Start your free 3-day trial — no credit card required, full access included

DE EN
Login Register

Anatomy - Iliacomesenteric venous bypass in superior mesenteric artery occlusion—Vascular Surgery

vascular surgery
Activate now
Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Abdominal aorta

    Abdominal aorta
    Zum Vergrößern bitte anklicken

    Origin

    • It is the extension of the thoracic aorta after it passes through the aortic hiatus at the level of 12th thoracic vertebra (T12)

    Course

    • Retroperitoneal
    • Left of midline, anterior to spine
    • At the level of umbilicus/4th lumbar vertebra (L4) dividing (aortic bifurcation) into the common iliac arteries

    Cephalocaudal branches

    • Inferior phrenic arteries
    • 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 digestive organs

  2. Paired branches of the abdominal aorta

    Main branches

    Course

    Branches and their distribution

    Inferior phrenic artery

    • Courses craniad on inferior aspect of diaphragm toward its dome
    • Reticular division into several terminal branches

    Superior suprarenal artery: adrenal gland

    Terminal branches: Inferior aspect of diaphragm

    Middle suprarenal artery

    • Courses laterad to the adrenal glands

    Terminal branches: adrenal glands

    Renal artery

    • Arises at around the level of the first / second lumbar vertebra (L1-2)
    • Right renal artery: courses posterior to inferior vena cava and head of pancreas to right kidney
    • Left renal artery: courses posterior to body of pancreas to left kidney

    Inferior suprarenal artery: adrenal gland

    Ovarian artery, 

    Testicular artery

    • Arises inferior to the renal arteries /second lumbar vertebra (L2) from anterior aspect of aorta
    • Crosses over psoas muscle, ureter and external iliac arteries to suspensory ligament of ovary / deep inguinal ring and testes

    Ovarian artery ovary, parts of uterine tube

    Testicular artery: testes, epididymides

    Lumbar arteries (bilateral 4)

    • Run laterad posterior to psoas muscle over 1st to 4th lumbar vertebra (L1–4)
    • Anastomose with 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, muscles of the back

  3. Unpaired branches of the abdominal aorta

    • All unpaired branches of the abdominal aorta form anastomoses maintaining organ perfusion via collaterals:
      • Celiac trunk -> gastroduodenal artery -> superior mesenteric artery
      • Superior mesenteric artery -> middle and left celiac artery -> inferior mesenteric artery (“Riolan anastomosis”)
      • Inferior mesenteric artery -> superior and middle rectal artery -> internal iliac artery
    1. Celiac trunk
    • Arises at the level of the 12th thoracic vertebra (T12)
    • Divides into splenic artery, left gastric artery and common hepatic artery (largest-caliber branch of trunk)

    Main branches

    Course

    Branches and their course 

    Distribution

    Splenic artery

    • Along superior margin of pancreas
    • Enters the splenorenal ligament and spleen

    Pancreatic branches:

    • Posterior to pancreas

    Dorsal pancreatic artery:

    • Posterior to pancreas
    • Anastomoses with greater pancreatic artery and continues as inferior pancreatic artery

    Greater pancreatic artery:

    • Caudad along the posterior aspect of tail of pancreas
    • Anastomosis at pancreatic tail with dorsal pancreatic artery and inferior pancreatic artery

    Pancreas

    Posterior gastric artery:

    • Runs craniad in phrenicosplenic ligament to gastric fundus

    Stomach (posterior aspect of fundus)

    Short gastric arteries:

    • Course in gastrosplenic ligament to gastric fundus

    Stomach (fundus and greater curvature)

    Left gastro-omental artery:

    • Courses in gastrocolic ligament to greater curvature
    • Anastomosis with right gastro-omental artery

    Stomach (fundus and greater curvature)

    Left gastric artery

    • Runs to lesser curvature of stomach
    • Anastomosis with right gastric artery

    Direct branches

    Stomach (lesser curvature)

    Esophageal branches

    Esophagus

    Common hepatic artery

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

    Proper hepatic artery

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

    1. Right gastric artery:

    • Runs in lesser omentum to lesser curvature of stomach
    • Anastomosis with left gastric artery

    Stomach (right lesser curvature)

    2. Right hepatic artery

    Liver (right half)

    Gallbladder (cystic artery)

    Part of caudate lobe

    3. Left hepatic artery

    Liver (left half)

    Part of caudate lobe

    Gastroduodenal artery

    • Courses posterior to lesser omentum to pancreas
    • Divides into 2 branches:

    1. Right gastro-omental artery:

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

    Pancreas, duodenum, stomach

    2. Anterior and posterior superior pancreaticoduodenal arteries:

    • Form a vascular plexus around the pancreatic head with branches of the inferior pancreaticoduodenal artery
    2. Superior mesenteric artery
    • Arises from aorta at the level of L1-2
    • Courses anteroinferiorly
    • Branches: Branches: inferior pancreaticoduodenal artery, jejunal arteries and iliac arteries, ileocolic artery, right colic artery, middle colic artery

    Main branches

    Course

    Branches

    Distribution

    Inferior pancreaticoduodenal artery

    • At horizontal part of duodenum it runs craniad to pancreatic head

    Anterior and posterior branch:

    • Anastomosis with anterior and posterior superior pancreaticoduodenal artery respectively

    Pancreatic head

    Jenunal and iliac arteries

    • Course in the mesenteric root to jejunum and Ileum
    • Form a vascular arch

    Terminal branches (Aa. rectae)

    Jejunum, Ileum

    Ileocolic artery

    • Runs in mesentery to ileocecal region

    Anterior and posterior cecal artery

    Cecum

    Appendicular artery (variant: branch of the posterior cecal artery)

    Vermiform appendix

    Right colic artery

    • Runs in ascending mesocolon to ascending colon

    Divides into 2 branches that anastomose with the middle colic artery and ileocolic artery respectively

    Ascending colon

    Middle colic artery

    • Runs in transverse mesocolon to transverse colon

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

    Transverse colon

    3. Inferior mesenteric artery
    • Arises from the aorta at the level of L3
    • Supplies the colon beyond the left flexure with left colic artery, sigmoid arteries and superior rectal artery

    Main branches

    Course

    Branches

    Distribution

    Left colic artery

    • Runs in descending mesocolon to descending colon

    Divides into 2 branches that anastomose with the middle colic artery and sigmoid arteries respectively

    Descending colon

    Sigmoid arteries

    • 2-4 arteries forming a vascular arch in the sigmoid mesocolon
    • Anastomosis with left colic artery and superior rectal artery

    Several small branches to sigmoid colon

    Sigmoid colon

    Superior rectal artery

    • Joins the rectum from posterior
    • Anastomosis with middle rectal artery

    Several small branches to rectum

    Upper rectum

     

     

  4. Arterial pelvic blood supply

    • The abdominal aorta divides at the aortic bifurcation (around level L4) into both common iliac arteries
    • In turn, each common iliac artery divides into an internal and external iliac artery
    • With its visceral branches, the internal iliac artery supplies mainly the pelvic organs, while its parietal branches ensure the blood supply to the lower extremities
    • The external iliac artery contributes to the pelvic blood supply and, after passing through the vascular compartment (lacuna vasorum retroinguinalis), becomes the femoral artery
    1. Internal iliac artery

    Origin

    • Arises from the common iliac artery immediately inferior to the aortic bifurcation

    Course

    • Courses caudad over the superior border of the greater sciatic foramen

    Relation

    • Posterior: internal iliac vein, pirirformis muscle, lumbosacral plexus
    • Anterior: ureter
    • Lateral: external iliac vein, psoas major
    • Inferior: obturator nerve

    Branches

    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

    Distribution

    • Pelvic organs, gluteal muscles
    1.1 Visceral branches of the internal iliac artery

    Main branches

    Course and branches

    Distribution

    Umbilical artery

    • Postnatal obliteration to middle umbilical ligament
    • Remaining branches: superior vesical arteries, in men: artery to ductus deferens
    • Body of urinary bladder
    • In men: Ductus deferens

    Inferior vesical artery

    • Divides into small branches at fundus of urinary bladder
    • Urinary bladder
    • In men: prostate, seminal vesicles

    Middle rectal artery

    • Divides in the middle part of rectum
    • Anastomoses with superior and inferior rectal artery
    • Rectal ampulla
    • In women: vagina
    • In men: prostate

    Uterine artery (women)

    • Crosses the ureter
    • Tortuous course in broad ligament of uterus
    • Gives rise to numerous small branches
    • Ovary
    • Uterine tube
    • proximal vagina
    • Uterus
    1.2 Parietal branches of the internal iliac artery

    Main branches

    Course and branches

    Distribution

    Iliolumbar artery

    • Runs obliquely craniad to iliopsoas muscle
    • Psoas major
    • Iliac muscle

    Lateral sacral arteries

    • Superior branch: Runs mediad through the 1st or 2nd anterior sacral foramen and emerges again through the posterior sacral foramen
    • Inferior branch: courses caudad on the sacrum over the piriform muscle and medial to the sacral foramina
    • Sacral canal
    • Piriform muscle
    • Muscles/skin posterior to sacrum

    Superior gluteal artery

    • Passes together 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
    • Piriform muscle
    • Tensor muscle of fascia lata
    • Skin over sacrum

    Inferior gluteal artery

    • Passes caudad on the piriform muscle through the infrapiriform foramen
    • Then runs together with the femoral cutaneous nerve and sciatic nerve through the gluteus maximus muscle
    • Gluteus maximus, medius and minimus muscles
    • Piriform muscle
    • Quadriceps femoris muscle
    • Skin of lower buttocks and proximal thigh

    Obturator artery

    • Courses anteroinferiorly on the lateral pelvic wall
    • Branches to iliacus muscle and ilium
    • After passing through the obturator canal, gives off other branches, including the pubic branch (anastomosis with the inferior epigastric artery to the corona mortis)and posterior branch (branch: acetabular branch-> artery of head of femur ligament)
    • Ilium
    • Iliac muscle
    • Thigh adductors
    • Pubic bone
    • Lateral hip muscles
    • Head of femur

    Internal pudendal artery

    • Runs anterior to sacral plexus to infrapiriform foramen
    • Enters the lesser pelvis via the minor sciatic foramen through the pudendal canal and divides in the ischiorectal fossa
    • Distal third of rectum
    • Anal canal
    • Urethra
    • Scrotal skin /labia
    • Bulb of penis/bulb of vestibule
    • Posterior aspect of penis/prepuce of clitoris
    ·         2. External iliac artery

    Origin

    • Arises from the common iliac artery immediately distal to the origin of the internal iliac artery

    Course

    • Courses along the major psoas muscle to the inguinal ligament, and after passing through the vascular compartment becomes the femoral artery

    Relation

    • The right external iliac artery courses posterior to the ureter

    Branches

    • The deep iliac circumflex artery courses to the superior iliac spine and joins the Iliolumbar artery and superior gluteal artery
    • The inferior epigastric artery runs craniad medial to the deep inguinal ring and between the transverse abdominis and rectus abdominis muscles; other branches include the cremasteric artery and artery of round ligament of uterus 

    Distribution

    • Iliac bone, inferior aspect of abdominal wall