Anatomy - Endovascular bifurcation prosthesis for infrarenal AAA with simultaneous aneurysm of the right common iliac artery (EVAR with iliac sidebranch)

• extends cranially on the underside of the diaphragm towards the diaphragmatic domes
• network-like division into several terminal branches

Superior suprarenal artery: Adrenal gland

Terminal branches: Underside of the diaphragm

• extends laterally to the adrenal glands

Terminal branches: Adrenal glands

• Origin approx. level L1 - 2
• Right renal artery: runs dorsal to the inferior vena cava and pancreatic head to the right kidney
• Left renal artery: runs dorsal to the pancreatic body to the left kidney

Inferior suprarenal artery: Adrenal gland

• Origin below the renal arteries/L2 from the anterior side of the aorta
• run over the psoas muscle, ureter, and external iliac arteries to the suspensory ligament of the ovary or to the deep inguinal ring of the inguinal canal and the testis

Ovarian arteries: Ovaries, parts of the uterine tube,

Testicular arteries: Testes, epididymides

• extend laterally behind the psoas muscle over L1 – 4
• Anastomoses with the arteries of the anterior abdominal wall (superior and inferior epigastric arteries,  iliolumbar artery, deep circumflex iliac artery)

Spinal branches: Spinal canal

Terminal branches: Abdominal wall, back musculature

• Along upper border of pancreas
• Entry into splenorenal ligament and spleen

Pancreatic branches:

• Dorsal to pancreas

Dorsal pancreatic artery:

• Dorsal to pancreas
• Anastomoses with great pancreatic artery to form inferior pancreatic artery

Great pancreatic artery:

• Dorsal to pancreatic tail caudally
• Anastomoses with dorsal pancreatic artery to form inferior pancreatic artery

Pancreas

Posterior gastric artery:

• Runs in phrenicosplenic ligament cranially to gastric fundus

Stomach (posterior surface of fundus)

Short gastric arteries:

• Run in gastrosplenic ligament to gastric fundus

Stomach (fundus and greater curvature)

Left gastro-omental artery:

• Runs in gastrocolic ligament to greater curvature
• Anastomoses with right gastro-omental artery

Stomach (fundus and greater curvature)

• Runs to lesser gastric curvature
• Anastomoses with right gastric artery

Direct branches

Stomach (lesser curvature)

Esophageal branches

Esophagus

• Runs to the right to hepatic portal
• Divides into proper hepatic artery and gastroduodenal artery

Proper hepatic artery

• Main branch of common hepatic artery
• Arises behind pylorus
• Runs in hepatoduodenal ligament together with hepatic portal vein and common bile duct to hepatic portal
• Gives off 3 branches:

1. Right gastric artery:

• Runs in lesser omentum to lesser gastric curvature
• Anastomoses with left gastric artery

Stomach (lesser curvature right)

2. Right hepatic artery

Liver (right part)

Gallbladder (cystic artery)

Partially caudate lobe

3. Left hepatic artery

Liver (left part)

Partially caudate lobe

Gastroduodenal artery

• Runs dorsal to lesser omentum to pancreas
• Divides into 2 branches:

1. Right gastro-omental artery:

• Runs to greater curvature
• Anastomoses with left gastro-omental artery

Pancreas, duodenum, stomach

2. Anterior and posterior superior pancreaticoduodenal artery:

• Form vascular plexus with branches of inferior pancreaticoduodenal artery around pancreatic head

• Runs in area of horizontal part of duodenum cranially to pancreatic head

Anterior and posterior branches:

• Anastomose with anterior and posterior pancreaticoduodenal artery

Pancreatic head

• Run in mesenteric root to jejunum and ileum
• Form vascular arcade among themselves

Straight arteries

Jejunum, ileum

• Runs in mesentery to ileocecal region

Anterior and posterior cecal artery

Cecum

Appendicular artery (Variant: Origin from posterior cecal artery)

Vermiform appendix

• Runs in ascending mesocolon to ascending colon

Divides into 2 branches, which anastomose with middle colic artery or ileocolic artery

Ascending colon

• Runs in transverse mesocolon to transverse colon

Divides into 2 branches: right branch anastomoses with right colic artery (right flexure), left branch anastomoses with left colic artery (left flexure)

Transverse colon

• Runs in descending mesocolon to descending colon

Divides into 2 branches, which anastomose with middle colic artery or sigmoid arteries

Descending colon

• 2-4 arteries that form vascular arcade in sigmoid mesocolon
• Anastomose with left colic artery and superior rectal artery

Several small branches to sigmoid

Sigmoid colon

• Approaches rectum from dorsal
• Anastomoses with middle rectal artery

Several small branches to rectum

Upper rectum

• arises directly caudal to the aortic bifurcation from the common iliac artery

• passes over the upper margin of the greater sciatic foramen caudally

• dorsal: internal iliac vein, piriformis muscle, lumbosacral plexus
• ventral: ureter
• lateral: external iliac vein, psoas major muscle
• caudal: obturator nerve

visceral branches:

• Umbilical artery
• Inferior vesical artery
• Middle rectal artery
• in women: uterine artery

parietal branches:

• Iliolumbar artery
• Lateral sacral arteries
• Superior gluteal artery
• Inferior gluteal artery
• Obturator artery
• Internal pudendal artery

• Pelvic organs, gluteal musculature

• postnatal obliteration to the medial umbilical ligament
• remaining branches: superior vesical arteries, in men: artery of the ductus deferens

• Urinary bladder body
• in men: ductus deferens

• branching in the urinary bladder fundus into small branches

• Urinary bladder
• in men: prostate, seminal vesicles

• branching in the middle rectal segment
• anastomoses with superior and inferior rectal arteries

• Rectal ampulla
• in women: vagina
• in men: prostate

• passes over the ureter
• tortuous course in the broad ligament of the uterus
• gives off numerous small branches

• Ovary
• Uterine tube
• proximal vagina
• Uterus

• runs obliquely upward to the iliopsoas muscle

• Psoas major muscle
• Iliacus muscle

• Superior branch: runs medially through the 1st or 2nd anterior sacral foramen and exits again through the posterior sacral foramen
• Inferior branch: passes over the piriformis muscle and medial to the sacral foramina on the sacrum caudally

• Sacral canal
• Piriformis muscle
• Muscles/skin dorsal to the sacrum

• passes with the superior gluteal nerve through the suprapiriform foramen and with branches to the gluteus maximus muscle (superficial branch) and gluteus medius muscle (deep branch)

• Gluteus maximus, medius, and minimus muscles
• Piriformis muscle
• Tensor fasciae latae muscle
• Skin over the sacrum

• passes on the piriformis muscle caudally through the infrapiriform foramen
• then runs together with the posterior femoral cutaneous nerve and sciatic nerve through the gluteus maximus muscle

• Gluteus maximus, medius, and minimus muscles
• Piriformis muscle
• Quadriceps femoris muscle
• Skin of the lower buttock and proximal thigh

• passes along the lateral pelvic wall forward and downward
• branches to the ilium and iliacus muscle
• after passing through the obturator canal, gives off further branches, including pubic branch (anastomoses with the inferior epigastric artery to form the corona mortis) and posterior branch (branch: acetabular artery → artery of the femoral head)

• Ilium
• Iliacus muscle
• Thigh adductors
• Pubis
• External hip muscles
• Femoral head

• runs ventral to the sacral plexus to the infrapiriform foramen
• re-enters the lesser pelvis via the lesser sciatic foramen, through the pudendal canal and branches in the ischiorectal fossa

• Distal third of the rectum
• Anal canal
• Urethra
• Scrotal skin/labia
• Bulb of the penis/vestibule
• Dorsum of the penis/clitoral prepuce

• arises caudal to the internal iliac artery from the common iliac artery

• runs along the psoas major muscle to the inguinal ligament, through the vascular lacuna and becomes the femoral artery here

• Right external iliac artery runs under the ureter

• Deep circumflex iliac artery runs to the anterior superior iliac spine and anastomoses with the iliolumbar artery and superior gluteal artery
• Inferior epigastric artery runs medial to the deep inguinal ring cranially and between the transversus abdominis muscle and rectus abdominis muscle, further branches including cremasteric artery or round ligament artery 

• Ilium, lower portion of the abdominal wall

• External iliac artery, which becomes the femoral artery after passing under the inguinal ligament

• runs between M. iliopsoas and M. pectineus (= iliopectineal fossa) covered by fascia lata
• is accompanied by M. sartorius up to the middle of the thigh
• passes together with V. femoralis and N. saphenus through the adductor canal
• transitions into the popliteal artery after passing through the adductor hiatus

• A. epigastrica superficialis
• A. circumflexa ilium superficialis
• A. profunda femoris (main artery for supplying the thigh!)
• Aa. pudendae externae
• A. descendens genus

• Thigh 
• Skin of the abdominal wall
• External genitalia
• Knee joint and proximal/medial lower leg

• Ø

• Skin of the abdominal wall up to the umbilical region

• Ø

• Anterior superior iliac spine

• A. circumflexa femoris medialis runs between M. iliopsoas and M. pectineus dorsally → trochanteric fossa; anastomosis with A. circumflexa femoris lateralis
• A. circumflexa femoris lateralis runs between M. rectus femoris and Mm. vasti laterally; anastomosis with A. circumflexa femoris medialis
• Aa. perforantes pass through the adductors to the back of the thigh

• Thigh

• Ø

• External genitalia
• Scrotum or labia majora

• Rr. articulares → Rete articulare genus
• R. saphenus → runs medially together with V. saphena magna and N. saphenus to the calf

• Knee
• Proximal medial calf