1. AORTA AND PERIPHERAL ARTERIES ANATOMY & VISUALIZATION
Presented By; Dr Rakesh Jain

2. The Aorta
After originating from LV (about 3 cm in diameter ), it ascending for a short distance, arches backward and to the left side, descends within the thorax on the left side of the vertebral column
Portions of aorta
Ascending aorta
Arch of the aorta and
Descending aorta (thoracic and abdominal aorta)

4. Ascending Aorta (Aorta Ascendens)
About 5 cm. in length
Passes obliquely upward, forward, and to the right, as high as the upper border of the second right costal cartilage
At its origin, three small dilatations called the aortic sinuses
At the union of the ascending aorta with the aortic arch, the caliber of the vessel is increased, owing to a bulging of its right wall. This dilatation is termed the bulb of the aorta
Only branches of the ascending aorta are the two coronary arteries

5. Arch of the Aorta
Begins at the level of the upper border of the Rt 2nd sternocostal joint
First runs upward, backward, and to the left, infront of the trachea, then directed backward on the left side of the trachea and finally passes downward on the left side of the body of T4, at lower border of which it becomes continuous with the descending aorta
Forms two curvatures: one with its convexity upward, the other with its convexity forward and to the left

6. Branches of arch of aorta
Three in number-
Innominate artery
Left common carotid artery
Left subclavian artery

8. LEFT ANTERIOR OBLIQUE VIEW
CCA= common carotid artery
VA= vertebral artery
SCA= subclavian artery

9. Variations of the supraaortic vessel origins
Vertibral
Lt CC
Rt CC
Lt CC
Lt Subclavian
Rt Subclavian
Vertibral
Inominate A Lt
Subclavian
Rt CC
Rt Subclavian

10. Descending Aorta Thoracic Aorta
Contained in the posterior mediastinal cavity
Begins at the lower border of the T4
Ends in front of the lower border of the T12 vertebra, at the aortic hiatus in the diaphragm

11. Branches of the Thoracic Aorta
Visceral
Pericardial
Bronchial
Esophageal
Mediastinal
Parietal 
Intercostal.- usually 9 pairs
Subcostal.
Superior Phrenic.

12. LEFT ANTERIOR OBLIQUE VIEW
LCC
RCC
Lt Subclavian
Rt Subclavian
Brachiocephalic A

13. Abdominal aorta Begins at aortic hiatus of diaphragm In front of lower
border of T12
Descending in front
of the vertebral column
Ends on L4-body,
a little to Left of midline
Summit of the convexity
corresponding to the L3

14. Branches of the abdominal aorta
Visceral Branches
Celiac.
Superior Mesenteric.
Inferior Mesenteric.
Middle Suprarenals.
Renals.
Internal Spermatics.
Ovarian (in the female)
Parietal Branches
Inferior Phrenics.
Lumbars.
Middle Sacral.
Terminal Branches
Common Iliacs.

15. a c b AP VIEW 2 6 1 3 4 5 1.Abdo Aorta 2.Coeliac trunk Lt gastric A
Splenic A
Hepatic A
3. S M A
4. I M A
5. Lt Renal A
6. Rt Renal A a b
AP VIEW c 2 5 6 1 3 4

16. Superior mesenteric artery
LATERAL VIEW
Catheter
Celiac trunk
Superior mesenteric artery
Abdominal aorta

17. Coeliac Artery Short thick trunk ≈1.25 cm length
Arises from the front of the aorta, just below the aortic hiatus of the diaphragm
Between T12 & L1
Passing nearly horizontally forward
3 large branches
Left gastric A - smallest
Hepatic A
Splenic A - largest
The Left Gastric 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. Here 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. 17

18. The Hepatic Artery (a. hepatica) 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 Winslow). 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 hepatic ducts. The hepatic artery, in its course along the right border of the lesser omentum, is in relation with the common bile-duct and portal vein, the duct lying to the right of the artery, and the vein behind.    9   Its branches are:    10 Right Gastric. Gastroduodenal     ( Right Gastroepiploic. Superior Pancreaticoduodenal). Cystic.
The Lienal or Splenic Artery (a. lienalis), the largest branch of the celiac artery, is remarkable for the tortuosity of its course. It passes 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 kidney, 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:    16 Pancreatic. Short Gastric. Left Gastroepiploic
The pancreatic branches (rami pancreatici) are numerous small vessels derived from the lienal as it runs behind the upper border of the pancreas, supplying its body and tail. One 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 pancreatica magna. These vessels anastomose with the pancreatic branches of the pancreaticoduodenal and superior mesenteric arteries
The short gastric arteries (aa. gastricæ breves; vasa brevia) consist of from five to seven small branches, which arise from the end of the 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.    18   The left gastroepiploic artery (a. gastroepiploica 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 right gastroepiploic. 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. 18

20. 2 3 1 4 4 ANTERIO-POSTERIOR VIEW 1.Coeliac A 2.Lt gastric A
3.Hepatic A
4.Splenic A
5.Gastroduodenal A
ANTERIO-POSTERIOR VIEW 2 3 1 4 4

21. Superior Mesenteric Artery
Large vessel
Arises from front of aorta, at L1, ~1.25 cm below Coeliac A
Passes downward and forward, to the right iliac fossa
Supply small intestine (expt superior Duo),
Cecum, Asc Colon & Rt ½ Transverse Colon

22. SMA-Branches Inferior Pancreatico-duodenal Middle Colic Right Colic
Ileocolic
Intestinal

24. 3 1 2 4 5 6 7 2.S M A 3.Middle colic A 4.Rt colic A 5.Ileocolic A
1.Abd Aorta
2.S M A
3.Middle colic A
4.Rt colic A
5.Ileocolic A
6. Intestinal A
7.Appendicular 1 2 3 4 5 6 7

25. Inferior Mesenteric Artery
Smaller than SMA
Arises from aorta at L3, about 3 or 4 cm above its division
Passes downward, posterior to the peritoneum
Continued into pelvis as Superior hemorrhoidal artery & ends on the upper rectum
Supply Lt ½ transverse colon, descending & sigmoid colon, and most of the rectum

26. Inferior Mesenteric Artery branches
Left Colic A
Sigmoid branches
Superior Hemorrhoidal A

28. 5.Superior hemorrhoidal A
1.Inf mesentric A
2.Lt colic A
3.Marginal A
4.Sigmoid A
5.Superior hemorrhoidal A 3 1 2 4 5

29. Superior Hemorrhoidal Artery
Form a series of loops around lower rectum
Communicate with
Middle hemorrhoidal branches of Internal Iliac A
and
Inferior hemorrhoidal branches of Internal pudendal A (branch of Internal Iliac A)

30. Renal arteries Two large arteries
Arises from side of aorta, immediately below SMA
Nearly a right angle with the aorta
Right is longer than left
Before reaching hilus of the kidney, each artery divides into four or five branches
Left is somewhat higher than the right

31. AP VIEW
Lt Renal arteries
Rt Renal arteries

32. Common Iliac Arteries Abdominal Aorta divides, on Lt side of L4
Each about 5 cm length
Rt Common Iliac A -somewhat longer than the Lt
Each divide, opposite the intervertebral fibrocartilage between L5 & S1
2 branches→
External Iliac A
&
Internal Iliac A (Hypogastric A )

33. 1.Abd Aorta 2.Common iliac A 3.External iliac A 4.Internal iliac A
AP VIEW 1 2 3 4

34. The External Iliac Artery
Larger than Internal Iliac A
Passes obliquely downward and lateralward along the medial border of the Psoas major
Beneath the inguinal ligament, midway between anterior superior iliac spine and symphysis pubis entering the thigh & becomes Femoral A

35. EIA-Branches 2 branches Continues as femoral A Inferior epigastric
Deep iliac circumflex
Continues as femoral A

36. The Internal Iliac A (Hypogastric A )
Short, thick vessel, smaller than EIA
Arises at the bifurcation of the common iliac, opposite the lumbosacral articulation
Abt 4 cm length, on medial side of the thigh
The lengths of the CIA & IIA bear an inverse proportion to each other→ IIA being long when CIA is short, and vice versa.
Divides into 2 large trunks at upper margin of the greater sciatic foramen → anterior & posterior

37. Branches of Internal Iliac A
Anterior Trunk
Superior Vesical
Middle Vesical
Inferior Vesical
Vaginal (in females)
Middle Hemorrhoidal
Obturator
Inferior Gluteal
Internal Pudendal
Inf Hemorrhoidal A
Uterine
Posterior Trunk
Iliolumbar
Lateral Sacral
Superior Gluteal

38. Femoral Artery
Begins behind inguinal ligament, midway between ASIS & symphysis pubis,
Ends at junction of upper ⅔ & lower ⅓ of thigh, to become Popliteal A
First 4 cm -enclosed, together with Femoral V, in a fibrous sheath—the Femoral Sheath
In the upper ⅓ of thigh Femoral A is contained in the Femoral Triangle (Scarpa’s triangle)
In the middle ⅓ of thigh, in the Adductor Canal (Hunter’s canal)

40. Profunda Femoris A
Large vessel arising from lateral & back part of Femoral A, 2-5 cm below inguinal ligament
Ends at the lower ⅓ of thigh
PFA provides an important source of collateral flow to the leg and foot in patients with significant SFA stenoses or occlusion
Branches.—
Lateral Femoral Circumflex,
Medial Femoral Circumflex,
Perforating branches (4 no.s)

42. AP VIEW
Catheter
Common femoral
artery
Superficial femoral
artery

43. 1.Profnda F A
2.Femoral artery
AP VIEW 1 2

44. Popliteal Artery Continuation of Femoral A
Extends from the opening in the Adductor magnus, at the junction of middle ⅔ & lower ⅓ of thigh
Courses downward and lateralward to the intercondyloid Popliteal fossa of the femur, then vertically downward to the lower border of the Popliteus
Divides into Anterior tibial A and tibioperoneal trunk.
Tibioperoneal trunk is the direct continuation of the popliteal artey, arises distal to the anterior tibial artery, bifurcates just beyond its origin into the posterior tibial and peroneal arteries

46. Anterior tibial artery
Superficial femoral
artery
Popliteal artery
Popliteal artery
Anterior tibial artery
Anterior tibial artery
Posterior tibial artery
Posterior tibial artery
Peroneal artery
Peroneal artery
Tibioperoneal trunk

47. Posterior Tibial A
Begins at lower border of Popliteus, opposite the interval betw tibia & fibula
Descends, approaching tibial side of leg
In the lower part, situated midway betw med malleolus & med process of calcaneal tuberosity
Divides into Medial & Lateral plantar A

49. Anterior Tibial A
Begins at bifurcation of Popliteal A, at the lower border of Popliteus
Passes forward through aperture above upper border of interosseous memb
Descends on anterior surface of interosseous memb, gradually approaching the tibia
On the front of ankle-joint (more superficial), becomes Dorsalis Pedis Artery.  

52. AP VIEW
Tibioperoneal Trunk
Anterior Tibial
Peroneal
Posterior Tibial

53. Ankle and Foot Vascular Anatomy
Lateral view
To resolve ischemic rest pain or heal an ulcer, one continuously patent infrapopliteal vessel to the foot is necessary
Peroneal
Anterior Tibial
Posterior Tibial
Medial & lateral
Plantar A
Dorsalis Pedis 53

54. Foot arteries front view
A. tibialis anterior
A. dorsalis pedis

55. Foot arteries down view
Arcus plantaris profundus
A. plantaris medialis
A. plantaris lateralis
A. tibialis posterior

56. Innominate Artery Largest branch of arch of the aorta
4 to 5 cm. in length
Arises, on a level with the upper border of the second right costal cartilage
Ascends obliquely upward, backward, and to the right to the level of the upper border of the right sternoclavicular articulation, where it divides into the right common carotid and right subclavian arteries.

57. Common Carotid Artery 2 in number (Rt & Lt)
Differ in length and mode of origin
The right begins at bifurcation of innominate A, behind sternoclavicular joint and is confined to the neck.
The left springs from the highest part of arch of the aorta to the left of, on a plane posterior to the innominate artery
Each vessel passes obliquely upward
Divides into the ECA & ICA, at the level of upper border of the thyroid cartilage

59. The Subclavian Artery
Right side: arises from the innominate artery behind right sternoclavicular articulation
Left side: arises directly from the arch of the aorta
Extends to the outer border of the first rib, where it becomes the axillary artery

60. branches of the subclavian artery
Vertebral.
Internal mammary
Thyrocervical
Costocervical

61. LEFT ANTERIOR OBLIQUE VIEW
LCC
RCC
Lt Subclavian
Rt Subclavian
Brachiocephalic A
Rt Axillary A

62. Axillary Artery Commences at the outer border of the first rib
Ends at lower border of the tendon of the Teres major, where it takes the name of brachial
At its origin the artery is very deeply situated, but near its termination is superficial

63. ANTERIO-POSTERIOR VIEW

64. Brachial Artery
Commences at the lower margin of the tendon of the Teres major
Passing down the arm
Ends about 1 cm. below the bend of the elbow, where it divides into the radial and ulnar arteries
Course; At first the brachial artery lies medial to the humerus; as it runs down the arm it gradually gets in front of the bone, and at the bend of the elbow it lies midway between its two epicondyles

66. Radial Artery Continuation of the brachial
Smaller in caliber than ulnar.
Commences at bifurcation of the brachial, just below the bend of the elbow
Passes along the radial side of the forearm to the wrist
Then winds backward, around the lateral side of the carpus, forward toward thumb and index finger into the palm of the hand and unite with the deep volar branch of the ulnar artery to form the deep volar arch

67. Ulnar Artery Larger than radial A.
Begins a little below the bend of the elbow
Passing obliquely downward, reaches ulnar side of the forearm, midway between the elbow and the wrist. It then runs along the ulnar border to the wrist
Immediately beyond pisiform bone, it divides into two branches, which enter into the formation of the superficial and deep volar arches

69. ANTERIO-POSTERIOR VIEW

70. POSTERIO-ANTERIOR VIEW

71. Thanks