Blood supply to the small intestine. superior mesenteric artery

The abdominal aorta gives off splanchnic, parietal and terminal branches.

Internal branches of the abdominal aorta

1. The celiac trunk (truncus celiacus), 9 mm in diameter, 0.5 - 2 cm long, departs ventrally from the aorta at the level of the XII thoracic vertebra (Fig. 402). Under the base of the celiac trunk is the upper edge of the body of the pancreas, and on the sides of it is the celiac nerve plexus. Behind the parietal peritoneum, the celiac trunk divides into 3 arteries: the left gastric, common hepatic, and splenic.

402. Branching of the celiac trunk.
1 - truncus celiacus; 2-a. gastric sinistra; 3-a. lienalis; 4-a. gastroepiploica sinistra; 5-a. gastroepiploica dextra; 6-a. gastroduodenalis; 7-v. portae; 8-a. hepatica communis; 9 - ductus choledochus; 10 - ductus cysticus; 11-a. cystica.

a) The left gastric artery (a. gastrica sinistra) initially passes behind the parietal peritoneum at a distance of 2-3 cm, goes up and to the left to the place where the esophagus flows into the stomach, where it penetrates into the thickness of the lesser omentum and, turning 180 °, descends along the lesser curvature of the stomach towards the right gastric artery. Branches depart from the left gastric artery to the anterior and posterior walls of the body and the cardial part of the esophagus, anastomosing with the arteries of the esophagus, the right gastric artery and the short arteries of the stomach. Sometimes the left gastric artery originates from the aorta in a common trunk with the inferior phrenic artery.
b) The common hepatic artery (a. hepatica communis) goes to the right of the celiac trunk, located behind and parallel to the pyloric part of the stomach. It has a length of up to 5 cm. At the beginning of the duodenum, the common hepatic artery is divided into the gastroduodenal artery (a. gastroduodenalis) and its own hepatic artery (a. hepatica propria). From the latter originates the right gastric artery (a. gastrica dextra). The proper hepatic artery is located medial to the common bile duct and divides into right and left branches at the hilum of the liver. The cystic artery (a. cystica) departs from the right branch to the gallbladder. A. gastroduodenalis, penetrating between the pyloric part of the stomach and the head of the pancreas, is divided into two arteries: the upper pancreaticoduodenal superior (a. pancreaticoduodenal superior) and the right gastroepiploica (a. gastroepiploica dextra). The latter passes in the omentum along the greater curvature of the stomach and anastomoses with the left gastroepiploic artery. A. gastrica dextra is located on the lesser curvature of the stomach and anastomoses with the left gastric artery.
c) The splenic artery (a. lienalis) passes behind the stomach along the upper edge of the pancreas, reaching the gate of the spleen, where it is divided into 3-6 branches. From it depart: branches to the pancreas (rr. pancreatici), short gastric arteries (aa. gastricae breves) to the fornix of the stomach, left gastroepiploic artery (a. gastroepiploica sinistra) to the greater curvature of the stomach. The latter anastomoses with the right gastroepiploic artery, which is a branch of a. gastroduodenalis (Fig. 403).

403. Scheme of branching of the celiac trunk.

1-tr. celiacus;
2-a. gastric sinistra;
3-a. lienalis;
4-a. gastroepiploica sinistra;
5-a. gastroepiploica dextra;
6-a. mesenterica superior;
7-a. gastrica dextra;
8-a. pancreaticoduodenalis inferior;
9-a. pancreaticoduodenalis superior;
10-a. gastroduodenalis;
11-a. cystica;
12-a. hepatica propria;
13-a. hepatica communis.

2. The superior mesenteric artery (a. mesenterica superior) is unpaired, departs from the anterior surface of the aorta at the level of the XII thoracic or I lumbar vertebra. Has a diameter of 10 mm. The initial part of the artery is located behind the head of the pancreas. The second section of the artery is surrounded by veins: above - splenic, below - left renal, left - inferior mesenteric, right - superior mesenteric. The artery and veins are located between the pancreas and the ascending part of the duodenum. At its lower edge at the level of the II lumbar vertebra, the artery enters the root of the mesentery of the small intestine (Fig. 404).

404. Superior mesenteric artery.
1 - omentum majus; 2 - anastomosis between a. colica media and a. colica sinistra: 3 - a. colica sinistra; 4-a. mesenterica superior; 5 - a.a. jejunales; 6 - a.a. appendiculares: 7 - aa. ilei; 8-a. ileocolica; 9-a. colica dextra; 10-a. colica media.

The superior mesenteric artery gives off the following branches: the inferior pancreaticoduodenal artery (a. pancreaticoduodenalis inferior), which anastomoses with the superior artery of the same name; their plexuses and networks (Fig. 405), the iliocolic artery (a. iliocolica) - to the caecum; it gives a branch to the appendix (a. appendicularis), which is located in the mesentery of the process. From the superior mesenteric artery to the ascending colon, the right colon artery (a. colica dextra), the middle colon artery (a. colica media), which goes in the thickness of the mesocolon, depart. These arteries in the mesentery of the colon anastomose with each other.

405. A network of blood capillaries in the mucous membrane of the small intestine.

3. The inferior mesenteric artery (a. mesenterica inferior) unpaired, like the previous one, starts from the anterior wall of the abdominal aorta at the level of the III lumbar vertebra. The main trunk of the artery and its branches are located behind the parietal sheet of the peritoneum and supply blood to the descending, sigmoid and rectum. The artery is divided into the following 3 large arteries: the left colon (a. colica sinistra) - to the descending colon, the sigmoid arteries (aa. sigmoideae) - to the sigmoid colon, the upper rectal (a. rectalis superior) - to the rectum (Fig. 406 ).

406. Inferior mesenteric artery.
1-a. mesenterica inferior; 2 - aorta abdominalis; 3 - a.a. sigmoideae; 4 - a.a. rectales superiores; 5-a. iliaca communis dextra; 6 - mesenterium; 7-a. colica media; 8-a. colic sinistra.

All arteries leading to the large intestine anastomose with each other. The anastomosis between the middle and left colonic arteries is especially important, as they represent branches of various arterial sources.

4. The middle adrenal artery (a. suprarenalis media) steam room, branches off from the lateral surface of the aorta at the level of the lower edge of the 1st lumbar vertebra, sometimes from the celiac trunk or from the lumbar arteries. At the gate of the adrenal gland, it is divided into 5-6 branches. In the adrenal capsule, they anastomose with branches of the superior and inferior adrenal arteries.

5. Renal artery (a. renalis) steam room, 7-8 mm in diameter. The right renal artery is 0.5 - 0.8 cm longer than the left. In the sinus of the kidney, the artery divides into 4-5 segmental arteries, which form the interlobar arteries. At the border of the cortical substance, they are connected to each other by arcuate arteries. From the arcuate arteries, interlobular arteries begin, located in the cortical substance. From the interlobular arteries, the afferent arterioles (vas efferens) originate, which pass into the vascular glomeruli. From the glomerulus of the kidney, the efferent arteriole (vas efferens) is formed, which breaks up into capillaries. Capillaries surround the nephron of the kidney. At the gates of the kidney, the inferior adrenal artery (a. suprarenalis inferior) departs from the renal artery, supplying blood to the adrenal gland and the fatty capsule of the kidney.

6. Testicular (ovarian) artery (a. testicularis s. a. ovarica) steam, branches off from the aorta at the level of the II lumbar vertebra behind the root of the mesentery of the small intestine. Branches depart from it in the upper part for blood supply to the fatty membrane of the kidney, ureter. Supplies blood to the corresponding gonads.

Arteriograms of the renal vessels. A contrast agent is injected through a catheter into the aorta or directly into the renal artery. Such pictures, as a rule, are performed with suspicion of sclerosis, narrowing or anomaly of the kidney (Fig. 407).

407. Selective arteriogram of the right kidney. 1 - catheter; 2 - right renal artery; 3 - intrarenal arterial branches.

Abdominal aorta(abdominal aorta), pars abdominalis aortae (aorta abdominalis), is a continuation of the thoracic aorta. It starts at the level of the XII thoracic vertebra and reaches the IV-V lumbar vertebra. Here the abdominal aorta divides into two common iliac arteries, aa. aliacae communes. The place of division is called the bifurcation of the aorta, bifurcatio aortica. A thin branch descends from the bifurcation, lying on the anterior surface of the sacrum - the median sacral artery, a. sacralis mediana.

Two types of branches depart from the abdominal part of the aorta: parietal and splanchnic.

The abdominal part of the aorta is located retroperitoneally. In the upper part, the body of the pancreas and two veins adjoin to its surface, crossing it: the splenic vein lying along the upper edge of the pancreas, v. lienalis, and the left renal vein, v. renalis sinistra, running behind the gland. Below the body of the pancreas, in front of the aorta, is the lower part of the duodenum, and below it is the beginning of the root of the mesentery of the small intestine. To the right of the aorta lies the inferior vena cava, v. cava inferior; behind the initial section of the abdominal aorta is the cistern of the thoracic duct, cisterna chyli, the initial part of the thoracic duct, ductus thoracicus.

Wall branches.

1. Inferior phrenic artery, a. phrenica inferior, is a rather powerful paired artery. It departs from the anterior surface of the initial part of the abdominal aorta at the level of the XII thoracic vertebra and goes to the lower surface of the tendon part of the diaphragm, where it gives off the anterior and posterior branches that supply the latter. In the thickness of the diaphragm, the right and left arteries anastomose with each other and with branches from the thoracic aorta. The right artery passes behind the inferior vena cava, the left one behind the esophagus.

In its course, the artery gives off 5-7 upper adrenal arteries, aa. suprarenales superiores. These are thin branches that extend from the initial section of the inferior phrenic artery and supply blood to the adrenal gland. On the way, several small branches depart from them to the lower parts of the esophagus and to the peritoneum.

2. Lumbar arteries, aa. lumbales, are 4 paired arteries. They depart from the posterior wall of the abdominal part of the aorta at the level of the body of the I-IV lumbar vertebrae. They are directed transversely, to the lateral side, while the two upper arteries pass behind the legs of the diaphragm, the two lower ones - behind the psoas major muscle.

All lumbar arteries anastomose with each other and with the superior and inferior epigastric arteries, which supply blood to the rectus abdominis. In their course, the arteries give a number of small branches to the subcutaneous tissue and to the skin; in the region of the white line, they anastomose here and there with the arteries of the same name on the opposite side. In addition, the lumbar arteries anastomose with the intercostal arteries, aa. intercostales, iliac-lumbar artery, a. iliolumbalis, deep circumflex iliac artery, a. circumflexa ilium profunda, and superior gluteal artery, a. glutea superior.

Having reached the transverse processes of the vertebrae, each lumbar artery gives off a dorsal branch, r. dorsalis. Then the lumbar artery goes behind the square muscle of the lower back, supplying it with blood; then it goes to the anterior wall of the abdomen, passes between the transverse and internal oblique muscles of the abdomen and reaches the rectus abdominis.

The dorsal branch goes to the back surface of the body to the muscles of the back and the skin of the lumbar region. Along the way, she gives a small branch to the spinal cord - the spinal branch, r. spinalis, which enters the spinal canal through the intervertebral foramen, supplying the spinal cord and its membranes with blood.

3. Median sacral artery, a. sacralis mediana, is a direct continuation of the abdominal aorta. It starts from its posterior surface, slightly above the aortic bifurcation, i.e., at the level of the V lumbar vertebra. It is a thin vessel passing from top to bottom in the middle of the pelvic surface of the sacrum and ending at the coccyx in the coccygeal body, glomus coccygeum.

From the median sacral artery along its course branch:

a) inferior lumbar artery, a. lumbalis imae, steam room, departs in the region of the V lumbar vertebra and supplies blood to the iliopsoas muscle. On its way, the artery gives off a dorsal branch, which is involved in the blood supply to the deep muscles of the back and spinal cord;

b) lateral sacral branches, rr. sacrales laterales, depart from the main trunk at the level of each vertebra and, branching on the anterior surface of the sacrum, anastomose with similar branches from the lateral sacral arteries (branches of the internal iliac arteries).

Several branches depart from the lower part of the median sacral artery, which supply blood to the lower parts of the rectum and the loose tissue around it.

Internal branches

I. celiac trunk, truncus celiacus, - a short vessel, 1-2 cm long, departs from the anterior surface of the aorta at the level of the upper edge of the body of the 1st lumbar vertebra or the lower edge of the body of the 12th thoracic vertebra in the place where the abdominal aorta exits the aortic orifice. The artery goes anteriorly and immediately divides into three branches: the left gastric artery, a. gastricasinistra, common hepatic artery, a. hepatica communis, and splenic artery, a. splenica (lienalis).

1. Left gastric artery, a. gastrica sinistra, the smaller of these three arteries. It rises a little up and to the left; approaching the cardial part, gives several branches towards the esophagus - esophageal branches, rr. esophageales, anastomosing with the same name branches from the thoracic aorta, and descends to the right side along the lesser curvature of the stomach, anastomosing with the right gastric artery, a. gastrica dextra (from the common hepatic artery). On its way along the lesser curvature, the left gastric artery sends small branches to the anterior and posterior walls of the stomach.

2. Common hepatic artery, a. hepatica communis, is a more powerful branch, has a length of up to 4 cm. Moving away from the celiac trunk, it goes along the right crus of the diaphragm, the upper edge of the pancreas from left to right and enters the thickness of the lesser omentum, where it is divided into two branches - its own hepatic and gastroduodenal arteries.

1) Own hepatic artery, a. hepatica propria, moving away from the main trunk, goes to the gates of the liver in the thickness of the hepatoduodenal ligament, to the left of the common bile duct and somewhat anterior to the portal vein, v. portae. Approaching the gates of the liver, the own hepatic artery is divided into the left and right branches, while the gallbladder artery departs from the right branch, a. cystica.

Right gastric artery, a. gastrica dextra, - a thin branch, departs from its own hepatic artery, sometimes from the common hepatic artery. It goes from top to bottom to the lesser curvature of the stomach, along which it goes from right to left, and anastomoses with a. gastric sinistra. The right gastric artery gives rise to a number of branches that supply blood to the anterior and posterior walls of the stomach.

At the gates of the liver, the right branch, r. dexter, own hepatic artery sends to the caudate lobe artery of the caudate lobe, a. lobi caudati, and arteries to the corresponding segments of the right lobe of the liver: to the anterior segment - the artery of the anterior segment, a. segmenti anterioris, and to the posterior segment - the artery of the posterior segment, a. segmenti posterioris.

Left branch, r. sinister, gives the following arteries: artery of the caudate lobe, a. lobi caudati, and arteries of the medial and lateral segments of the left lobe of the liver, a. segmenti medialis et a. segmenti lateralis. In addition, a non-permanent intermediate branch, r, departs from the left branch (less often from the right branch). intermedius, supplying the square lobe of the liver.

2) Gastroduodenal artery, a. gastroduodenalis, is a rather powerful trunk. It is directed from the common hepatic artery downwards, behind the pyloric part of the stomach, crossing it from top to bottom. Sometimes the supraduodenal artery departs from this artery, a. supraduodenalis, which crosses the anterior surface of the head of the pancreas.

The following branches depart from the gastroduodenal artery:

a) posterior superior pancreatoduodenal artery, a. pancreaticoduodenalis superior posterior, passes along the posterior surface of the head of the pancreas and, heading down, gives pancreatic branches along its course, rr. pancreatici, and duodenal branches, rr. duodenales. At the lower edge of the horizontal part of the duodenum, the artery anastomoses with the inferior pancreatoduodenal artery, a. pancreaticoduodenalis inferior (branch of the superior mesenteric artery, a. mesenterica superior);

b) anterior superior pancreatoduodenal artery, a. pancreaticoduodenalis superior anterior, is located arcuately on the anterior surface of the head of the pancreas and the medial edge of the descending part of the duodenum, goes down, giving duodenal branches along its way, rr. duodenales, and pancreatic branches, rr. pancreatici. At the lower edge of the horizontal part of the duodenum, it anastomoses with the inferior pancreatoduodenal artery, a. pancreatoduodenalis inferior (branch of the superior mesenteric artery).

c) right gastroepiploic artery, a. gastroepiploica dextra, is a continuation of the gastroduodenal artery. It goes to the left along the greater curvature of the stomach between the leaves of the greater omentum, sends branches to the anterior and posterior walls of the stomach - gastric branches, rr. gastrici, as well as omental branches, rr. epiploici to the greater omentum. In the region of greater curvature, it anastomoses with the left gastroepiploic artery, a. gastroepiploica sinistra (branch of the splenic artery, a. splenica);

d) retroduodenal arteries, aa. retroduodenales, are the right terminal branches of the gastroduodenal artery. They surround the right edge of the pancreatic head along the anterior surface.

3. Splenic artery, a. splenica, is the thickest of the branches extending from the celiac trunk. The artery goes to the left and, together with the vein of the same name, lies behind the upper edge of the pancreas. Having reached the tail of the pancreas, it enters the gastrosplenic ligament and breaks up into terminal branches heading to the spleen.

The splenic artery gives off branches that supply the pancreas, stomach, and greater omentum.

1) Pancreatic branches, rr. pancreatici, depart from the splenic artery along its entire length and enter the parenchyma of the gland. They are represented by the following arteries:

a) dorsal pancreatic artery, a. pancreatica dorsalis, follows downward, respectively, the middle section of the posterior surface of the body of the pancreas and, at its lower edge, passes into the inferior pancreatic artery, a. pancreatica inferior, supplying the lower surface of the pancreas;

b) large pancreatic artery, a. pancreatica magna, departs from the main trunk or from the dorsal pancreatic artery, follows to the right and goes along the posterior surface of the body and head of the pancreas. It connects to the anastomosis between the posterior superior and inferior pancreatoduodenal arteries;

c) tail pancreatic artery, a. caude pancreatis, is one of the terminal branches of the splenic artery, supplies blood to the tail of the pancreas.

2) Splenic branches, rr. splenici, only 4 - 6, are the terminal branches of the splenic artery and penetrate through the gate into the parenchyma of the spleen.

3) Short gastric arteries, aa. gastricae breves, in the form of 3-7 small stems, depart from the terminal section of the splenic artery and in the thickness of the gastro-splenic ligament go to the fundus of the stomach, anastomosing with other gastric arteries.

4) Left gastroepiploic artery, a. gastroepiploica sinistra, starts from the splenic artery in the place where the terminal branches to the spleen depart from it, and follows down in front of the pancreas. Having reached the greater curvature of the stomach, it goes along it from left to right, lying between the leaves of the greater omentum. On the border of the left and middle thirds of the greater curvature, it anastomoses with the right gastroepiploic artery (from a. gastroduodenalis). In its course, the artery sends a number of branches to the anterior and posterior walls of the stomach - gastric branches, rr. gastrici, and to the greater omentum - omental branches, rr. epiploici.

5) Posterior gastric artery, a. gastrica posterior, unstable, supplies blood to the back wall of the stomach, closer to the cardial part.

II. superior mesenteric artery, a. mesenterica superior, is a large vessel that starts from the anterior surface of the aorta, slightly lower (1 - 3 cm) of the celiac trunk, behind the pancreas.

Coming out from under the lower edge of the gland, the superior mesenteric artery goes down and to the right. Together with the superior mesenteric vein located to the right of it, it goes along the anterior surface of the horizontal (ascending) part of the duodenum, crosses it across immediately to the right of the duodenal-lean flexure. Having reached the root of the mesentery of the small intestine, the superior mesenteric artery penetrates between the leaves of the latter, forming an arc with a bulge to the left, and reaches the right iliac fossa.

In its course, the superior mesenteric artery gives off the following branches: to the small intestine (with the exception of the upper part of the duodenum), to the caecum with the appendix, ascending and partially to the transverse colon.

The following arteries depart from the superior mesenteric artery.

1. Inferior pancreatoduodenal artery, a. pancreaticoduodenalis inferior (sometimes non-single), originates from the right edge of the initial section of the superior mesenteric artery. Divides into an anterior branch, r. anterior, and posterior branch, r. posterior, which go down and to the right along the anterior surface of the pancreas, go around its head along the border with the duodenum. Gives branches to the pancreas and duodenum; anastomoses with the anterior and posterior superior pancreatoduodenal arteries and with the branches of a. gastroduodenalis.

2. Jejunum arteries, aa. jejunales, only 7 - 8, depart sequentially one after another from the convex part of the arch of the superior mesenteric artery, are sent between the sheets of the mesentery to the loops of the jejunum. On its way, each branch divides into two trunks, which anastomose with the same trunks formed from the division of neighboring intestinal arteries.

3. Ileo-intestinal arteries, aa. ileales, in the amount of 5 - 6, like the previous ones, go to the loops of the ileum and, dividing into two trunks, anastomose with adjacent intestinal arteries. Such anastomoses of the intestinal arteries look like arcs. New branches depart from these arcs, which also divide, forming arcs of the second order (slightly smaller). From the arcs of the second order, the arteries again depart, which, dividing, form the arcs of the third order, and so on. From the last, most distal row of arcs, straight branches extend directly to the walls of the loops of the small intestine. In addition to intestinal loops, these arcs give small branches that supply blood to the mesenteric lymph nodes.

4. Ileocolic-intestinal artery, a. ileocolica, departs from the cranial half of the superior mesenteric artery. Heading to the right and down under the parietal peritoneum of the posterior abdominal wall to the end of the ileum and to the caecum, the artery divides into branches supplying the caecum, the beginning of the colon and the terminal ileum.

A number of branches depart from the iliac-colon-intestinal artery:

a) the ascending artery goes to the right to the ascending colon, rises along its medial edge and anastomoses (forms an arc) with the right colonic artery, a. colic dextra. Colon-intestinal branches depart from the specified arc, rr. colici, supplying the ascending colon and upper caecum;

b) anterior and posterior cecum arteries, aa. cecales anterior et posterior, are sent to the corresponding surfaces of the caecum. Are a continuation of a. ileocolica, approach the ileocecal angle, where, connecting with the terminal branches of the ileo-intestinal arteries, they form an arc, from which branches extend to the caecum and to the terminal ileum, - ileo-intestinal branches, rr. ileales;

c) arteries of the appendix, aa. appendiculares, depart from the posterior cecal artery between the sheets of the mesentery of the appendix; blood supply to the appendix.

5. Right colonic artery. a. colica dextra, departs on the right side of the superior mesenteric artery, in its upper third, at the level of the root of the mesentery of the transverse colon, and goes almost transversely to the right, to the medial edge of the ascending colon. Before reaching the ascending colon, it is divided into ascending and descending branches. The descending branch connects to branch a. ileocolica, and the ascending branch anastomoses with the right branch of a. colica media. From the arcs formed by these anastomoses branches extend to the wall of the ascending colon, to the right flexure of the colon, and to the transverse colon.

6. Middle colonic artery, a. colica media, departs from the initial section of the superior mesenteric artery, goes forward and to the right between the sheets of the mesentery of the transverse colon and is divided at the bottom of the branch: right and left.

The right branch connects to the ascending branch a. colica dextra, a the left branch runs along the mesenteric edge of the transverse colon and anastomoses with the ascending branch a. colica sinistra, which departs from the inferior mesenteric artery. Connecting in this way with the branches of neighboring arteries, the middle colon-intestinal artery forms arcs. From the branches of these arcs, arcs of the second and third order are formed, which give direct branches to the walls of the transverse colon, to the right and left bends of the colon.

III. Inferior mesenteric artery, a. mesenterica inferior, departs from the anterior surface of the abdominal aorta at the level of the lower edge of the III lumbar vertebra. The artery goes behind the peritoneum to the left and down and is divided into three branches.

1. Left colonic artery, a. colica sinistra, lies retroperitoneally in the left mesenteric sinus in front of the left ureter and left testicular (ovarian) artery, a. testicularis (ovarica) sinistra; splits into ascending and descending branches. The ascending branch anastomoses with the left branch of the middle colic artery, forming an arc; blood supply to the left side of the transverse colon and the left flexure of the colon. The descending branch joins the sigmoid intestinal artery and supplies the descending colon with blood.

2. Sigmoid-intestinal artery, a. sigmoidea (sometimes there are several), goes down first retroperitoneally, and then between the sheets of the mesentery of the sigmoid colon; anastomoses with the branches of the left colonic artery and the superior rectal artery, forming arcs from which the branches extend, supplying the sigmoid colon.

3. Superior rectal artery, a. rectalis superior, is the terminal branch of the inferior mesenteric artery; heading down, it is divided into two branches. One branch anastomoses with a branch of the sigmoid artery and supplies blood to the lower sections of the sigmoid colon. Another branch goes to the cavity of the small pelvis, crosses in front a. iliaca communis sinistra and, lying in the mesentery of the pelvic section of the sigmoid colon, is divided into the right and left branches, which supply the rectal ampulla with blood. In the intestinal wall, they anastomose with the middle rectal artery, a. rectalis media, a branch of the internal iliac artery, a. iliaca interna.

IV. Middle adrenal artery, a. suprarenalis media, steam room, departs from the side wall of the upper aorta, slightly below the place of origin of the mesenteric artery. It is directed transversely outward, crosses the pedicle of the diaphragm and approaches the adrenal gland, in the parenchyma of which it anastomoses with branches of the superior and inferior adrenal arteries.

v. renal artery, a. renalis, - paired large artery. It starts from the lateral wall of the aorta at the level of the II lumbar vertebra almost at a right angle to the aorta, 1-2 cm below the origin of the superior mesenteric artery. The right renal artery is somewhat longer than the left, since the aorta lies to the left of the midline; heading towards the kidney, it is located behind the inferior vena cava.

Before reaching the hilum of the kidney, each renal artery gives off a small inferior adrenal artery, a. suprarenalis inferior, which, having penetrated the adrenal parenchyma, anastomoses with the branches of the middle and superior adrenal arteries.

At the hilum of the kidney, the renal artery divides into anterior and posterior branches.

Anterior branch, r. anterior, enters the renal gate, passing in front of the renal pelvis, and branches, sending arteries to the four segments of the kidneys: the artery of the upper segment, a. segmenti superioris, - to the top; artery of the upper anterior segment, a. segmenti anterior superioris, - to the upper anterior; artery of the lower anterior segment, a. segmenti anterior is inferioris, - to the lower anterior and artery of the lower segment, a. segmenti inferioris, - to the bottom. Back branch, r. posterior, the renal artery passes behind the renal pelvis and, heading to the posterior segment, gives off the ureteral branch, r. uretericus, which may originate from the renal artery itself, divides into posterior and anterior branches.

VI. testicular artery, a. testicularis, steam room, thin, departs (sometimes right and left common trunk) from the anterior surface of the abdominal aorta, slightly below the renal artery. It goes down and laterally, goes along the psoas major muscle, crosses the ureter on its way, above the arcuate line - the external iliac artery. Along the way, it gives branches to the fatty capsule of the kidney and to the ureter - ureteral branches, rr. ureterici. Then it goes to the deep inguinal ring and, having joined the vas deferens here, passes through the inguinal canal into the scrotum and breaks up into a number of small branches that go to the parenchyma of the testicle and its epididymis - branches of the epididymis, rr. epididymales.

In its course it anastomoses with a. cremasterica (branch a. epigastrica inferior and with a. ductus deferentis (branch a. iliaca interna).

In women, the corresponding testicular artery is the ovarian artery, a. ovarica, gives off a number of ureteral branches, rr. ureterici, and then passes between the sheets of the broad ligament of the uterus, along its free edge, and gives off branches to the fallopian tube - tubal branches, rr. tubales, and into the hilum of the ovary. The terminal branch of the ovarian artery anastomoses with the ovarian branch of the uterine artery.

The portal vein has the following tributaries.

425. Scheme of the portal vein.

2-r. sinister v. portae;

3-v. gastric sinistra;

4-v. gastrica dextra;

6-v. gastroepiploica sinistra;

7-v. mesenterica inferior;

8-v. colica sinistra;

9-vv. sigmoideae;

10-v. rectalis superior;

11-vv. rectales mediae;

12-vv. rectal inferiores;

13-v. iliocolica;

14-vv. jejunales;

15-v. mesenterica superior;

16-vv. paraumbilical;

17-r. dexter v. portae;

18 - venous capillaries of the liver;

19-vv. hepaticae;

20-v. cava inferior.

1. The superior mesenteric vein (v. mesenterica superior) is single, located at the root of the mesentery of the small intestine, next to the superior mesenteric artery, collects blood from the small intestine (vv. jejunales et ilei), appendix and caecum (vv. ileocolicae), ascending colon (v. colica dextra), transverse colon (v. colica media), head of the pancreas and duodenum (vv. pancreaticoduodenales superior et inferior), greater curvature of the stomach and transverse colon (v. gastroepiploica dextra).

2. The splenic vein (v. lienalis) is single, collects blood from the spleen, fundus and body of the stomach along the greater curvature (v. gastroepiploica sinistra, vv. gastricae breves) and pancreas (vv. pancreaticae). The splenic vein joins behind the head of the pancreas and the upper horizontal part of the duodenum with the superior mesenteric vein into the portal vein.

3. The inferior mesenteric vein (v. mesenterica inferior) collects blood from the descending colon (v. colica sinistra), sigmoid (vv. sigmoideae) and the upper part of the rectum (v. rectalis superior) intestine. The inferior mesenteric vein joins the splenic vein in the middle of the body of the pancreas or flows into the angle of the junction of the superior mesenteric and splenic veins.

4. The cystic vein (v. cystica), paraumbilical veins (vv. paraumbilicales) located in the lig. teres hepatis, left and right gastric veins (vv. gastricae sinistra et dextra), prepyloric vein (v. prepylorica).

The portal vein from the place of formation (behind the head of the pancreas) from the gate of the liver has a length of 4-5 cm and a diameter of 15-20 mm. It lies in lig. hepatoduodenale, where the ductus choledochus passes to the right of it, and a. hepatica propria. At the hilum of the liver, the portal vein divides into two large lobar branches, which in turn branch into 8 segmental veins. Segmental veins are divided into interlobular and septal veins, which end in sinusoids (capillaries) of the lobules. The capillaries are radially oriented between the hepatic ducts towards the center of the lobule. In the center of the lobules, the central veins (vv. centrales) are formed from the capillaries, representing the initial vessels for the hepatic veins flowing into the inferior vena cava. Thus, venous blood from the internal organs of the abdominal cavity, before entering the inferior vena cava, passes through the liver, where it is cleared of toxic metabolic products.

Portal Vein: Blood Pathways, Diseases, Diagnosis and Treatment Methods

The main task assigned to the portal vein is the well-established removal of venous blood from unpaired organs, with the exception of the liver. The circulatory system is associated primarily with the gastrointestinal tract and its major glands.

Portal tributaries

The portal vein system is characterized by the presence of branches that act as connecting links between individual unpaired internal organs. There are several main tributaries of the portal system of blood vessels, which are assigned separate functions.

splenic vein

The splenic vein is located along the upper border of the pancreas, behind the splenic artery. The vein intersects with the aorta, running in the direction from left to right.

In the dorsal part of the pancreas, the blood vessels of the splenic vein merge with another tributary of the portal vein, the mesenteric circulatory pathway. In turn, short gastric, omental and pancreatic vessels act as tributaries of the splenic vein.

The main function of the splenic vein is to ensure the outflow and movement of blood from the spleen, individual sections of the stomach.

Superior mesenteric vein

The mesenteric vein runs from the base of the mesentery of the small intestine, located on the right in relation to the blood artery of the same name. The veins of the ileum and jejunum, the middle and right colic veins act as tributaries of this blood path.

The blood vessels of the mesenteric vein mentioned above carry blood from the transverse colon, ileum, jejunum, and also the appendix. In general, the system of the superior mesenteric vein is responsible for stable blood flow in the region of the stomach, greater omentum and duodenum.

Inferior mesenteric vein

It is formed by the confluence of the sigmoid, left colonic and superior rectal veins. It is located in close proximity to the left colic artery. Passes the blood path behind the pancreas, after which it connects to the splenic vein.

The inferior mesenteric vein is responsible for collecting and draining blood from the walls of the rectum, colon, and sigmoid colon.

Portal vein - the norm of blood flow

Portal blood flow in the liver is unstable. Its distribution is possible with a predominance in one of the lobes of the liver. As a result, the flow of venous blood between the lobar branches of individual systems can be observed in the human body.

The optimal pressure in the portal vein is close to 7 mmHg. At the same time, the blood flow here is more laminar than turbulent.

Portal vein: dimensions

The dimensions of the portal vein correspond to the distance over which venous blood drains, starting from the vestibule of the liver and ending with the gastrointestinal tract. The portal vein is on average 8 to 10 cm long and about 1.5 cm wide.

Circulatory disturbance of the portal vein

In the presence of disturbances in the stable outflow of blood in the portal vein, regardless of their nature, portal blood begins to outflow into the central blood pathways with a noticeable expansion of venous collaterals. The collaterals connected with the lumbar veins can increase significantly in size. Disturbed distribution of the outflowing blood flow to the tributaries of the portal vein can lead to thrombosis and varicose veins in the lower layers of the stomach and esophagus.

Thrombosis

The portal vein, subject to acute thrombosis, causes pathological changes, followed by frequent severe pain in the abdominal cavity. The consequences of circulatory disorders in the system of this pathway can be:

progressive drop in blood pressure;

Quite quickly, against the background of impaired blood circulation in the portal vein system in acute thrombosis, liver abscesses, intestinal infarctions, jaundice, and cirrhosis are formed.

Chronic thrombosis of the portal vein can be caused by portal hypertension, varicose veins of the esophagus. Complications in the initial stages of the development of chronic thrombosis are usually gastrointestinal bleeding. There are frequent cases of impaired functioning and even rupture of the spleen.

Circulation diagnostics

Indications for diagnosis for the presence of diseases associated with disorders in the portal vein may be symptoms inherent in portal hypertension.

With the confluence of a whole complex of negative factors, the portal vein is prone to the development of acute thrombosis, which manifests itself in an increase in the diameter of the vein from 8-10 to 13 or more millimeters. However, with the development of chronic thrombosis, this symptom may not appear.

The most reliable method for diagnosing the state of the portal vein system is angiography. In recent years, the method of laparoscopy has been actively used and demonstrates excellent diagnostic results.

Treatment

The portal vein is restored using a whole complex of anticoagulants and fibrinolytics. Excellent treatment results are obtained by a combination of pharmacological preparations containing streptokinase, heparin and fibrinolysin.

Often, the restoration of normal blood flow in the portal vein system requires surgical intervention. Here, such proven methods of treatment as thrombectomy and surgical restoration of portal blood flow are widely used.

superior mesenteric vein

Russian-Italian medical dictionary with indexes of Russian and Latin terms. - M .: "Russo". C.C. Prokopovich. 2003 .

See what the "superior mesenteric vein" is in other dictionaries:

Superior mesenteric arteries (arteria mesenlerica superior), its branches - Front view. The transverse colon and the greater omentum are elevated. superior mesenteric artery; superior mesenteric vein; toshe intestinal arteries; arcades; loops of the small intestine; appendix; cecum; ascending colon; ... ... Atlas of human anatomy

portal vein - (v. portae) a large venous vessel that collects blood from unpaired abdominal organs (stomach, intestines, spleen, pancreas) and goes to the liver. Venous blood from these organs, before entering the system of the inferior vena cava, ... ... Dictionary of terms and concepts on human anatomy

The mesenteric part - the small intestine is located in the lower part of the abdominal cavity, its length is 4-6 m, and its diameter is 2-4 cm. / 5 and without visible boundaries ... ... Atlas of human anatomy

superior mesenteric vein - (v. mesenterica superior, PNA, BNA) see the list of anat. terms ... Big Medical Dictionary

The inferior mesenteric artery (arteria mesenterica inferior) and its branches - the transverse colon and the greater omentum are raised upwards. The loops of the small intestine are turned to the right. transverse colon; arterial anastomosis (riolan arch); inferior mesenteric vein; inferior mesenteric artery; abdominal aorta; right ... ... Atlas of human anatomy

Digestive system - provides the body with the absorption it needs as a source of energy, as well as for cell renewal and growth of nutrients. The human digestive apparatus is represented by a digestive tube, large digestive glands ... ... Atlas of Human Anatomy

Endocrine glands (endocrine glands) - Fig. 258. The position of the endocrine glands in the human body. Front view. I pituitary and epiphysis; 2 parathyroid glands; 3 thyroid gland; 4 adrenal glands; 5 pancreatic islets; 6 ovary; 7 testicle. Fig. 258. Position of the endocrine glands ... Atlas of human anatomy

The inferior vena cava system is formed by vessels that collect blood from the walls and organs of the abdominal cavity and pelvis, as well as from the lower extremities. The inferior vena cava (v. cava inferior) (Fig. 215, 233, 236, 237) begins at the level of the right anterolateral surface IV V ... ... Atlas of human anatomy

BLOOD VESSELS - BLOOD VESSELS. Contents: I. Embryology. 389 P. General anatomical sketch. 397 Arterial system. 397 Venous system. . 406 Table of arteries. 411 Table of veins. … … Big medical encyclopedia

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portal vein system

The portal vein (liver) occupies a special place among the veins that collect blood from the internal organs. This is not only the largest visceral vein (its length is 5-6 cm, diameter is mm), but it is also the afferent venous link of the so-called portal system of the liver. The portal vein of the liver is located in the thickness of the hepatoduodenal ligament behind the hepatic artery and common bile duct along with nerves, lymph nodes and vessels. It is formed from the veins of unpaired organs of the abdominal cavity: stomach, small and large intestine, except for the anus, spleen, pancreas. From these organs, venous blood flows through the portal vein to the liver, and from it through the hepatic veins to the inferior vena cava. The main tributaries of the portal vein are the superior mesenteric and splenic veins, as well as the inferior mesenteric vein, which merge with each other behind the head of the pancreas. Upon entering the hilum of the liver, the portal vein divides into a larger right branch and a left branch. Each of the branches, in turn, splits first into segmental, and then into branches of ever smaller diameter, which pass into the interlobular veins. Inside the lobules, they give off wide capillaries - the so-called sinusoidal vessels that flow into the central vein. The sublobular veins emerging from each lobule merge to form 34 hepatic veins. Thus, the blood flowing into the inferior vena cava through the hepatic veins passes on its way through two capillary networks: located in the wall of the digestive tract, where the tributaries of the portal vein originate, and formed in the liver parenchyma from the capillaries of its lobules. Before entering the portal of the liver (in the thickness of the hepatoduodenal ligament), the gallbladder vein (from the gallbladder), the right and left gastric veins and the prepyloric vein flow into the portal vein, delivering blood from the corresponding parts of the stomach. The left gastric vein anastomoses with the esophageal veins - tributaries of the unpaired vein from the system of the superior vena cava. In the thickness of the round ligament of the liver, the paraumbilical veins follow to the liver. They begin in the navel, where they anastomose with the superior epigastric veins - tributaries of the internal thoracic veins (from the system of the superior vena cava) and with the superficial and inferior epigastric veins - tributaries of the femoral and external iliac veins from the system of the inferior vena cava.

Portal tributaries

The superior mesenteric vein runs at the root of the mesentery of the small intestine to the right of the artery of the same name. Its tributaries are the veins of the jejunum and ileum, the pancreatic veins, the pancreatoduodenal veins, the iliococolic vein, the right gastroepiploic vein, the right and middle colon veins, and the vein of the appendix. In the superior mesenteric vein, these veins bring blood from the walls of the jejunum and ileum and the appendix, the ascending colon and transverse colon, partly from the stomach, duodenum and pancreas, and the greater omentum.

The splenic vein, located along the upper edge of the pancreas below the splenic artery, runs from left to right, crossing the aorta in front, and merges with the superior mesenteric vein behind the head of the pancreas. Its tributaries are the pancreatic veins, short gastric veins and the left gastroepiploic vein. The latter anastomoses along the greater curvature of the stomach with the right vein of the same name. The splenic vein collects blood from the spleen, part of the stomach, pancreas, and greater omentum.

The inferior mesenteric vein is formed by the fusion of the superior rectal vein, the left colic vein, and the sigmoid veins. Located next to the left colic artery, the inferior mesenteric vein goes up, passes under the pancreas and flows into the splenic vein (sometimes into the superior mesenteric vein). This vein collects blood from the walls of the upper rectum, sigmoid colon, and descending colon.

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portal vein system

Portal vein, v. portae hepatis, collects blood from unpaired abdominal organs.

It is formed behind the head of the pancreas as a result of the confluence of three veins: the inferior mesenteric vein, v. mesenterica inferior, superior mesenteric vein, v. mesenterica superior, and splenic vein, v. splenica.

The portal vein from the place of its formation goes up and to the right, passes behind the upper part of the duodenum and enters the hepatoduodenal ligament, passes between the sheets of the latter and reaches the gate of the liver.

In the thickness of the ligament, the portal vein is located with the common bile and cystic ducts, as well as with the common and proper hepatic arteries in such a way that the ducts occupy the extreme position on the right, to the left are the arteries, and behind the ducts and arteries and between them is the portal vein.

At the gates of the liver, the portal vein divides into two branches - the right and left, respectively, the right and left lobes of the liver.

Right branch, r. dexter, wider than left; it enters through the gates of the liver into the thickness of the right lobe of the liver, where it is divided into anterior and posterior branches, r. anterior et r. posterior.

Left branch, r. sinister, longer than right; heading to the left side of the gate of the liver, it, in turn, divides along the way into a transverse part, pars transversa, giving branches to the caudate lobe - tail branches, rr. caudati, and the umbilical part, pars umbilicalis, from which the lateral and medial branches depart, rr. laterales et mediales, into the parenchyma of the left lobe of the liver.

Three veins: inferior mesenteric, superior mesenteric and splenic, from which v. portae are called roots of the portal vein.

In addition, the portal vein receives the left and right gastric veins, vv. gastricae sinistra et dextra, prepyloric vein, v. prepylorica, paraumbilical veins, vv. paraumbilicales, and gallbladder vein, v. cystica.

1. Inferior mesenteric vein, v. mesenterica inferior, collects blood from the walls of the upper part of the straight, sigmoid colon and descending colon and with its branches corresponds to all branches of the inferior mesenteric artery.

It begins in the pelvic cavity as the superior rectal vein, v. rectalis superior, and in the wall of the rectum with its branches is connected with the rectal venous plexus, plexus venosus rectalis.

The superior rectal vein goes up, crosses the iliac vessels in front at the level of the left sacroiliac joint and receives the sigmoid intestinal veins, vv. sigmoideae, which follow from the wall of the sigmoid colon.

The inferior mesenteric vein is located retroperitoneally and, heading up, forms a small arc, facing the bulge to the left. Having taken the left colic vein, v. colica sinistra, the inferior mesenteric vein deviates to the right, passes immediately to the left of the duodenal-lean bend under the pancreas and most often connects with the splenic vein. Sometimes the inferior mesenteric vein flows directly into the portal vein.

2. Superior mesenteric vein, v. mesenterica superior, collects blood from the small intestine and its mesentery, caecum and appendix, ascending and transverse colon and from the mesenteric lymph nodes of these areas.

The trunk of the superior mesenteric vein is located to the right of the artery of the same name, and its branches accompany all the branches of this artery.

The superior mesenteric vein begins at the ileocecal angle, where it is called the ileocolic vein.

Ileococolic intestinal vein, v. ileocolica, collects blood from the terminal ileum, appendix (vein of the appendix, v. appendicularis) and the caecum. Heading up and to the left, the iliac-colon-intestinal vein continues directly into the superior mesenteric vein.

The superior mesenteric vein is located at the root of the mesentery of the small intestine and, forming an arc with a bulge to the left and down, receives a number of veins:

a) jejunal and ileo-intestinal veins, vv. jejunales et ileales, only 16 - 20, go to the mesentery of the small intestine, where they accompany the branches of the small intestinal arteries with their branches. Intestinal veins flow into the superior mesenteric vein on the left;

b) right colonic veins, vv. colicae dextrae, go retroperitoneally from the ascending colon and anastomose with the ileocolic-intestinal and middle colon-intestinal veins;

c) middle colic vein, v. colica media, located between the sheets of the mesentery of the transverse colon; it collects blood from the right flexure of the colon and the transverse colon. In the region of the left flexure of the colon, it anastomoses with the left colonic vein, v. colica sinistra, forming a large arcade;

d) right gastroepiploic vein, v. gastroepiploica dextra, accompanies the artery of the same name along the greater curvature of the stomach; collects blood from the stomach and greater omentum; at the level of the pylorus flows into the superior mesenteric vein. Before confluence, it takes pancreatic and pancreatoduodenal veins;

e) pancreatoduodenal veins, vv. pancreaticoduodenales, repeating the path of the arteries of the same name, collect blood from the head of the pancreas and duodenum;

e) pancreatic veins, vv. pancreaticae, depart from the parenchyma of the head of the pancreas, passing into the pancreatoduodenal veins.

3. Splenic vein, v. splenica, collects blood from the spleen, stomach, pancreas, and greater omentum.

It is formed in the region of the gate of the spleen from the numerous veins emerging from the substance of the spleen.

Here the splenic vein receives the left gastroepiploic vein, v. gastroepiploica sinistra, which accompanies the artery of the same name and collects blood from the stomach, greater omentum, and short gastric veins, vv. gastricae breves, which carry blood from the fundus of the stomach.

From the gate of the spleen, the splenic vein goes to the right along the upper edge of the pancreas, located below the artery of the same name. It crosses the anterior surface of the aorta just above the superior mesenteric artery and merges with the superior mesenteric vein to form the portal vein.

The splenic vein receives the pancreatic veins, vv. pancreaticae, mainly from the body and tail of the pancreas.

In addition to the indicated veins that form the portal vein, the following veins flow directly into its trunk:

a) prepyloric vein, v. prepylorica, begins in the pyloric region of the stomach and accompanies the right gastric artery;

b) gastric veins, left and right, v. gastrica sinistra et v. gastrica dextra, go along the lesser curvature of the stomach and accompany the gastric arteries. In the region of the pylorus, the veins of the pylorus flow into them, in the region of the cardial part of the stomach - the veins of the esophagus;

c) paraumbilical veins, vv. paraumbilicales (see Fig. 829, 841), begin in the anterior abdominal wall in the circumference of the umbilical ring, where they anastomose with the branches of the superficial and deep superior and inferior epigastric veins. Heading to the liver along the round ligament of the liver, the paraumbilical veins either merge into one trunk, or empty into the portal vein in several branches;

d) gall bladder vein, v. cystica, flows into the portal vein directly into the substance of the liver.

In addition, in this area in v. portae hepatis, a number of small veins flow from the walls of the portal vein itself, the hepatic arteries and ducts of the liver, as well as the veins from the diaphragm, which reach the liver through the falciform ligament.

Superior mesenteric vein

Location: Root of the mesentery of the small intestine

Blood collection basin: small intestine, caecum, ascending colon, transverse colon, pancreas;

Location: lies in the retroperitoneal space

Blood collection pool: Descending colon, sigmoid colon, rectum (via superior rectal vein)

Location: lies along the upper edge of the pancreas

Blood collection pool: Spleen, stomach, pancreas

TRUCKS OF THE PORTAL VEIN

Blood collection pool: stomach

Anastomoses: esophageal veins (tributaries of the unpaired and semi-unpaired veins)

Paraumbilical veins (remnants of the fetal umbilical vein). They come from the umbilical ring in the thickness of the round ligament of the liver;

Anastomoses: Superior epigastric vein, inferior epigastric vein

Forms around the umbilical ring from the junction of the superior and inferior epigastric veins and paraumbilical veins

Outflow path from the superior epigastric veins: internal thoracic vein, brachiocephalic vein, superior vena cava;

Outflow tract from the inferior epigastric veins: external iliac vein, common iliac vein, inferior vena cava

Paraumbilical veins - Portal vein

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Portal vein: functions, structure of the portal circulatory system, diseases and diagnostics

The portal vein (BB, portal vein) is one of the largest vascular trunks in the human body. Without it, the normal functioning of the digestive system and adequate detoxification of the blood is impossible. The pathology of this vessel does not go unnoticed, causing serious consequences.

The portal vein system of the liver collects blood coming from the abdominal organs. The vessel is formed by connecting the superior and inferior mesenteric and splenic veins. In some people, the inferior mesenteric vein empties into the splenic vein, and then the connection between the superior mesenteric and splenic veins forms the trunk of the MV.

Anatomical features of blood circulation in the portal vein system

The anatomy of the portal vein system (portal system) is complex. This is a kind of additional circle of venous circulation necessary to cleanse the plasma of toxins and unnecessary metabolites, without which they would immediately fall into the lower hollow, then into the heart and then into the pulmonary circle and the arterial part of the large.

The latter phenomenon is observed in lesions of the hepatic parenchyma, for example, in patients with cirrhosis. It is the absence of an additional "filter" on the path of venous blood from the digestive system that creates the prerequisites for severe intoxication with metabolic products.

Having studied the basics of anatomy at school, many remember that an artery enters most of the organs of our body, carrying blood rich in oxygen and nutrients, and a vein comes out, carrying “waste” blood to the right half of the heart and lungs.

The portal vein system is arranged somewhat differently; its peculiarity can be considered the fact that, in addition to the artery, the liver includes a venous vessel, the blood from which again enters the hepatic veins, having passed through the parenchyma of the organ. An additional blood flow is created, on the work of which the state of the whole organism depends.

The formation of the portal system occurs due to large venous trunks that merge with each other near the liver. The mesenteric veins transport blood from the intestinal loops, the splenic vein leaves the spleen and receives blood from the veins of the stomach and pancreas. Behind the head of the pancreas there is a connection of the venous "highways", giving rise to the portal system.

Between the sheets of the pancreatoduodenal ligament, the gastric, paraumbilical, and prepyloric veins flow into the EV. In this area, the EV is located behind the hepatic artery and common bile duct, together with which it follows to the gate of the liver.

At the gates of the liver, or not reaching them one and a half centimeters, there is a division into the right and left branches of the portal vein, which enter both hepatic lobes and there they break up into smaller venous vessels. Reaching the hepatic lobule, the venules braid it from the outside, enter inside, and after the blood is neutralized upon contact with hepatocytes, it enters the central veins emerging from the center of each lobule. The central veins gather into larger ones and form the hepatic veins, which carry blood from the liver and flow into the inferior vena cava.

A change in the size of the VV is of great diagnostic value and can indicate various pathologies - cirrhosis, venous thrombosis, pathology of the spleen and pancreas, etc. The normal length of the portal vein of the liver is approximately 6-8 cm, and the diameter of the lumen is up to one and a half centimeters.

The portal vein system does not exist in isolation from other vascular beds. Nature provides for the possibility of dumping "excess" blood into other veins if there is a violation of hemodynamics in this department. It is clear that the possibilities of such a discharge are limited and cannot last indefinitely, but they allow at least partially compensating the patient's condition in severe diseases of the hepatic parenchyma or thrombosis of the vein itself, although sometimes they themselves cause dangerous conditions (bleeding).

The connection between the portal vein and other venous collectors of the body is carried out through anastomoses, the localization of which is well known to surgeons, who quite often encounter acute bleeding from the anastomotic zones.

Anastomoses of the portal and caval veins in a healthy body are not expressed, since they do not bear any load. In pathology, when the flow of blood into the liver is difficult, the portal vein expands, the pressure in it increases, and the blood is forced to look for other ways of outflow, which become anastomoses.

These anastomoses are called portocaval, that is, the blood that was supposed to go to the vena cava goes to the vena cava through other vessels that unite both blood flow basins.

The most significant anastomoses of the portal vein include:

• Connection of gastric and esophageal veins;
• Anastomoses between the veins of the rectum;
• Fistula of the veins of the anterior wall of the abdomen;
• Anastomoses between the veins of the digestive organs with the veins of the retroperitoneal space.

In the clinic, the anastomosis between the gastric and esophageal vessels is of the greatest importance. If the movement of blood along the EV is disturbed, it is expanded, portal hypertension increases, then the blood rushes into the flowing vessels - the gastric veins. The latter have a system of collaterals with the esophagus, where the venous blood that has not gone to the liver is redirected.

Since the possibilities of dumping blood into the vena cava through the esophageal are limited, their overload with excess volume leads to varicose expansion with the likelihood of bleeding, often fatal. The longitudinally located veins of the lower and middle thirds of the esophagus do not have the ability to subside, but are at risk of injury when eating, gag reflex, reflux from the stomach. Bleeding from varicose veins of the esophagus and the initial part of the stomach is not uncommon in cirrhosis of the liver.

From the rectum, venous outflow occurs both into the BB system (upper third), and directly into the lower vena cava, bypassing the liver. With an increase in pressure in the portal system, stagnation inevitably develops in the veins of the upper part of the organ, from where it is discharged through collaterals into the middle vein of the rectum. Clinically, this is expressed in varicose veins of hemorrhoids - hemorrhoids develop.

The third junction of the two venous basins is the abdominal wall, where the veins of the umbilical region take on "excess" blood and expand towards the periphery. Figuratively, this phenomenon is called the “head of a jellyfish” because of some external resemblance to the head of the mythical Gorgon Medusa, which had writhing snakes instead of hair on its head.

Anastomoses between the veins of the retroperitoneal space and VV are not as pronounced as those described above, it is impossible to trace them by external signs, they are not prone to bleeding.

Video: lecture on the veins of the systemic circulation

Video: basic information about the portal vein from the abstract

Pathology of the portal system

Among the pathological conditions in which the BB system is involved, there are:

1. Thrombus formation (extra- and intrahepatic);
2. Portal hypertension syndrome (SPH) associated with liver pathology;
3. Cavernous transformation;
4. Purulent inflammatory process.

Portal vein thrombosis

Portal vein thrombosis (PVT) is a dangerous condition in which blood clots appear in the PV, preventing its movement towards the liver. This pathology is accompanied by an increase in pressure in the vessels - portal hypertension.

4 stages of portal vein thrombosis

According to statistics, in residents of developing regions, CPH is accompanied by thrombus formation in the ventricle in a third of cases. In more than half of patients who die of cirrhosis, thrombotic clots can be detected postmortem.

The causes of thrombosis are:

• Cirrhosis of the liver;
• Malignant tumors of the intestine;
• Inflammation of the umbilical vein during catheterization in infants;
• Inflammatory processes in the digestive organs - cholecystitis, pancreatitis, intestinal ulcers, colitis, etc.;
• Injuries; surgical interventions (bypass surgery, removal of the spleen, gallbladder, liver transplant);
• Blood clotting disorders, including some neoplasias (polycythemia, pancreatic cancer);
• Some infections (tuberculosis of the portal lymph nodes, cytomegalovirus inflammation).

Pregnancy and long-term use of oral contraceptives are among the very rare causes of PVT, especially if the woman has crossed the age limit.

Symptoms of PVT consist of severe abdominal pain, nausea, dyspeptic disorders, and vomiting. An increase in body temperature, bleeding from hemorrhoids is possible.

Chronic progressive thrombosis, when blood circulation through the vessel is partially preserved, will be accompanied by an increase in the typical picture of SPH - fluid will accumulate in the abdomen, the spleen will increase, giving a characteristic heaviness or pain in the left hypochondrium, the veins of the esophagus will expand with a high risk of dangerous bleeding.

The main way to diagnose PVT is ultrasound, while the thrombus in the portal vein looks like a dense (hyperechoic) formation that fills both the lumen of the vein itself and its branches. If ultrasound is supplemented with dopplerometry, then there will be no blood flow in the affected area. Cavernous degeneration of vessels due to the expansion of small-caliber veins is also considered characteristic.

Small thrombi in the portal system can be detected by endoscopic ultrasound, and CT and MRI can determine the exact causes and find possible complications of thrombus formation.

Video: incomplete portal vein thrombosis on ultrasound

portal hypertension syndrome

Portal hypertension is an increase in pressure in the portal vein system, which may be accompanied by local thrombosis and severe pathology of internal organs, primarily the liver.

Normally, the pressure in the BB is not more than ten mm Hg. st, if this indicator is exceeded by 2 units, we can already talk about LNG. In such cases, porto-caval anastomoses gradually turn on, and varicose expansion of the collateral outflow tract occurs.

• Cirrhosis of the liver;
• Budd-Chiari syndrome (liver vein thrombosis);
• Hepatitis;
• Severe heart defects;
• Metabolic disorders - hemochromatosis, amyloidosis with irreversible damage to the liver tissue;
• Thrombosis of the vein of the spleen;
• Thrombosis of the portal vein.

Clinical signs of SPH are dyspeptic disorders, a feeling of heaviness in the right hypochondrium, jaundice, weight loss, and weakness. Splenomegaly, that is, an enlargement of the spleen, which experiences venous congestion on itself, since blood is not able to leave the splenic vein, as well as ascites (fluid in the abdomen) and varicose veins of the lower esophagus (as a result of venous blood bypass) ).

Ultrasound of the abdominal cavity with LPH will show an increase in the volume of the liver, spleen, the presence of fluid. The width of the lumen of the vessels and the nature of the movement of blood is assessed by Doppler ultrasound: the BB is increased in diameter, the lumen of the superior mesenteric and spleen veins are dilated.

Cavernous transformation

With SPH, PVT, congenital malformations of the liver veins (narrowing, partial or complete absence), a so-called cavernous can often be detected in the region of the portal vein trunk. This zone of cavernous transformation is represented by many intertwining vessels of small diameter, which partially compensate for the lack of blood circulation in the portal system. Cavernous transformation has an outward resemblance to a tumor-like process, which is why it is called a cavernoma.

The detection of cavernoma in children may be an indirect sign of congenital anomalies of the vascular system of the liver; in adults, it often indicates the development of portal hypertension against the background of cirrhosis and hepatitis.

Inflammatory processes

an example of the development of pylephlebitis due to a diverticulum of the sigmoid colon

Among the rare lesions of the portal vein include acute purulent inflammation - pylephlebitis, which has a distinct tendency to "develop" into thrombosis. The main culprit of pylephlebitis is acute appendicitis, and the consequence of the disease is abscessing in the liver tissue and the death of the patient.

The symptoms of inflammation in the VV are extremely nonspecific, so it is very difficult to suspect this process. More recently, the diagnosis was made mainly posthumously, but the possibility of using MRI has somewhat changed the quality of diagnosis for the better, and pylephlebitis can be detected during life.

Signs of pylephlebitis include fever, chills, severe intoxication, and abdominal pain. Purulent inflammation of the BB can cause an increase in pressure in the vessel and, accordingly, bleeding from the esophageal and gastric veins. When an infection enters the liver parenchyma and purulent cavities develop in it, jaundice will appear.

Laboratory examinations for pylephlebitis will show the presence of an acute inflammatory process (ESR will increase, leukocytes will increase), but ultrasound, dopplerometry, CT and MRI help to reliably judge the presence of pylephlebitis.

Diagnostics of the pathology of the portal vein

The main method for diagnosing changes in the portal vein is ultrasound, the advantages of which can be considered safety, low cost and high availability for a wide range of people. The study is painless, does not take much time, can be used for children, pregnant women and the elderly.

Doppler ultrasound is considered a modern addition to routine ultrasound, which allows you to assess the speed and direction of blood flow. BB on ultrasound is visible at the gates of the liver, where it bifurcates into horizontally located right and left branches. So the blood during dopplerometry is directed towards the liver. The norm on ultrasound is the diameter of the vessel within 13 mm.

With thrombus formation in a vein, hyperechoic content will be detected, heterogeneous, filling part of the diameter of the vessel or completely the entire lumen, leading to a total cessation of blood flow. Color Doppler imaging will show the absence of blood flow with complete obstruction by a thrombus or its parietal character near the blood clot.

With SPH on ultrasound, the doctor will detect an expansion of the lumen of the vessels, an increase in the volume of the liver, the accumulation of fluid in the abdominal cavity, and a decrease in blood flow velocity on color Doppler. An indirect sign of SPH will be the presence of cavernous changes that can be confirmed by dopplerometry.

In addition to ultrasound, contrast-enhanced CT is used to diagnose portal vein pathology. The advantages of MRI can be considered the ability to determine the causes of changes in the portal system, examination of the liver parenchyma, lymph nodes and other nearby formations. The disadvantage is the high cost and low availability, especially in small towns.

Angiography is one of the most accurate methods for diagnosing portal thrombosis. In case of portal hypertension, the examination necessarily includes FGDS to assess the state of porto-caval anastomoses in the esophagus, esophagoscopy, and possibly X-ray contrast examination of the esophagus and stomach.

The data of instrumental examination methods are supplemented by blood tests, in which deviations from the norm are detected (leukocytosis, an increase in liver enzymes, bilirubin, etc.), and patient complaints, after which the doctor can make an accurate diagnosis of damage to the portal system.

Pancreas (superior mesenteric vein)

The superior mesenteric vein is in contact with the gland for 1.5-2 cm. It is located in the incisura pancreatis and is almost completely surrounded by the tissue of the gland. Only on the left this groove is open, and here next to the vein is the superior mesenteric artery surrounded by periarterial tissue.

The posterior wall of the stomach is adjacent to the anterior surface of the body of the gland. Often, the body of the gland partially or completely protrudes above the lesser curvature of the stomach and comes into contact with the hepatogastric ligament, as well as the caudate lobe of the liver. At the upper edge of the body of the gland is the gastro-pancreatic ligament, between the leaves of which the left gastric artery passes, accompanied by the vein of the same name. To the right of this ligament, along the upper edge of the gland or somewhat posterior to it, lies the common hepatic artery. Along the lower edge of the gland (in rare cases on its front surface) is the root of the mesentery of the transverse colon.

The posterior surface of the body of the pancreas is in direct contact with the splenic vessels and the inferior mesenteric vein. The splenic artery is located behind the upper edge of the pancreas. Sometimes bends or loops form along its course. In such cases, in some areas, the artery may protrude above the upper edge of the gland or go downward, approaching the splenic vein or crossing it.

The splenic vein is located below the artery of the same name and, on the way to the portal vein, receives 15-20 short venous trunks coming from the gland. At the lower edge of the pancreas runs the inferior mesenteric vein, heading to the superior mesenteric, splenic or portal vein.

"Atlas of operations on the abdominal wall and abdominal organs" V.N. Voilenko, A.I. Medelyan, V.M. Omelchenko

The head of the pancreas is placed in the C-curve of the duodenum. At the top, it is adjacent to the lower and posterior surfaces of the upper part of the duodenum. In some cases, the glandular mass also partially covers the anterior or posterior surface of the descending part of the duodenum. The uncinate process is in contact with the lower part of the duodenum, its medial part is located behind the superior mesenteric and portal veins, ...

The inferior vena cava is covered by a gland for 5-8 cm. Between the head of the gland and the inferior vena cava, as well as the renal vessels, there is a thin layer of retroperitoneal tissue. There are no tight adhesions here, and therefore, if necessary, for example, during pancreatoduodenal resection, as well as during mobilization of the duodenum, the head of the gland, together with the descending part of the duodenum, can be completely free ...

In the retroperitoneal tissue posterior to the pancreas is the aorta, as well as branches extending from it: the celiac trunk and the superior mesenteric artery. The distance between these vessels at the place of their departure from the aorta in most cases does not exceed 0.5-3 cm, sometimes they depart in one common trunk. The celiac trunk is surrounded by the celiac nerve plexus, from which along the arterial ...

1 - ductus choledochus; 2-v. portae; 3-a. hepatica communis; 4 - ductus pancreaticus; 5 - pancreas; 6 - flexura duodenojejunalis; 7 - papilla duodeni major; 8 - ductus pancreaticus accessorius; 9 - papilla duodeni minor; 10 - duodenum. Blood supply. The pancreatic arteries are branches of the hepatic, splenic, and superior mesenteric arteries. Blood supply…

Blood supply to the head of the pancreas (front view). 1 - aorta abdominalis; 2 - truncus coeliacus; 3-a. gastric sinistra; 4-a. lienalis; 5-a. et v. colica media; 6-a. et v. mesenterica superior; 7-a. et v. pancreaticoduodenalis inferior anterior; 8 - caput pancreatis; 9 - duodenum; 10-a….

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Superior mesenteric vein

portal vein system

From the unpaired organs of the abdominal cavity, except for the liver, blood is first collected in the portal vein system, through which it goes to the liver, and then through the hepatic veins to the inferior vena cava.

The portal vein (Fig. 96) is a large visceral vein (length 5-6 cm, diameter 11-18 mm), formed by connecting the inferior and superior mesenteric and splenic veins. The veins of the stomach, small and large intestine, spleen, pancreas and gallbladder flow into the portal vein. Then the portal vein goes to the gate of the liver and enters its parenchyma. In the liver, the portal vein is divided into two branches: the right and the left, each of which, in turn, is divided into segmental and smaller ones. Inside the lobules of the liver, they branch into wide capillaries (sinusoids) and flow into the central veins, which pass into the sublobular veins. The latter, connecting, form three or four hepatic veins. Thus, blood from the organs of the digestive tract passes through the liver, and then only enters the system of the inferior vena cava.

The superior mesenteric vein runs into the roots of the mesentery of the small intestine. Its tributaries are the veins of the jejunum and ileum, pancreatic, pancreatoduodenal, iliac-colic, right gastroepiploic, right and middle colic veins and the vein of the appendix. The superior mesenteric vein receives blood from the above organs.

Rice. 96. Portal vein system:

1 - superior mesenteric vein; 2 - stomach; 3 - left gastroepiploic vein; 4 - left gastric vein; 5- spleen; 6- tail of the pancreas; 7- splenic vein; 8- inferior mesenteric vein; 9 - descending colon; 10 - rectum; 11 - lower rectal vein; 12 - middle rectal vein; 13 - superior rectal vein; 14 - ileum; 15 - ascending colon; 16 - head of the pancreas; 17, 23 - right gastroepiploic vein; 18 - portal vein; 19 - gallbladder vein; 20 - gallbladder; 21 - duodenum; 22 - liver; 24- pyloric vein

The splenic vein collects blood from the spleen, stomach, pancreas, duodenum, and greater omentum. The tributaries of the splenic vein are the short gastric veins, the pancreatic vein, and the left gastroepiploic vein.

The inferior mesenteric vein is formed by the fusion of the superior rectal vein, left colic, and sigmoid veins; it collects blood from the walls of the upper rectum, sigmoid colon, and descending colon.

1. Superior mesenteric artery, a mesenteric superior. Unpaired branch of the abdominal aorta. It starts about 1 cm below the celiac trunk, first lies behind the pancreas, then passes in front of the uncinate process. Its branches continue into the mesentery of the small and transverse colon. Rice. A, B.
2. Inferior pancreatoduodenal artery pancreaticoduodenalis inferior. It departs at the level of the upper edge of the horizontal part of the duodenum. Its branches lie in front and behind the head of the pancreas. Rice. A. 2a Anterior branch, ramus anterior. Anastomoses with the anterior superior pancreatoduodenal artery. Rice. AT.
3. Jejunal arteries, aajejunales. Goes to the jejunum in her mesentery. Rice. BUT.
4. The ileal arteries, aa ileales. They approach the ileum between the two sheets of its mesentery. Rice. BUT.
5. Ileocolic artery, a. ileocolica. In the mesentery of the small intestine goes down and to the right to the iliocecal angle. Rice. BUT.
6. Colon branch, ramus colicus. Goes to the ascending colon. Anastomoses with the right colonic artery. Rice. BUT.
7. Anterior caecum artery, a. caecalis (cecalis) anterior. In the caecal fold, it approaches the anterior surface of the caecum. Rice. BUT.
8. Posterior caecum artery, a. caecalis (cecalis) posterior. Heads behind the terminal ileum to the posterior surface of the caecum. Rice. BUT.
9. Artery of the appendix, a. appendicularis. It crosses behind the ileum and lies along the free edge of the mesentery of the appendix. The place of origin of the artery is unstable, it can be double. Rice. A. 9a Ileal branch, ramus ile: alis. It goes to the ileum and anastomoses with one of the small intestinal arteries. Rice. BUT.
10. Right colonic artery, a. colic dextra. Anastomoses with the ascending branch of the ileocolic and middle colonic arteries. Rice. A. 10a Artery of the right flexure of the colon, aflexura dextra. Rice. BUT.
11. Middle colonic artery, a. colica media. It is located in the mesentery of the transverse colon. Rice. A. Pa Regional colonic artery, a. marginalis coli[]. Anastomosis of the left colic and sigmoid arteries. Rice. B.
12. Inferior mesenteric artery, and tesenterica inferior. Departs from the abdominal part of the aorta at the level of L3 - L4. Heads to the left and supplies the left third of the transverse colon, descending, sigmoid colon, as well as most of the rectum. Rice. B. 12a Ascending [intermesenteric] artery, a ascendeus. Anastomoses with the left colonic and middle colonic arteries. Rice. A, B.
13. Left colonic artery, a. colic sinistra. Retroperitoneally goes to the descending colon. Rice. B.
14. Sigmoid intestinal arteries, aa. sigmoideae. Goes obliquely down to the wall of the sigmoid colon. Rice. B.
15. Superior rectal artery, a. rectalis superior. Behind the rectum, it enters the small pelvis, where it is divided into right and left branches, which, perforating the muscle layer, supply the intestinal mucosa with blood to the anal flaps. Rice. B.
16. Middle adrenal artery, and suprarenalis (adrenalis) media. It departs from the abdominal part of the aorta and supplies the adrenal gland with blood. Rice. AT.
17. Renal artery, a. renalis. It starts from the aorta at the level of L 1 and divides into several branches that go to the hilum of the kidney. Rice. C, D. 17a Capsular arteries, aaxapsulares (perirenales). Rice. AT.
18. Inferior adrenal artery, a. suprarenalis inferior. Participates in the blood supply to the adrenal gland. Rice. AT.
19. Anterior branch, ramus anterior. Blood supply to the upper, anterior and lower segments of the kidney. Rice. V, G.
20. Upper segment artery, a. segment superioris. Spreads to the posterior surface of the kidney. Rice. AT.
21. Artery of the upper anterior segment, a.segmenti anterioris superioris. Rice. AT.
22. Artery of the lower anterior segment, a segmenti anterioris inferioris. Branch to the anteroinferior segment of the kidney. Rice. AT.
23. Artery of the lower segment, a. segmenti inferioris. It spreads to the back surface of the organ. Rice. AT.
24. Posterior branch, ramus posterior. Heads to the posterior, largest segment of the kidney. Rice. V, G.
25. Artery of the posterior segment, a. segmenti posterioris. Branches in the corresponding segment of the kidney. Rice. G.
26. Ureteric branches, rami ureterici. Branches to the ureter. Rice. AT.

The superior mesenteric artery (a. mesenterica superior) is a large vessel that supplies blood to most of the intestines and pancreas. The place of origin of the artery varies within the limits of the XII thoracic - II lumbar vertebrae. The distance between the orifices of the celiac trunk and the superior mesenteric artery varies from 0.2 to 2 cm.

Coming out from under the lower edge of the pancreas, the artery goes down and to the right and, together with the superior mesenteric vein (to the left of the latter), lies on the anterior surface of the ascending part of the duodenum. Descending along the root of the mesentery of the small intestine towards the ileocecal angle, the artery gives off numerous jejunal and ileo-intestinal arteries, passing into the free mesentery. Two right branches of the superior mesenteric artery (iliococolic and right colic), heading to the right part of the large intestine, together with the veins of the same name, lie retroperitoneally, directly under the peritoneal sheet of the bottom of the right sinus (between the parietal peritoneum and Toldt's fascia). Regarding the syntopy of the various parts of the trunk of the superior mesenteric artery, it is divided into three sections: I - pancreatic, II - pancreatic duodenal, III - mesenteric.

The pancreatic section of the superior mesenteric artery is located between the crura of the diaphragm and, heading anteriorly from the abdominal aorta, pierces the pre-renal fascia and Treitz's fascia.

The pancreas-duodenal region is located in the venous ring, formed from above by the splenic vein, from below by the left renal vein, to the right by the superior mesenteric vein, and to the left by the inferior mesenteric vein at its confluence with the splenic vein. Such an anatomical feature of the location of the second section of the superior mesenteric artery determines the cause of arterio-mesenteric intestinal obstruction due to compression of the ascending part of the duodenum between the aorta at the back and the superior mesenteric artery at the front.

The mesenteric part of the superior mesenteric artery is located in the mesentery of the small intestine.

Variants of the superior mesenteric artery are combined into four groups: I - origin of branches common to the superior mesenteric artery from the aorta and celiac trunk (absence of the trunk of the superior mesenteric artery), II - doubling of the trunk of the superior mesenteric artery, III - origin of the superior mesenteric artery by a common trunk with the celiac, IV - the presence of supernumerary branches extending from the superior mesenteric artery (common hepatic, splenic, gastroduodenal, right gastroepiploic, right gastric, transverse pancreas, left colon, superior rectal) [Kovanov V.V., Anikina T.I., 1974].

Visceral branches: middle adrenal and renal arteries

Middle adrenal artery (a. supra-renalis midia) - a small paired vessel extending from the side wall of the upper aorta, slightly below the origin of the superior mesenteric artery. It goes outward, to the adrenal gland, crossing the transverse lumbar pedicle of the diaphragm. It may originate from the celiac trunk or from the lumbar arteries.

renal artery (a. renalis) - steam room, powerful short artery. Starts from the lateral wall of the aorta almost at a right angle to it at the level I-II lumbar vertebrae. The distance from the origin of the superior mesenteric artery varies within 1-3 cm. The trunk of the renal artery can be conditionally divided into three sections: peri-aortic, middle, perirenal. The right renal artery is slightly longer than the left because the aorta lies to the left of the midline. Heading to the kidney, the right renal artery is located behind the inferior vena cava, crosses the spine with the thoracic lymphatic duct lying on it. Both renal arteries, on their way from the aorta to the hilum of the kidneys, cross the medial crura of the diaphragm in front. Under certain conditions, variants of the relationship of the renal arteries with the medial crus of the diaphragm can be the cause of the development of vasorenal hypertension (abnormal development of the medial crus of the diaphragm, in which the renal artery is posterior to it). Except

In addition, the abnormal location of the trunk of the renal artery anterior to the inferior vena cava can lead to congestion in the lower extremities. From both renal arteries, thin inferior suprarenal arteries depart upward and ureteral branches downward (Fig. 26).

Rice. 26. Branches of the renal artery. 1 - middle adrenal artery; 2 - lower adrenal artery; 3 - renal artery; 4 - ureteral branches; 5 - rear branch; 6 - front branch; 7 - artery of the lower segment; 8 - artery of the lower anterior segment; 9 - artery of the upper anterior segment; 10 - artery of the upper segment; 11 - capsular arteries. Quite often (15-35% of cases submitted by different authors) there are additional renal arteries. All their diversity can be divided into two groups: the arteries entering the gate of the kidney (accessory hylus) and the arteries penetrating the parenchyma outside the gate, more often through the upper or lower pole (additional polar or perforating). The arteries of the first group almost always depart from the aorta and run parallel to the main artery. Polar (perforating) arteries, in addition to the aorta, can also depart from other sources (common, external or internal iliac, adrenal, lumbar) [Kovanov V.V., Anikina T.I., 1974].