a. thoracica interna, a. subclavia dextra, a. thyroidea inferior, truncus thyrocervicalis

Trachea a. thyroidea inferior  rr. tracheales aorta thoracica  rr. bronchiales (a. thyroidea ima – 2 %) neonates and children – branches from thymic arteries

Bronchi and lungs – nutritive circulation aorta thoracica rami bronchiales 1 on the right – most often from a. intercostalis tertia 2 on the left from the aorta thoracica  along the bronchi up to the respiratory bronchi (rami bronchiales accessorii in lig. pulmonale)

Lungs – functional circulation right atrium  truncus pulmonalis  arteriae pulmonales dx.+ sin.  the branching corresponds to the bronchi hypoarterial bronchus on the left, eparterial bronchus on the right elastic (low-pressure circulation, muscle only in fetus, in adults only in calibers < 1mm), deoxygenated blood !!!

Lungs – functional circulation capillaries  veins independent on the arteries in the septi between alveoles  4 venae pulmonales (2 dx., 2 sin.)  left atrium (oxygenated blood!!!) arteriovenous (+ a-a, v-v) anastomoses in hypoxic states in the adult, the muscular layer of the pulmonary arteries proliferates  pulmonary hypertension  right ventricular hypertrophy

Heart arteria coronaria dextra (ACD) sinus aortae (Valsalvae) dexter → r. coni arteriosi → Vieussens‘ circle r. nodi sinuatrialis (65%) rr. atriales r. marginalis dexter (RMD) r. interventricularis posterior (RIP) r. nodi atrioventricularis (80%) r. posterolateralis dexter (RPLD)

Heart arteria coronaria sinistra (ACS) sinus aortae (Valsalvae) sinister → short→ r. interventricularis ant. (RIA) r. coni arteriosi → Vieussens‘ ring r. diagonalis (RD) r. circumflexus (RC) rr. atriales r. marginalis sinister (RMS) r. intermedius (RIM) – 25%, from ACS bifurcation

Heart – coronary arteries

Spleen Thymus truncus coeliacus  a. splenica  rr. splenici  aa. trabeculares  aa. vaginatae (within PALS)  aa. centrales (within noduli lymphoidei)  aa. penicillares (Schweigger-Seidel‘s sheath)  sinus splenis (within red pulp) Thymus branches from a. thyroidea inferior, arcus aortae, thoracica interna ( a. pericardiacophranica)

Diaphragm arcus aortae → a. subclavia → a. thoracica interna a. pericardiacophrenica a. musculophrenica, (a. epigastrica superior) aorta thoracica aa. intecostales posteriores IX.-XI. aa. phrenicae superiores (rudimentary) aorta abdominalis aa. phrenicae inferiores aa. lumbales (3 on the left, 2 on the right)

Intercostal spaces arcus aortae → a. subclavia → a. thoracica interna aa. intercostales anteriores (I.-VI.) a. musculophrenica aa. intercostales anteriores (VII.-IX.) arcus aortae → a. subclavia → truncus costocervicalis → a. intercosalis suprema aa. intercostales posteriores (I.,II.) (arcus aortae → a. subclavia → a. axillaris → a. thoracica superior → I. a II. intercostal spaces) aorta thoracica aa. intercostales posteriores (III.-IX.)

Mammary gland arcus aortae → a. subclavia → a. thoracica interna aa. intercostales anteriores (I.-V./VI.) → rr. perforantes arcus aortae → a. subclavia → a. axillaris → a. thoracica superior → (r. pectoralis a. thoracoacromialis, a. thoracica lat., a. subscapularis) aorta thoracica aa. intercostales posteriores (II.-V.) → rr. perforantes /II. strongest/

Pituitary gland branches from arteria carotis interna a. hypophysialis superior (pars cerebralis a. carotis internae) primary capillary network in the infundibulum secondary portal network in the anterior lobe = hypothalamo-hypophyseal portal system a. hypophysialis inferior (pars cavernosa a. carotis internae) capillary network in the posterior lobe

Pituitary gland

Spinal cord longitudinal vessels transverse vessels (segmental) a. spinalis anterior unpaired, ventrally originate from short paired branches from a. vertebralis anterior 2/3 of spinal cord aa. sulcocommissurales → gray matter aa. spinales posteriores paired, dorsally (sometimes doubled) branch from a. basilaris → a. inf. post. cerebelli transverse vessels (segmental) rr. spinales → a. radicularis anterior et posterior → join the longitudinal arteries → vasocoronae (encircling the medulla spinalis) aa. periphericae → white matter

Origins of rr. spinales aa. radiculares a. vertebralis a. cervicalis ascendens a. cervicalis profunda aa. intercostales posteriores aa. lumbales a. iliolumbalis aa. sacrales laterales aa. radiculares irregular 5-9 a. radicularis magna Adamkiewiczi

 Tympanic cavity  arteria carotis externa a. maxillaris /pars mandibularis/ fissura petrotympanica Glaseri  a. tympanica anterior a. maxillaris /pars mandibularis/  a. meningea media  foramen spinosum  canalis nervi petrosi minoris  a. tympanica superior a. pharyngea ascendens  canaliculus tympanicus Jacobsoni  a. tympanica inferior a. auricularis posterior  a. stylomastoidea  canalis nervi facialis Falloppii  canaliculus chordae tympani (posterior)  a. tympanica posterior arteria carotis interna (pars petrosa)  canaliculi caroticotympanici  rr. caroticotympanici