Anatomy - Interventional exclusion of a type Ia endoleak following bilateral endoluminal repair of an internal iliac artery aneurysm

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

Superior suprarenal artery: adrenal gland

Terminal branches: inferior aspect of the diaphragm

• Courses laterad to the adrenal glands

Terminal branches: adrenal glands

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

Inferior suprarenal artery: adrenal gland

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

Ovarian arteries: ovaries, parts of the uterine tube,

Testicular arteries: testes, epididymides

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

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

Pancreatic branches:

• Posterior to the pancreas

Dorsal pancreatic artery:

• Posterior to pancreas
• Anastomoses with greater pancreatic artery to form the inferior pancreatic artery

Greater pancreatic artery:

• Caudad along the posterior aspect of the tail of pancreas
• Anastomoses with dorsal pancreatic artery to form the inferior pancreatic artery

Pancreas

Posterior gastric artery:

• Runs craniad in the phrenicosplenic ligament to the gastric fundus

Stomach (posterior aspect of fundus)

Short gastric arteries:

• Course in the gastrosplenic ligament to the gastric fundus

Stomach (fundus and greater curvature)

Left gastro-omental artery:

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

Stomach (fundus and greater curvature)

• Runs to the lesser curvature of the stomach
• Anastomoses with right gastric artery

Direct branches

Stomach (lesser curvature)

Oesophageal branches

Oesophagus

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

Proper hepatic artery

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

1. Right gastric artery:

• Runs in the lesser omentum to the lesser curvature of the stomach
• Anastomoses 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 the lesser omentum to the pancreas
• Divides into 2 branches:

1. Right gastro-omental artery:

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

Pancreas, duodenum, stomach

2. Anterior and posterior superior pancreaticoduodenal arteries:

• Together with branches of the inferior pancreaticoduodenal artery, they form a vascular plexus around the pancreatic head

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

Anterior and posterior branch:

• Anastomose with the anterior and posterior superior pancreaticoduodenal artery respectively

Pancreatic head

• Course in the mesenteric root to the jejunum and ileum
• Form a vascular arcade among themselves

Aa. rectae

Jejunum, ileum

• Runs in the mesentery to the ileocaecal region

Anterior and posterior caecal artery

Caecum

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

Vermiform appendix

• Runs in the ascending mesocolon to the ascending colon

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

Ascending colon

• Runs in the transverse mesocolon to the transverse colon

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

Transverse colon

• Runs in the descending mesocolon to the descending colon

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

Descending colon

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

Several small branches to the sigmoid colon

Sigmoid colon

• Approaches the rectum posteriorly
• Anastomoses with the middle rectal artery

Several small branches to the rectum

Upper rectum