ABDOMINAL AORTA AND ABDOMINAL AORTA AND INFERIOR VENA CAVA INFERIOR VENA CAVA By: Dr. Mujahid Khan By: Dr. Mujahid Khan
Feb 13, 2016
ABDOMINAL AORTA AND ABDOMINAL AORTA AND INFERIOR VENA CAVAINFERIOR VENA CAVA
By: Dr. Mujahid KhanBy: Dr. Mujahid Khan
LocationLocation Aorta enters the abdomen through the Aorta enters the abdomen through the
aortic opening of the diaphragmaortic opening of the diaphragm
The opening lies in front of twelfth thoracic The opening lies in front of twelfth thoracic vertebravertebra
It descends behind the peritoneum on the It descends behind the peritoneum on the anterior surface of the bodies of the anterior surface of the bodies of the lumbar vertebraelumbar vertebrae
LocationLocation
On its right side lies the inferior vena cava, On its right side lies the inferior vena cava, the cisterna chyli and beginning of the the cisterna chyli and beginning of the azygos veinazygos vein
On the left side lies the left sympathetic On the left side lies the left sympathetic trunktrunk
It divides into two common iliac arteries at It divides into two common iliac arteries at the level of fourth lumbar vertebrathe level of fourth lumbar vertebra
BranchesBranches
Three anterior visceral branches: celiac Three anterior visceral branches: celiac artery, superior and inferior mesenteric artery, superior and inferior mesenteric arteriesarteries
Three lateral visceral branches: suprarenal Three lateral visceral branches: suprarenal artery, renal artery, testicular or ovarian artery, renal artery, testicular or ovarian arteryartery
BranchesBranches
Five lateral abdominal wall branches: the Five lateral abdominal wall branches: the inferior phrenic artery and four lumbar inferior phrenic artery and four lumbar arteriesarteries
Three terminal branches: two common Three terminal branches: two common iliac and the median sacral arteryiliac and the median sacral artery
Common Iliac ArteriesCommon Iliac Arteries
Right and left common iliac arteries are the Right and left common iliac arteries are the terminal branches of the aortaterminal branches of the aorta
They arise at the level of fourth lumbar vertebraThey arise at the level of fourth lumbar vertebra
Runs downward and laterally along the medial Runs downward and laterally along the medial border of the psoas muscleborder of the psoas muscle
Each artery divides into external and internal Each artery divides into external and internal iliac arteries in front of the sacroiliac jointiliac arteries in front of the sacroiliac joint
External Iliac ArteryExternal Iliac Artery
It runs along the medial border of psoas, It runs along the medial border of psoas, following the pelvic brimfollowing the pelvic brim
It gives off the inferior epigastric and deep It gives off the inferior epigastric and deep circumflex iliac branchescircumflex iliac branches
The artery enters the thigh by passing The artery enters the thigh by passing under the inguinal ligament to become the under the inguinal ligament to become the femoral arteryfemoral artery
Inferior Epigastric ArteryInferior Epigastric Artery
The inferior epigastric artery arises just The inferior epigastric artery arises just above the inguinal ligamentabove the inguinal ligament
Passes upward and medially along the Passes upward and medially along the medial margin of the deep inguinal ringmedial margin of the deep inguinal ring
Enters the rectus sheath behind the rectus Enters the rectus sheath behind the rectus abdominis muscleabdominis muscle
Deep Circumflex Iliac ArteryDeep Circumflex Iliac Artery
Arises close to the inferior epigastric arteryArises close to the inferior epigastric artery
Ascends laterally to the anterior superior Ascends laterally to the anterior superior iliac spine and the iliac crestiliac spine and the iliac crest
Supplies the muscles of the anterior Supplies the muscles of the anterior abdominal wallabdominal wall
Internal Iliac ArteryInternal Iliac Artery
It passes down into the pelvis in front of It passes down into the pelvis in front of the sacroiliac jointthe sacroiliac joint
Aortic AneurismsAortic Aneurisms
Localized or diffuse dilatations of the Localized or diffuse dilatations of the abdominal part of the aorta usually occur abdominal part of the aorta usually occur below the origin of the renal arteriesbelow the origin of the renal arteries
Most result from atherosclerosis which Most result from atherosclerosis which causes weakening of the arterial wallcauses weakening of the arterial wall
Occur most commonly in elderly menOccur most commonly in elderly men
Aortic AneurismsAortic Aneurisms
Large aneurysms should be surgically Large aneurysms should be surgically excised and replaced with a prosthetic excised and replaced with a prosthetic graft graft
The bifurcation of the abdominal aorta The bifurcation of the abdominal aorta where the lumen suddenly narrows may where the lumen suddenly narrows may be a lodging site for an embolus from the be a lodging site for an embolus from the heartheart
Severe ischemia of the lower limbs resultsSevere ischemia of the lower limbs results
Obliteration of Abdominal Aorta and Obliteration of Abdominal Aorta and Iliac ArteriesIliac Arteries
Gradual occlusion of the bifurcation of the Gradual occlusion of the bifurcation of the abdominal aorta produced by atherosclerosis abdominal aorta produced by atherosclerosis causes pain in the legs on walking causes pain in the legs on walking
Impotence may occur due to lack of blood in Impotence may occur due to lack of blood in internal iliac arteriesinternal iliac arteries
Surgical treatment by thromboendarterectomy or Surgical treatment by thromboendarterectomy or a bypass graft should be considereda bypass graft should be considered
Inferior Vena CavaInferior Vena Cava
It conveys most of the blood from the body It conveys most of the blood from the body below the diaphragm to the right atrium of the below the diaphragm to the right atrium of the heartheart
It is formed by the union of common iliac veins It is formed by the union of common iliac veins behind the right common iliac artery at the level behind the right common iliac artery at the level of fifth lumbar vertebraof fifth lumbar vertebra
It ascends on the right side of the aortaIt ascends on the right side of the aorta
Pierces the central tendon of the diaphragm at Pierces the central tendon of the diaphragm at the level of the eighth thoracic vertebrathe level of the eighth thoracic vertebra
Inferior Vena CavaInferior Vena Cava
It drains into the right atrium of the heartIt drains into the right atrium of the heart
Right sympathetic trunk lies behind its Right sympathetic trunk lies behind its right margin right margin
Right ureter lies close to its right borderRight ureter lies close to its right border
The entrance into the lesser sac separates The entrance into the lesser sac separates the inferior vena cava from the portal veinthe inferior vena cava from the portal vein
TributariesTributaries
Two anterior visceral tributaries: the hepatic Two anterior visceral tributaries: the hepatic veinsveins
Three lateral visceral tributaries: the right Three lateral visceral tributaries: the right suprarenal vein, renal veins, right testicular or suprarenal vein, renal veins, right testicular or ovarian veinovarian vein
Lateral abdominal wall tributaries: inferior Lateral abdominal wall tributaries: inferior phrenic vein and four lumbar veinsphrenic vein and four lumbar veins
Three veins of origin: two common iliac veins Three veins of origin: two common iliac veins and the median sacral veinand the median sacral vein
Trauma to IVCTrauma to IVC
Injuries to inferior vena cava are Injuries to inferior vena cava are commonly lethalcommonly lethal
The anatomical inaccessibility of the The anatomical inaccessibility of the vessel behind the liver, duodenum and vessel behind the liver, duodenum and mesentery of the small intestine and the mesentery of the small intestine and the blocking presence of the right costal blocking presence of the right costal margin make a surgical approach difficultmargin make a surgical approach difficult
Trauma to IVCTrauma to IVC
The thin wall of the vena cava makes it The thin wall of the vena cava makes it prone to extensive tearsprone to extensive tears
Due to the multiple anastomoses of the Due to the multiple anastomoses of the tributaries of IVC, it is impossible in an tributaries of IVC, it is impossible in an emergency to ligate the vesselemergency to ligate the vessel
Most patients have venous congestion of Most patients have venous congestion of the lower limbsthe lower limbs
Compression of IVCCompression of IVC
It is commonly compressed by the It is commonly compressed by the enlarged uterus during the later stages of enlarged uterus during the later stages of pregnancypregnancy
This produces edema of the ankles and This produces edema of the ankles and feet and temporary varicose veinsfeet and temporary varicose veins
Malignant retroperitoneal tumors can Malignant retroperitoneal tumors can cause severe compression and eventual cause severe compression and eventual blockage of IVCblockage of IVC
Compression of IVCCompression of IVC
This results in the dilatation of the This results in the dilatation of the extensive anastomoses of the tributariesextensive anastomoses of the tributaries
This alternative pathway for the blood to This alternative pathway for the blood to return to the right atrium is referred to as return to the right atrium is referred to as the caval-caval shunt the caval-caval shunt