Anatomy - Aortobifemoral bypass for peripheral arterial disease Fontaine stage IIb–III

  1. Abdominal aorta

    Abdominal aorta
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    Origin

    • From the thoracic aorta after its passage through the aortic hiatus in the diaphragm at the level of T12

    Course

    • Retroperitoneal
    • Left to the median plane and anterior to the spine
    • Bifurcation into the common iliac arteries (bifurcatio aortae) at the level of the umbilicus / L4

    Branches from superior to inferior

    • Inferior phrenic artery, left and right
    • Celiac trunk
    • Middle suprarenal artery, left and right
    • Superior mesenteric artery
    • Renal artery, left and right
    • Ovarian / testicular artery, left and right
    • Lumbar arteries
    • Inferior mesenteric artery
    • Median sacral artery

    Distribution

    • Paired branches: Abdominal wall, paired retroperitoneal organs, gonads
    • Unpaired branches: Spleen, unpaired intestinal organs
  2. Paired branches of the abdominal aorta

    Main branches

    Course

    Branches/rami and distribution

    Inferior phrenic artery

    • Travels craniad along the underside of the diaphragm towards the diaphragmatic dome
    • Network-like division into several terminal branches

    Superior suprarenal artery: Suprarenal gland

    Terminal branches: Underside of the diaphragm

    Middle suprarenal artery

    • Travels laterad to the suprarenal glands

    Terminal branches: Suprarenal glands

    Renal artery

    • Arises at the level of L1–2
    • Right renal artery: Travels posterior to the vena cava and pancreatic head to the right kidney
    • Left renal artery: Travels posterior to the body of the pancreas to the left kidney

    Inferior suprarenal artery: Suprarenal gland

    Ovarian artery 

    Testicular artery

    • Arises from the anterior wall of the aorta inferior to the renal arteries / L2
    • Travels across the psoas muscle, ureter, and external iliac artery to the suspensory ligament of ovary / deep inguinal ring and testis

    Ovarian arteries: Ovaries, parts of the uterine tubes

    Testicular arteries: Testes, epididymides

    Lumbar arteries (4 bilat.)

    • Travels lateroposteriad to the psoas muscle across L1–4
    • Anastomose with the arteries of the anterior abdominal wall (superior and inferior epigastric arteries; liliolumbar artery; deep circumflex iliac artery)

    Spinal rami: Spinal canal

    Terminal branches: Abdominal wall, back muscles

Unpaired branches of the abdominal aorta

All unpaired branches of the abdominal aorta terminate in anastomoses maintaining organ perfusion v

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