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Anatomy - Endovascular Therapy of a Penetrating Atheromatous Aortic Ulcer of the Descending Aorta (PAU, TEVAR)

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  1. Thoracic Aorta

    The thoracic aorta is divided into 3 sections:

    • Ascending aorta (Pars ascendens aortae)
    • Aortic arch (Arcus aortae)
    • Descending aorta (Pars descendens aortae)

    1. The ascending aorta gives off the two coronary arteries (Aa. coronariae dextra et sinistra), which supply the heart.

    2. From the aortic arch originate from a short common trunk (Truncus brachiocephalicus) the right common carotid artery and right subclavian artery. Then follow as branches the left common carotid artery and left subclavian artery. In about 10% of cases, an A. thyroidea ima to the thyroid gland originates from the aortic arch or truncus brachiocephalicus. There are some other anatomical variants, e.g., A. lusoria or truncus bovinus.

    3. The descending aorta sends parietal branches to the thorax and visceral branches to the viscera:

     a) Parietal branches: 

    • Posterior intercostal arteries, 9 arteries to the intercostal spaces (the first two originate from the costocervical trunk). After giving off a dorsal branch with muscle and skin branches (medial and lateral cutaneous branches) to the back and with a spinal branch for the spinal canal, they run between vein and intercostal nerve (“VAN”) at the lower edge of the rib between the intercostal muscles in the costal groove. At the costal angle, the collateral branch descends to the upper edge of the next lower rib. After giving off the lateral cutaneous branches with lateral mammary branches, the intercostal arteries anastomose with the anterior intercostal branches of the internal thoracic artery.
    • Subcostal artery: The last of the intercostal arteries lies under the 12th rib.
    • Superior phrenic artery: small branches to the lumbar part of the diaphragm.

    Usually one of the medullary radicular arteries is dominant, so-called Adamkiewicz artery (usually Th 11-12).

    b) Visceral branches:

    • Bronchial branches to the bronchi: The right vessel often originates from the III intercostal artery.
    • Esophageal branches: 3–6 branches to the esophagus
    • Mediastinal branches: small branches to the lymph nodes in the posterior mediastinum as well as to the pericardium (pericardial branches)