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AORTA AND PERIPHERAL ARTERIES ANATOMY & VISUALIZATION Presented By; Dr Rakesh Jain.

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Presentation on theme: "AORTA AND PERIPHERAL ARTERIES ANATOMY & VISUALIZATION Presented By; Dr Rakesh Jain."— Presentation transcript:

1 AORTA AND PERIPHERAL ARTERIES ANATOMY & VISUALIZATION Presented By; Dr Rakesh Jain

2 The Aorta After originating from LV (about 3 cm in diameter ), it ascending for a short distance, arches backward and to the left side, descends within the thorax on the left side of the vertebral column After originating from LV (about 3 cm in diameter ), it ascending for a short distance, arches backward and to the left side, descends within the thorax on the left side of the vertebral column Portions of aorta Portions of aorta 1. Ascending aorta 2. Arch of the aorta and 3. Descending aorta (thoracic and abdominal aorta)

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4 Ascending Aorta (Aorta Ascendens) About 5 cm. in length About 5 cm. in length Passes obliquely upward, forward, and to the right, as high as the upper border of the second right costal cartilage Passes obliquely upward, forward, and to the right, as high as the upper border of the second right costal cartilage At its origin, three small dilatations called the aortic sinuses At its origin, three small dilatations called the aortic sinuses At the union of the ascending aorta with the aortic arch, the caliber of the vessel is increased, owing to a bulging of its right wall. This dilatation is termed the bulb of the aorta At the union of the ascending aorta with the aortic arch, the caliber of the vessel is increased, owing to a bulging of its right wall. This dilatation is termed the bulb of the aorta Only branches of the ascending aorta are the two coronary arteries Only branches of the ascending aorta are the two coronary arteries

5 Arch of the Aorta Begins at the level of the upper border of the Rt 2nd sternocostal joint Begins at the level of the upper border of the Rt 2nd sternocostal joint First runs upward, backward, and to the left, infront of the trachea, then directed backward on the left side of the trachea and finally passes downward on the left side of the body of T4, at lower border of which it becomes continuous with the descending aorta First runs upward, backward, and to the left, infront of the trachea, then directed backward on the left side of the trachea and finally passes downward on the left side of the body of T4, at lower border of which it becomes continuous with the descending aorta Forms two curvatures: one with its convexity upward, the other with its convexity forward and to the left Forms two curvatures: one with its convexity upward, the other with its convexity forward and to the left

6 Branches of arch of aorta Three in number- Innominate artery Innominate artery Left common carotid artery Left common carotid artery Left subclavian artery Left subclavian artery

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8 CCA= common carotid artery VA= vertebral artery SCA= subclavian artery LEFT ANTERIOR OBLIQUE VIEW

9 Variations of the supraaortic vessel origins Inominate A Rt Subclavian Rt CC Vertibral Lt CC Lt Subclavian Rt Subclavian Rt CC Lt CC Vertibral Lt Subclavian

10 Descending Aorta Thoracic Aorta Contained in the posterior mediastinal cavity Contained in the posterior mediastinal cavity Begins at the lower border of the T4 Begins at the lower border of the T4 Ends in front of the lower border of the T12 vertebra, at the aortic hiatus in the diaphragm Ends in front of the lower border of the T12 vertebra, at the aortic hiatus in the diaphragm

11 Branches of the Thoracic Aorta Visceral Visceral 1. Pericardial 2. Bronchial 3. Esophageal 4. Mediastinal Parietal Parietal 1. Intercostal.- usually 9 pairs 2. Subcostal. 3. Superior Phrenic.

12 RCC LCC Lt Subclavian Rt Subclavian Brachiocephalic A LEFT ANTERIOR OBLIQUE VIEW

13 Abdominal aorta Begins at aortic Begins at aortic hiatus of diaphragm In front of lower In front of lower border of T 12 border of T 12 Descending in front Descending in front of the vertebral column of the vertebral column Ends on L 4- body, Ends on L 4- body, a little to Left of midline a little to Left of midline Summit of the convexity Summit of the convexity corresponding to the L3 corresponding to the L3

14 Branches of the abdominal aorta Visceral Branches Celiac. Celiac. Superior Mesenteric. Superior Mesenteric. Inferior Mesenteric. Inferior Mesenteric. Middle Suprarenals. Middle Suprarenals. Renals. Renals. Internal Spermatics. Internal Spermatics. Ovarian (in the female) Ovarian (in the female) Parietal Branches Inferior Phrenics. Inferior Phrenics. Lumbars. Lumbars. Middle Sacral. Middle Sacral. Terminal Branches Common Iliacs. Common Iliacs.

15 1.Abdo Aorta 2.Coeliac trunk a.Lt gastric A b.Splenic A c.Hepatic A 3. S M A 4. I M A 5. Lt Renal A 6. Rt Renal A 2 c a b 6 5 3 1 4 AP VIEW

16 Catheter Abdominal aorta Celiac trunk Superior mesenteric artery LATERAL VIEW

17 Coeliac Artery Short thick trunk Short thick trunk ≈1.25 cm length ≈1.25 cm length Arises from the front of the aorta, just below the aortic hiatus of the diaphragm Arises from the front of the aorta, just below the aortic hiatus of the diaphragm Between T 12 & L 1 Between T 12 & L 1 Passing nearly horizontally forward Passing nearly horizontally forward 3 large branches 3 large branches Left gastric A - smallest Left gastric A - smallest Hepatic A Hepatic A Splenic A - largest Splenic A - largest

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20 1.Coeliac A 2.Lt gastric A 3.Hepatic A 4.Splenic A 5.Gastroduo denal A 13 2 4 4 ANTERIO-POSTERIOR VIEW

21 Superior Mesenteric Artery Large vessel Large vessel Arises from front of aorta, at L 1, ~1.25 cm below Coeliac A Arises from front of aorta, at L 1, ~1.25 cm below Coeliac A Passes downward and forward, to the right iliac fossa Passes downward and forward, to the right iliac fossa Supply small intestine (expt superior Duo), Supply small intestine (expt superior Duo), Cecum, Asc Colon & Rt ½ Transverse Colon Cecum, Asc Colon & Rt ½ Transverse Colon

22 SMA-Branches Inferior Pancreatico-duodenal Inferior Pancreatico-duodenal Middle Colic Middle Colic Right Colic Right Colic Ileocolic Ileocolic Intestinal Intestinal

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24 1.Abd Aorta 2.S M A 3.Middle colic A 4.Rt colic A 5.Ileocolic A 6. Intestinal A 7.Appendicular 5 7 4 1 6 2 3

25 Inferior Mesenteric Artery Smaller than SMA Smaller than SMA Arises from aorta at L3, about 3 or 4 cm above its division Arises from aorta at L3, about 3 or 4 cm above its division Passes downward, posterior to the peritoneum Passes downward, posterior to the peritoneum Continued into pelvis as Superior hemorrhoidal artery & ends on the upper rectum Continued into pelvis as Superior hemorrhoidal artery & ends on the upper rectum Supply Lt ½ transverse colon, descending & sigmoid colon, and most of the rectum Supply Lt ½ transverse colon, descending & sigmoid colon, and most of the rectum

26 Inferior Mesenteric Artery branches Left Colic A Left Colic A Sigmoid branches Sigmoid branches Superior Hemorrhoidal A Superior Hemorrhoidal A

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28 1.Inf mesentric A 2.Lt colic A 3.Marginal A 4.Sigmoid A 5.Superior hemorrhoidal A 1 2 4 5 3

29 Superior Hemorrhoidal Artery Form a series of loops around lower rectum Form a series of loops around lower rectum Communicate with Communicate with Middle hemorrhoidal branches of Internal Iliac A Middle hemorrhoidal branches of Internal Iliac A and and Inferior hemorrhoidal branches of Internal pudendal A (branch of Internal Iliac A) Inferior hemorrhoidal branches of Internal pudendal A (branch of Internal Iliac A)

30 Renal arteries 1.Two large arteries 2.Arises from side of aorta, immediately below SMA 3.Nearly a right angle with the aorta 4.Right is longer than left 5.Before reaching hilus of the kidney, each artery divides into four or five branches 6.Left is somewhat higher than the right

31 Rt Renal arteries Lt Renal arteries AP VIEW

32 Common Iliac Arteries Abdominal Aorta divides, on Lt side of L4 Abdominal Aorta divides, on Lt side of L4 Each about 5 cm length Each about 5 cm length Rt Common Iliac A -somewhat longer than the Lt Rt Common Iliac A -somewhat longer than the Lt Each divide, opposite the intervertebral fibrocartilage between L5 & S1 Each divide, opposite the intervertebral fibrocartilage between L5 & S1 2 branches→ 2 branches→ External Iliac A External Iliac A & Internal Iliac A (Hypogastric A ) Internal Iliac A (Hypogastric A )

33 1.Abd Aorta 2.Common iliac A 3.External iliac A 4.Internal iliac A 1 2 3 4 AP VIEW

34 The External Iliac Artery Larger than Internal Iliac A Larger than Internal Iliac A Passes obliquely downward and lateralward along the medial border of the Psoas major Passes obliquely downward and lateralward along the medial border of the Psoas major Beneath the inguinal ligament, midway between anterior superior iliac spine and symphysis pubis entering the thigh & becomes Femoral A Beneath the inguinal ligament, midway between anterior superior iliac spine and symphysis pubis entering the thigh & becomes Femoral A

35 EIA-Branches 2 branches 2 branches Inferior epigastric Inferior epigastric Deep iliac circumflex Deep iliac circumflex Continues as femoral A Continues as femoral A

36 The Internal Iliac A (Hypogastric A ) Short, thick vessel, smaller than EIA Short, thick vessel, smaller than EIA Arises at the bifurcation of the common iliac, opposite the lumbosacral articulation Arises at the bifurcation of the common iliac, opposite the lumbosacral articulation Abt 4 cm length, on medial side of the thigh Abt 4 cm length, on medial side of the thigh The lengths of the CIA & IIA bear an inverse proportion to each other→ IIA being long when CIA is short, and vice versa. The lengths of the CIA & IIA bear an inverse proportion to each other→ IIA being long when CIA is short, and vice versa. Divides into 2 large trunks at upper margin of the greater sciatic foramen → anterior & posterior Divides into 2 large trunks at upper margin of the greater sciatic foramen → anterior & posterior

37 Branches of Internal Iliac A Anterior Trunk Superior Vesical Superior Vesical Middle Vesical Middle Vesical Inferior Vesical Inferior Vesical Vaginal (in females) Vaginal (in females) Middle Hemorrhoidal Middle Hemorrhoidal Obturator Obturator Inferior Gluteal Inferior Gluteal Internal Pudendal Internal Pudendal Inf Hemorrhoidal A Inf Hemorrhoidal A Uterine Uterine Posterior Trunk Iliolumbar Iliolumbar Lateral Sacral Lateral Sacral Superior Gluteal Superior Gluteal

38 Femoral Artery Begins behind inguinal ligament, midway between ASIS & symphysis pubis, Begins behind inguinal ligament, midway between ASIS & symphysis pubis, Ends at junction of upper ⅔ & lower ⅓ of thigh, to become Popliteal A Ends at junction of upper ⅔ & lower ⅓ of thigh, to become Popliteal A First 4 cm -enclosed, together with Femoral V, in a fibrous sheath—the Femoral Sheath First 4 cm -enclosed, together with Femoral V, in a fibrous sheath—the Femoral Sheath In the upper ⅓ of thigh Femoral A is contained in the Femoral Triangle (Scarpa’s triangle) In the upper ⅓ of thigh Femoral A is contained in the Femoral Triangle (Scarpa’s triangle) In the middle ⅓ of thigh, in the Adductor Canal (Hunter’s canal) In the middle ⅓ of thigh, in the Adductor Canal (Hunter’s canal)

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40 Profunda Femoris A Large vessel arising from lateral & back part of Femoral A, 2-5 cm below inguinal ligament Large vessel arising from lateral & back part of Femoral A, 2-5 cm below inguinal ligament Ends at the lower ⅓ of thigh Ends at the lower ⅓ of thigh PFA provides an important source of collateral flow to the leg and foot in patients with significant SFA stenoses or occlusion PFA provides an important source of collateral flow to the leg and foot in patients with significant SFA stenoses or occlusion Branches.— Branches.— Lateral Femoral Circumflex, Lateral Femoral Circumflex, Medial Femoral Circumflex, Medial Femoral Circumflex, Perforating branches (4 no.s) Perforating branches (4 no.s)

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42 AP VIEW Catheter Superficial femoral artery Common femoral artery

43 1.Profnda F A 2.Femoral artery 1 2 AP VIEW

44 Popliteal Artery Continuation of Femoral A Continuation of Femoral A Extends from the opening in the Adductor magnus, at the junction of middle ⅔ & lower ⅓ of thigh Extends from the opening in the Adductor magnus, at the junction of middle ⅔ & lower ⅓ of thigh Courses downward and lateralward to the intercondyloid Popliteal fossa of the femur, then vertically downward to the lower border of the Popliteus Courses downward and lateralward to the intercondyloid Popliteal fossa of the femur, then vertically downward to the lower border of the Popliteus Divides into Anterior tibial A and tibioperoneal trunk. Divides into Anterior tibial A and tibioperoneal trunk. Tibioperoneal trunk is the direct continuation of the popliteal artey, arises distal to the anterior tibial artery, bifurcates just beyond its origin into the posterior tibial and peroneal arteries Tibioperoneal trunk is the direct continuation of the popliteal artey, arises distal to the anterior tibial artery, bifurcates just beyond its origin into the posterior tibial and peroneal arteries

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46 Popliteal artery Anterior tibial artery Posterior tibial artery Peroneal artery Popliteal artery Anterior tibial artery Posterior tibial artery Peroneal artery Superficial femoral artery Tibioperoneal trunk

47 Posterior Tibial A Begins at lower border of Popliteus, opposite the interval betw tibia & fibula Begins at lower border of Popliteus, opposite the interval betw tibia & fibula Descends, approaching tibial side of leg Descends, approaching tibial side of leg In the lower part, situated midway betw med malleolus & med process of calcaneal tuberosity In the lower part, situated midway betw med malleolus & med process of calcaneal tuberosity Divides into Medial & Lateral plantar A Divides into Medial & Lateral plantar A

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49 Anterior Tibial A Begins at bifurcation of Popliteal A, at the lower border of Popliteus Begins at bifurcation of Popliteal A, at the lower border of Popliteus Passes forward through aperture above upper border of interosseous memb Passes forward through aperture above upper border of interosseous memb Descends on anterior surface of interosseous memb, gradually approaching the tibia Descends on anterior surface of interosseous memb, gradually approaching the tibia On the front of ankle-joint (more superficial), becomes Dorsalis Pedis Artery. On the front of ankle-joint (more superficial), becomes Dorsalis Pedis Artery.

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52 Tibioperoneal Trunk Anterior Tibial Peroneal Posterior Tibial AP VIEW

53 Ankle and Foot Vascular Anatomy Dorsalis Pedis Anterior Tibial Peroneal Posterior Tibial To resolve ischemic rest pain or heal an ulcer, one continuously patent infrapopliteal vessel to the foot is necessary Medial & lateral Plantar A Lateral view

54 Foot arteries front view A. tibialis anterior A. dorsalis pedis

55 Foot arteries down view A. tibialis posterior A. plantaris lateralis A. plantaris medialis Arcus plantaris profundus

56 Innominate Artery Largest branch of arch of the aorta Largest branch of arch of the aorta 4 to 5 cm. in length 4 to 5 cm. in length Arises, on a level with the upper border of the second right costal cartilage Arises, on a level with the upper border of the second right costal cartilage Ascends obliquely upward, backward, and to the right to the level of the upper border of the right sternoclavicular articulation, where it divides into the right common carotid and right subclavian arteries. Ascends obliquely upward, backward, and to the right to the level of the upper border of the right sternoclavicular articulation, where it divides into the right common carotid and right subclavian arteries.

57 Common Carotid Artery 2 in number (Rt & Lt) 2 in number (Rt & Lt) Differ in length and mode of origin Differ in length and mode of origin The right begins at bifurcation of innominate A, behind sternoclavicular joint and is confined to the neck. The right begins at bifurcation of innominate A, behind sternoclavicular joint and is confined to the neck. The left springs from the highest part of arch of the aorta to the left of, on a plane posterior to the innominate artery The left springs from the highest part of arch of the aorta to the left of, on a plane posterior to the innominate artery Each vessel passes obliquely upward Each vessel passes obliquely upward Divides into the ECA & ICA, at the level of upper border of the thyroid cartilage Divides into the ECA & ICA, at the level of upper border of the thyroid cartilage

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59 The Subclavian Artery Right side: arises from the innominate artery behind right sternoclavicular articulation Right side: arises from the innominate artery behind right sternoclavicular articulation Left side: arises directly from the arch of the aorta Left side: arises directly from the arch of the aorta Extends to the outer border of the first rib, where it becomes the axillary artery Extends to the outer border of the first rib, where it becomes the axillary artery

60 branches of the subclavian artery Vertebral. Vertebral. Internal mammary Internal mammary Thyrocervical Thyrocervical Costocervical Costocervical

61 RCC LCC Lt Subclavian Rt Subclavian Brachiocephalic A LEFT ANTERIOR OBLIQUE VIEW Rt Axillary A

62 Axillary Artery Commences at the outer border of the first rib Commences at the outer border of the first rib Ends at lower border of the tendon of the Teres major, where it takes the name of brachial Ends at lower border of the tendon of the Teres major, where it takes the name of brachial At its origin the artery is very deeply situated, but near its termination is superficial At its origin the artery is very deeply situated, but near its termination is superficial

63 ANTERIO-POSTERIOR VIEW

64 Brachial Artery Commences at the lower margin of the tendon of the Teres major Commences at the lower margin of the tendon of the Teres major Passing down the arm Passing down the arm Ends about 1 cm. below the bend of the elbow, where it divides into the radial and ulnar arteries Ends about 1 cm. below the bend of the elbow, where it divides into the radial and ulnar arteries Course; At first the brachial artery lies medial to the humerus; as it runs down the arm it gradually gets in front of the bone, and at the bend of the elbow it lies midway between its two epicondyles Course; At first the brachial artery lies medial to the humerus; as it runs down the arm it gradually gets in front of the bone, and at the bend of the elbow it lies midway between its two epicondyles

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66 Radial Artery Continuation of the brachial Continuation of the brachial Smaller in caliber than ulnar. Smaller in caliber than ulnar. Commences at bifurcation of the brachial, just below the bend of the elbow Commences at bifurcation of the brachial, just below the bend of the elbow Passes along the radial side of the forearm to the wrist Passes along the radial side of the forearm to the wrist Then winds backward, around the lateral side of the carpus, forward toward thumb and index finger into the palm of the hand and unite with the deep volar branch of the ulnar artery to form the deep volar arch Then winds backward, around the lateral side of the carpus, forward toward thumb and index finger into the palm of the hand and unite with the deep volar branch of the ulnar artery to form the deep volar arch

67 Ulnar Artery Larger than radial A. Larger than radial A. Begins a little below the bend of the elbow Begins a little below the bend of the elbow Passing obliquely downward, reaches ulnar side of the forearm, midway between the elbow and the wrist. It then runs along the ulnar border to the wrist Passing obliquely downward, reaches ulnar side of the forearm, midway between the elbow and the wrist. It then runs along the ulnar border to the wrist Immediately beyond pisiform bone, it divides into two branches, which enter into the formation of the superficial and deep volar arches Immediately beyond pisiform bone, it divides into two branches, which enter into the formation of the superficial and deep volar arches

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69 ANTERIO-POSTERIOR VIEW

70 POSTERIO-ANTERIOR VIEW

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