Abdominal Aorta

Dr. H Rajshree Devi

Thoracic aorta

Abdominal
aorta
Abdominal Aorta
• begins at the aortic hiatus of the
diaphragm, anterior to the
lower border of vertebra T 12
• It descends through the
abdomen, anterior to the
vertebral bodies
• ends at the level of vertebra L 4
it is slightly to the left of
midline.
• The terminal branches are the
two common iliac arteries.
Diameter in cadavers
• Proximal
– 9-14 mm
• Distal
– 8-12 mm
• Diminishes in calibre as
it descends
• Slightly increases with
advancing age
Posterior relations
• Upper 4 lumbar
vertebrae
• Intervertibral disc
• Inferior vena cava
• 2 lumbar veins
• Anterior longitudinal
ligament
 Left 3rd & 4th lumbar
veins

Inf. Vena cava

 Anterior Relations
• Coeliac plexus
• Aortic plexus
• Body of pancreas
• Lt renal vein
• Uncinnate process of pancreas
• 3rd part of duodenum
• Parietal peritoneum
Uncinnate
process Abdominal
Aorta

Splenic vein

3rd part of
duodenum Left renal vein

Inferior vena
cava
 Lateral relations
Right side Left side
• Cysterna chyli • Lt crus of diaphragm
• Thoracic duct • Pancreas
• Azygos vein • 4th part of duodenum
• Right crus of diaphragm • Lt sympathetic chain
• Lumbar lymph nodes
Crura of Diaphragm
Sympathetic
chain
Inferior
vena cava
 Para-aortic
Cisterna lymph nodes
chyli
 Branches
• The abdominal aorta has anterior, lateral, and
posterior branches as it passes through the
abdominal cavity.
 Anterior branches
• The three anterior branches supply the
gastrointestinal viscera:
–the celiac trunk
– the superior mesenteric and
–the inferior mesenteric arteries.
– The Median sacral artery
• which represents the continuation primitive dorsal
aorta
 Lateral Branches
• Inferior phrenic
arteries
• Middle Suprarenal
artery
• Renal arteries
• Gonadal artery
 Inferior phrenic artery
• Arises just above coeliac
trunk
• Runs upwards and laterally
on corresponding crus of
diaphragm, medial to
suprarenal gland
• Rt passes behind IVC and
left behind the Oesophagus
• Each Inf phrenic has 2-3
suprarenal branches
• Supplies diaphragm
 Middle Suprarenal artery
• Arises at the level of Superior mesenteric
artery
• Runs over the crura of diaphragm
• Anastomoses with suprarenal branches of
Phrenic and renal arteries
• Right middle suprarenal passes behind the IVC
• Left middle suprarenal passes close to coeliac
ganglion, splenic artery and pancreas
 Renal artery
• One of the largest branches of abdominal aorta
• Arises just below the level of origin of SMA
• Right Renal artery is
– slightly longer
– Arises slightly higher than left
– It passes posterior to IVC, Rt Renal Vein, Head of Pancreas
and 2nd part of Duodenum
• Left Renal artery is
– slightly shorter and arises slightly lowerer than right
– It passes posterior to Lt Renal Vein, body of Pancreas and
splenic vein
 Gonadal arteries
• Two long slender
vessels
• Arises little inferior to
Renal arteries
• Passes inferolaterally
• Under the parietal
peritoneum on the
Psoas major
 Dorsal branches
• 4 pairs of Lumbar arteries
• Median sacral artery
 Lumbar arteries: 4 pairs
• Arises opposite bodies of
upper 4 lumbar vertibrae
• 5th represented by lumbar
branch of iliolumbar artery
• May occasionally arise from
median sacral artery
• Passes deep to IVC and
sympathetic chain
• Passes deep to Psoas and
quadratus lumborum
Median Sacral artery
• Continuation of primitive
dorsal aorta
• Arises posteriorly, little
above the bifurcation into
common iliac arteries
• Ends in front of coccyx
• Supplies the rectum
• Anastomoses with
iliolumbar and lateral sacral
arteries
 Common Iliac Arteries
• These are the terminal
branches of the abdominal
aorta
• Divides in front of L4
• 1.25 cm to the left of the
median plane
• Passes downwards laterally
• Ends in front of Sacroiliac
joint by dividing into
external and internal iliac
arteries
 Common iliac artery
Right common Iliac artery Left common Iliac artery
• Passes in front of • Shorter than right
commencement of IVC • Crossed at its middle by
• Rt common iliac vein is inferior mesenteric vessels
posterior to IVC above • Lt common iliac vein is
medialbelow medial to it
 External iliac artery
• Continues as femoral
artery behind the
inguinal ligament at the
mid inguinal point
• Chief artery of the
lower limb
 Internal iliac artery
• Smaller branch of Common iliac artery
• 3.7 cm long
• Supplies
– the pelvic organs except those supplied by
Superior rectal, ovarian, median sacral arteries
– Perineum
– Greater part of gluteal region
– Iliac fossa
 Internal iliac artery
• Begins in front of the sacroiliac joint
• At the level of the 5th lumbar and sacrum
• Medial to the psoas major muscle
• Runs downwards and backwards
• Ends near the upper margin of greater sciatic
notch by dividing into anterior and posterior
divisions
 Relation
• Anterior: ureter, ovary and lateral end of
uterine tube.
• Posterior: Internal iliac vein, lumbosacral trunk
and sacroiliac joint.
• Laterally: external iliac vein and obturator
nerve
• Medially: peritoneum, few tributaries of
internal iliac vein
 Internal Iliac artery Branches
1. Iliolumbar
2. Lateral sacral
3. Superior gluteal
4. Inferior gluteal
5. Internal pudendal
6. Obturator
7. Middle rectal
8. Inferior vesical
9. Superior vesical
 Branches of internal iliac artery
Anterior division Posterior division
• Superior vesical Iliolumbar
• Obturator Lateral sacral and
• Middle rectal Superior gluteal
• Inferior vesical
• Inferior gluteal
• Internal pudendal

• In female 7 branches
– Uterine artery
– Inf vesical is replaced by
Vaginal artery
Inferior vena cava
 INFERIOR VENA CAVA
• It conveys most of the blood from the body
below the diaphragm to the right atrium of
the heart
• It is formed by the union of common iliac
veins behind the right common iliac artery at
the level of fifth lumbar vertebra
• It ascends on the right side of the aorta
• Grooves the posterior surface of liver
• Pierces the central tendon of the diaphragm at
the level of the eighth thoracic vertebra
• Opens in Rt atrium
 Relations
Anterior
• Post surface of liver
• Epiploic foramen
• Ist part of duodenum and
portal vein
• Head of pancreas and bile
duct
• 3rd part of duodenum
Posterior
• Rt crus of diaphragm is
searated from IVC by Rt
Renal Artery, Rt Coeliac
ganglion, Rt Suprarenal
gland
• Rt sympathetic chain
• Rt Psoas
 Relations
• Right sympathetic trunk
lies behind its right
margin
• Right ureter lies close to
its right border
• The entrance into the
lesser sac separates the
inferior vena cava from
the portal vein
 Tributaries

• Two anterior visceral

tributaries: the hepatic
veins
• Three lateral visceral
tributaries: the right
suprarenal vein, renal veins,
right testicular or ovarian
vein
• Lateral abdominal wall
tributaries: inferior phrenic
vein and third and fourth
lumbar veins
• Three veins of origin: two
common iliac veins and the
median sacral vein
• 3rd and 4th Lumbar veins opens into
the posterior aspect of Inferior
vena cava
• Testicular or ovarian veins
• Renal veins joins the IVC just below
the transpyloric plane
• Lt renal vein crosses in front of
aorta and lies behind the pancreas
and splenic vein, it receives Lt
suprarenal and Gonadal veins
• Lt Testicular vein joins Lt Renal vein
at right angle thus it predisposes
formation of varicocoele of the Lt
pampiniform plexus.
• Hepatic veins open directly into
anterior surface of IVC just before it
pierces diaphragm
 Aortic aneurysm
• Localized or diffuse dilatations of the
abdominal part of the aorta
• Most result from atherosclerosis which causes
weakening of the arterial wall
• Occur most commonly in elderly men
• Large aneurysms should be surgically excised
and replaced with a prosthetic graft
Applied (IVC)
• Injuries to inferior vena cava are commonly lethal
• The anatomical inaccessibility of the vessel behind
the liver, duodenum and mesentery of the small
intestine and the blocking presence of the right
costal margin make a surgical approach difficult
• The thin wall of the vena cava makes it prone to
extensive tears
• It is commonly compressed by the enlarged uterus
during the later stages of pregnancy
• This produces edema of the ankles and feet and
temporary varicose veins
• Malignant retroperitoneal tumors can cause severe
compression and eventual blockage of IVC
 Atherosclerosis
• Severe ischemia of the lower limbs results
• Gradual occlusion of the bifurcation of the
abdominal aorta produced by atherosclerosis
causes pain in the legs on walking
• Impotence may occur due to lack of blood in
internal iliac arteries
• Surgical treatment by thromboendarterectomy
or a bypass graft should be considered