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