Branches of the thoracic aorta. Thoracic aorta anatomy Arteries of the thoracic aorta

10. There are three branches on the vine; it developed, color appeared on it, berries grew and ripened on it; 11 And Pharaoh's cup is in my hand; I took the berries, squeezed them into Pharaoh's cup, and gave the cup into Pharaoh's hand. 12. And Joseph said to him: This is the interpretation of it: three branches are three days; 13. in three days

Nutrition of all organs and systems of the human body, its growth and development is possible thanks to the work of the circulatory system. Nutrients and oxygen are carried with the blood, metabolic products and carbon dioxide are removed.

The heart and blood vessels are components of the circulatory system. The aorta is the largest arterial vessel in the human body. The part of the aorta located in the chest area is called the thoracic aorta, and it extends from the heart. The condition of the body as a whole depends on the condition and functioning of this part of the aorta.

Structure

The thoracic aorta is the part of the aorta located in the chest, adjacent to the spine. Two types of branches arise from the aorta:

Internal branches of the thoracic aorta:

• Esophageal (3-6 pieces) - directed towards the wall of the esophagus.
• Bronchial (from 2 pieces) – directed to the bronchi. The lungs are fed with blood.
• Pericardial (pericardial sac) - supplies blood to the back of the pericardial sac.
• Mediastinal (mediastinal) - small in size, in large quantities, supply connective tissue, lymph nodes, and mediastinal organs with blood.

Wall:

• Intercostal posterior arteries (10 pairs). 9 pairs of arteries are located in the spaces between ribs 3-11, the last 10th pair passes under the 12th ribs, which is why they are called subcostal. These 10 pairs of arteries supply blood to the abdominal muscles, mammary glands, intercostal muscles, back muscles, skin, and spinal cord.
• 2 diaphragmatic superior arteries of the thoracic aorta - supply blood to the upper part of the diaphragm.

Diseases of the thoracic aorta

The most common diseases affecting the aorta are:

• Atherosclerosis is a vascular disease that is accompanied by the appearance of plaques on the walls of blood vessels. In this case, the walls are deformed, blood circulation is disrupted, internal organs receive insufficient nutrition, and their work deviates from the norm. Plaques on the walls of the thoracic aorta affect the functioning of all organs and systems, since the body cannot function normally without proper blood flow. The main cause of atherosclerosis is excess fat in the arteries.
• An aneurysm is an expansion of a vessel in some area, the walls of the vessel bulge. The protrusion occurs due to the pressure of blood passing through the aorta on the weakened walls of the vessel. An aneurysm can be in any artery or vein, but most often occurs in the aorta. In 25% of cases of aortic aneurysm, the protrusion occurs in its thoracic part. An aneurysm is dangerous not only for health, but also for human life due to the likelihood of its rupture.

Symptoms of an aneurysm

Often atherosclerosis, followed by a thoracic aortic aneurysm, develops asymptomatically. The protrusion can reach enormous sizes without showing itself in any way. Symptoms occur when an enlarged part of the aorta begins to put pressure on nearby organs. About 50% of patients describe 1 or more of the following symptoms accompanying an aortic aneurysm:

Causes

Aneurysm is the most dangerous consequence of atherosclerosis. In addition, a thoracic aortic aneurysm can occur for the following reasons:

• Congenital disease. Most often, Marfan syndrome is the cause of thoracic aortic aneurysm in half of the cases.
• The result of injury, such as a car accident.
• Consequence of mycotic, syphilitic damage to the walls of blood vessels.

In 50% of cases, the exact cause of the aneurysm cannot be determined. Although in most cases such patients have high blood pressure.

Diagnostics

Often an aneurysm is discovered by chance during an examination. If you have 1 or more symptoms, you can determine the presence of a thoracic aortic aneurysm using:

• X-rays, fluoroscopy of the chest area.
• Computed tomography, magnetic resonance imaging, transesophageal ultrasound, which allow you to find out the size of the aneurysm.
• Aortography is an x-ray research method that is carried out using a contrast agent injected into the blood. With its help, you can see the aneurysm and determine the type of surgery required.

Treatment

The most effective and often the only possible method of treating thoracic aortic aneurysm is surgery. At any time, a damaged vessel can rupture and lead to hemorrhage and death. The operation is performed when the aneurysm diameter is more than 7.5 cm. In patients with Marfan syndrome, the likelihood of aneurysm rupture is much higher, so in this case the operation can be performed with a smaller aneurysm size.

The modified part of the vessel is removed and an artificial vessel is inserted in its place. Such a prosthesis usually does not reject, repeated operations are not required, and the new vessel functions normally for the rest of the patient’s life. The mortality rate during the operation is 10-15%. Therefore, until the aneurysm has reached a critical size, drug treatment is carried out - taking beta-blockers, which reduce the heart rate and lower blood pressure.

The thoracic aorta is the largest artery in the body and carries blood from the heart.

It is located in the chest, which is why it is called the thoracic cavity.

Structure of the thoracic aorta

The thoracic aorta is located in the posterior mediastinum and is adjacent to the vertebral column.

The splanchnic branches of the thoracic aorta include:

• Esophageal branches, which in the amount of 3-6 are directed to the wall of the esophagus. They branch out into ascending branches that anastomose with the left ventricular artery, as well as descending branches that anastomose with the inferior thyroid artery.
• Bronchial branches, which in the amount of 2 or more branch with the bronchi. They supply blood to the lung tissues. Their terminal branches approach the bronchial lymph nodes, esophagus, pericardial sac and pleura.
• Pericardial bursal or pericardial branches, which are responsible for supplying blood to the posterior surface of the pericardial sac.
• Mediastinal or mediastinal branches, small and numerous, which nourish the mediastinal organs, lymph nodes and connective tissue.

The group of parietal branches of the thoracic aorta consists of:

• There are 10 pairs of posterior intercostal arteries. 9 of them pass in the intercostal spaces, from the 3rd to the 11th. The lower arteries lie under the twelfth ribs and are called subcostal. Each artery divides into a spinal branch and a dorsal branch. Each intercostal artery at the heads of the ribs branches into an anterior branch, which supplies the rectus and broad abdominal muscles, intercostal muscles, mammary gland, chest skin, and a posterior branch, which supplies blood to the muscles and skin of the back, as well as the spinal cord.
• There are two superior phrenic arteries of the thoracic aorta, which supply blood to the upper surface of the diaphragm.

Arteries of the chest cavity

• Aortic arch;
• Vertebral artery;
• Left and right common carotid arteries;
• Highest intercostal artery;
• Renal artery;
• Aorta;
• Common hepatic artery;
• Left subclavian artery;
• Intercostal arteries;
• Superior mesenteric artery;
• Right subclavian artery;
• Inferior phrenic artery;
• Left gastric artery.

The most common diseases of the thoracic aorta

The most common diseases of the thoracic aorta include aneurysm and atherosclerosis of the thoracic aorta.

Atherosclerosis of the thoracic aorta usually develops earlier than other forms of atherosclerosis, but may not manifest itself for a long time. It often develops simultaneously with atherosclerosis of the coronary arteries of the heart or atherosclerosis of the brain vessels.

The first symptoms of atherosclerosis, as a rule, appear already in adulthood, when the walls of the aorta have already been largely destroyed. Patients complain of periodic burning pain in the chest (aortalgia), increased systolic pressure, difficulty swallowing, and dizziness.

Often less specific signs of atherosclerosis of the thoracic aorta are too early aging and the appearance of gray hair, wen on the face, a light stripe along the outer edge of the iris, and strong hair growth in the ears.

One of the most dangerous complications of atherosclerosis is aortic aneurysm.

A thoracic aortic aneurysm is a condition in which a weak part of the aorta bulges or expands. The pressure of the blood flowing through the aorta causes it to bulge.

Aneurysms pose a serious danger not only to the health, but also to the life of the patient, since the aorta can rupture, leading to internal bleeding and death. Up to 30% of patients with a ruptured aneurysm who are admitted to hospital survive. This is why a thoracic aortic aneurysm must be treated to avoid rupture.

About half of patients with an aneurysm do not have any symptoms of the disease. Mostly people complain of pain in the lower back and chest, neck, back and jaw. Difficulty breathing, coughing, and hoarseness occur.

With a large aneurysm, the aortic heart valve may be involved, resulting in heart failure.

The most common causes of thoracic aortic aneurysm are:

• Congenital diseases of connective tissue (Marfan syndrome, Ehlers-Danlos syndrome), cardiovascular system (coarctation of the aorta, heart defects, tortuosity of the aortic isthmus).
• Acquired diseases such as atherosclerosis, or after operations on the sites of aortic cannulation, aortic patches or suture lines of prosthetic anastomoses.
• Inflammatory diseases (infection of the aortic prosthesis, non-infectious and infectious aortritis).

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Branches of the thoracic aorta

Two groups of branches depart from the thoracic aorta: visceral (rr. viscerales) and parietal (rr. parietales) (Fig. 401).

401. Scheme of the structure of intercostal arteries and their anastomoses.

3 - a. intercostalis anterior;

4 - r. cutaneus lateralis;

5 - a. thoracica interna;

Visceral branches of the thoracic aorta: 1. Bronchial branches (rr. bronchiales), numbering 2-4, originate from the anterior surface of the aorta at the level of the origin of the third intercostal arteries, enter the gates of the right and left lungs, forming an intraorgan bronchial arterial network that supplies blood of the bronchi, connective tissue stroma of the lung, peribronchial lymph nodes, walls of the branches of the pulmonary arteries and veins, pericardium and esophagus. In the lung, the bronchial branches anastomose with the branches of the pulmonary arteries.

2. Esophageal branches (rr. esophagei), 3-4 in number, 1.5 cm long and thin branches reach the wall of the thoracic part of the esophagus. They arise from the thoracic aorta at the level of ThIV - ThVIII. Anastomose with the branches of the superior and inferior thyroid, mediastinal, left coronary artery of the heart and superior arteries of the diaphragm.

3. Pericardial branches (rr. pericardiaci), numbering 1-2, short and thin, start from the anterior surface of the aorta and supply the posterior wall of the pericardium with blood. Anastomose with the arteries of the esophagus and mediastinum.

4. Mediastinal branches (rr. mediastinales) are unstable and vary in position. They are often common with pericardial branches. They supply blood to the posterior wall of the pericardium, fiber and lymph nodes of the posterior mediastinum.

Anastomose with previous arteries.

Parietal branches of the thoracic aorta: 1. Posterior intercostal arteries (aa. intercostales posteriores), numbering 9-10 pairs, arise from the posterior wall of the aorta and are located in the third to eleventh intercostal spaces. The last posterior intercostal artery, the subcostal (a. subcostalis), goes below the XII rib and anastomoses with the lumbar arteries. The first and second intercostal spaces receive blood from the subclavian artery due to a. intercostalis suprema. The right intercostal arteries are slightly longer than the left ones and pass under the pleura to the corners of the ribs behind the organs of the posterior mediastinum along the anterior surface of the vertebral bodies. The intercostal arteries at the head of the ribs give off dorsal branches (rr. spinales) to the skin and muscles of the back, the spine and the spinal cord with its membranes. From the corners of the ribs, the arteries penetrate between the external and internal intercostal muscles, located in the costal groove. Anterior to the linea axillaris posterior, starting from the eighth intercostal space and below, the arteries lie in the middle of the intercostal space below the corresponding rib, give off lateral branches to the skin and muscles of the lateral part of the chest, and then anastomose with the anterior intercostal branches of the internal mammary artery. From the IV, V, VI intercostal arteries branches extend to the mammary gland.

The upper intercostal arteries supply blood to the chest, the lower three - the anterior abdominal wall and diaphragm. A branch departs from the right III intercostal artery to the right bronchus, and branches supplying blood to the left bronchus begin from the left I - V intercostal arteries.

The esophageal arteries originate from the III-VI intercostal arteries.

2. The superior phrenic arteries (aa. phrenicae superiores) originate from the aorta above the hiatus aorticus. They supply blood to the lumbar part of the diaphragm and pleura. Anastomose with the lower intercostal arteries, with the branches of the internal thoracic and lower phrenic arteries.

Thoracic aorta

1. The superior phrenic arteries, aa.. phrenicae superiores, number 2, arise from the anterior wall of the lower part of the aorta and are directed to the upper surface of the lumbar part of the diaphragm.
2. The posterior intercostal arteries (III-XI), aa.. intercostales posteriores (III-XI), are quite powerful vessels, 10 pairs in number, starting from the posterior surface of the thoracic aorta along its entire length. Nine of them lie in the intercostal spaces, from the third to the eleventh inclusive, and the lowest ones go under the XII ribs; they are called subcostal arteries, aa.. subcostales. The right intercostal arteries are slightly longer than the left ones, since aorta in this place it is located asymmetrically, on the left surface of the vertebral trunk. Having reached the heads of the ribs, each intercostal artery splits into two branches: a smaller one - the dorsal branch, the dorsalis, and a more powerful one - the anterior branch, or the intercostal artery itself.

a) The dorsal branch, g. dorsalis, is directed under the neck ribs between its ligaments (lig. costotransversarium) on the posterior (dorsal) surface of the body; through the intervertebral foramen it gives to the spinal cord a spinal branch, the spina-lis, which in the spinal canal anastomoses with the vessels of the same name lying above and below and with the branch of the same name on the opposite side, forming an arterial ring around the spinal cord. It also supplies the membranes of the spinal cord and vertebrae. The terminal trunks of the posterior branches go further posteriorly, giving rise to muscular branches. Then each of the terminal trunks is divided into two branches: the medial cutaneous branch, cutaneus medialis, which supplies the skin in the area of ​​the spinous processes and along its path gives a number of small muscle branches to m. longissimus and m.. semispinalis; and the lateral cutaneous branch, cutaneus latera-lis, supplying blood to the skin of the lateral parts of the back, and also giving off muscle branches to m. iliocostalis.

b) The anterior branch of the intercostal artery, which, as stated above, is its own intercostal artery, is directed slightly upward and lies on the inner surface of the external intercostal muscle, being here covered only by the pectoral fascia and parietal pleura.

Further in the region of the angles of the ribs, the proper intercostal artery splits into the lower costal branch, which is actually its continuation (called intercostal), and the upper costal branch. The larger one, lower costal, lies in the sulcus costae; thinner, upper costal, follows the upper edge of the underlying ribs. Starting from the corners of the ribs, both branches run along the intercostal space between the external and internal intercostal muscles and anastomose with the r. intercostales anteriores a. thoracicae intemae (see a. subclavia), and the first intercostal artery anastomoses with a. intercostalis suprema. The terminal branches from VII to XII intercostal arteries cross the edge of the costal arch and exit between the layers of the vast abdominal muscles, supplying them with blood and the rectus abdominal muscles and anastomosing with the branches of the superior and inferior epigastric arteries, aa.. epigastricae superior et inferior. Along its course, the intercostal artery gives off three types of branches: lateral cutaneous branches, rr. cutanei laterales. which pierce the intercostal or broad abdominal muscles and exit into the subcutaneous layer; medial cutaneous branches, rr. cutanei mediates, and branches of the mammary gland, rr. mammarii. which arise from the IV, V and VI intercostal arteries.

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Arteries of the trunk. Thoracic part of the aorta.

The thoracic part of the aorta (thoracic aorta), pars thoracica aortae (aorta thoracica), is located in the posterior mediastinum, directly on the spinal column.

The upper parts of the thoracic aorta are located on the left side of the spinal column, then the aorta moves slightly to the right and passes into the abdominal cavity, located slightly to the left of the midline. To the right of the thoracic part of the aorta are adjacent the thoracic duct, ductus thoracicus, and the azygos vein, v. azygos, on the left - hemizygos vein, v. hemiazygos, in front - the left bronchus. The upper third of the esophagus is located to the right of the aorta, the middle third is in front, and the lower third is to the left.

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

1. Superior phrenic arteries, aa. phrenicae superiores, only two, depart from the anterior wall of the lower part of the aorta and go to the upper surface of the lumbar part of the diaphragm, anastomosing in its thickness with the branches of the lower phrenic arteries from the abdominal part of the aorta.

2. Posterior intercostal arteries (III-XI), aa. intercostales posteriores are quite powerful vessels, 10 pairs in total, extending from the posterior surface of the thoracic aorta along its entire length. Nine of them lie in the intercostal spaces, from the third to the eleventh inclusive, and the lowest ones go under the XII ribs and are called the subcostal arteries, aa. subcostales.

The right posterior intercostal arteries are slightly longer than the left ones, since the thoracic part of the aorta is located on the left surface of the spinal column.

Each posterior intercostal artery along its course gives off a dorsal branch, r. dorsalis, and itself is directed slightly upward and runs along the inner surface of the external intercostal muscle; covered only by the pectoral fascia and parietal pleura. Passes in the groove of the overlying rib.

In the region of the angles of the ribs, a rather powerful collateral branch, r, departs from the posterior intercostal artery. collateralis. It is directed downward and anteriorly, runs along the upper edge of the underlying rib, passing between the external and internal intercostal muscles and supplying blood to their lower sections.

Starting from the corners of the ribs, a. intercostalis posterior and r. collateralis run along the intercostal space between the external and internal intercostal muscles and anastomose with the rr. intercostales anteriores a. thoracicae internae (from a. subclavia), and the first intercostal artery anastomoses with a. intercostalis suprema. The terminal branches of the intercostal arteries, from the 7th to the 12th, cross the edge of the costal arch and exit between the layers of the vast abdominal muscles, supplying them and the rectus abdominis muscles. They anastomose with the branches of the superior and inferior epigastric arteries, aa. epigastricae superior et inferior.

The posterior intercostal artery gives rise to the lateral cutaneous branch, r. cutaneus lateralis, which pierces the intercostal or broad abdominal muscles and enters the subcutaneous layer, as well as the branches of the mammary gland, rr. mammarii, which arise from the 4th, 5th and 6th intercostal arteries.

The dorsal branch, r, departs from the initial section of the posterior intercostal artery. dorsalis, which is directed under the neck of the rib, between its ligaments, to the posterior (dorsal) surface of the body; The spinal branch, r., approaches the spinal cord through the intervertebral foramen. spinalis, which in the spinal canal anastomoses with the vessels of the same name lying above and below and with the branch of the same name on the opposite side, forming an arterial ring around the spinal cord. It also supplies blood to the membranes of the spinal cord and vertebrae.

The terminal trunks of the posterior branches go further posteriorly, giving off muscular branches. Then each of the terminal trunks is divided into two branches - medial and lateral. Medial cutaneous branch, r. cutaneus medialis, supplies the skin in the area of ​​the spinous processes and on its way gives a number of small branches to the longissimus and semispinalis muscles. Lateral cutaneous branch, r. cutaneus lateralis, supplies blood to the skin of the lateral parts of the back, and also gives off branches to the iliocostal muscle.

1. Bronchial branches, rr. bronchiales, only two, rarely 3 - 4, extend from the anterior wall of the initial part of the thoracic aorta, enter the gates of the lungs and branch together with the bronchi.

The terminal branches of the bronchial branches are directed to the bronchopulmonary lymph nodes, pericardium, pleura and esophagus.

2. Esophageal branches, rr. esophageales, 3-6 in total, are directed to the area of ​​the esophagus where it contacts the aorta, and branch here into ascending and descending branches. In the lower sections, the esophageal branches anastomose with the left gastric artery, a. gastrica sinistra, and in the upper ones - with the inferior thyroid artery, a. thyroidea inferior.

3. Mediastinal branches, rr. mediastinales, - numerous small branches that start from the anterior and lateral walls of the aorta; supply blood to the connective tissue and lymph nodes of the mediastinum.

4. Pericardial branches, rr. pericardiaci, - small vessels, the number of which varies, are directed to the posterior surface of the pericardium.

Thoracic aorta anatomy

Two groups of branches depart from the thoracic aorta: visceral, rami viscerates, and parietal, rami parietales (Fig. 153).

Rice. 153. Vessels and nerves of the posterior wall of the left half of the chest cavity (the lung is turned away). 1 - truncus synipathicus; 2 - v. hemiazygos; 3- aorta descendens; 4 - v. hemiazygos ace; 5 - a. et v. intercostales posteriores, n. intercostalis; 6 - n. vagus; 7 - a. subclavia; 8 - plexus brachialis

Visceral branches of the thoracic aorta. The largest branches of the thoracic aorta are the following.

Bronchial branches, rami bronchioles, which in number 3-4 originate from the anterior surface of the aorta at the level of the origin of the third intercostal arteries, enter the gates of the right and left lungs. An arterial plexus is formed around the intraorgan bronchi, which supplies blood to the bronchi, connective tissue stroma of the lung, peribronchial lymph nodes, and the walls of the upper pulmonary arteries and veins. The bronchial branches anastomose with the branches of the pulmonary arteries.

The esophageal branches, rami esophagei, pericardial, rami pericardiaci, and mediastinal, rami mediastinals, are smaller and supply the corresponding formations with blood.

Parietal branches of the thoracic aorta. 1. Posterior intercostal arteries, aa. intercostales posteriores, in an amount of 9-10 pairs, extend from the posterior wall of the aorta and are located in the III-XI intercostal spaces. The last posterior intercostal artery is the subcostal, a. subcostalis, goes below the XII rib and anastomoses with the lumbar arteries. The I and II intercostal spaces receive blood from the subclavian artery due to a. intercostalis suprema. The right intercostal arteries are slightly longer than the left ones and pass under the pleura behind the organs of the posterior mediastinum. The intercostal arteries at the heads of the ribs give off dorsal branches to the skin and muscles of the back, the spine and the spinal cord with its membranes. Continuations of the posterior intercostal arteries are located under the parietal pleura, and from the angles of the ribs they penetrate between the external and internal intercostal muscles to the costal groove. Anterior to the linea axillaris posterior, starting from the eighth intercostal space and below, the arteries lie in the intercostal spaces below the corresponding rib, give off lateral branches to the skin and muscles of the lateral part of the chest, and then anastomose with the anterior intercostal branches of the internal mammary artery. Branches extend from the IV, V and VI intercostal arteries to the mammary gland. The upper intercostal arteries supply blood to the chest, the lower three - the anterior abdominal wall and diaphragm.

2. Superior phrenic arteries, aa. phrenicae superiores, paired, originate from the aorta above the hiatus aorticus. They supply blood to the lumbar part of the diaphragm. Anastomose with the lower intercostal arteries, with the branches of the internal thoracic and lower phrenic arteries.

The abdominal aorta, aorta abdominalis, is located to the left of the midline; length eecm; initial diametermm. It is covered by the parietal peritoneum, stomach, pancreas and duodenum. It is crossed by the root of the mesentery of the small and transverse colon, the left renal and splenic veins. Autonomic nerve plexuses are located around the abdominal aorta,

lymphatic vessels and nodes. In the area of ​​the hiatus aorticus behind the aorta lies the beginning of the thoracic lymphatic duct, and the inferior vena cava is adjacent to it on the right. At the level of the IV lumbar vertebra, the abdominal aorta is divided into paired common iliac arteries and the unpaired median sacral artery. The splanchnic and parietal branches begin from the abdominal aorta (Fig. 154).

Rice. 154. Abdominal aorta and its branches (according to Kishsh-Sentagotai). 1 - aorta thoraeica; 2 - esophagus; 3, 35 - a. a. phrenicae inferiores; 4, 36 - diaphragma; 5 - glandula suprarenalis sinistra; 6, 34 - a. a. suprarenales superiores; 7 - truncus coeliacus; 8 - a. suprarenalis media; 9 - a. suprarenalis inferior; 10 - a. renalis; 11 - a. mesenterica superior; 12 - ren sinister; 13 - truncus sympathicus; 14, 31 - a. a. et v. v. testiculares; 15 - a. mesenterica inferior; 16 - aorta abdominalis; 17 - m. quadratus lumborum; 18 - a. iliaca communis sinistra; 19 - a. rectalis superior; 20, 30 - ureteri; 21 - a. et v. sacrales medianae; 22, 27 - a. et v. iliacae externae; 23 - a. iliaca interna; 24 - v. saphena magna; 25 - a. et v. femorales; 26 - funiculus spermaticus; 28 - m. psoas major; 29 - v. iliaca communis dext., 32, 38 - v. cava inferior; 33 - v. renalis; 37 - vv. hepaticae

Internal branches of the abdominal aorta. 1. The celiac trunk, truncus coeliacus, with a diameter of 9 mm and a length of 0.5-2 cm, extends ventral from the aorta at the level of the XII thoracic vertebra (Fig. 155). 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 layer of the peritoneum, the celiac trunk is divided into 3 arteries: the left gastric, common hepatic and splenic.

Rice. 155. Celiac trunk and its branches. 1 - lig. teres hepatis; 2 - a. cystica; 3 - left lobe of the liver; 4, 16 - ductus choledochus; 5 - v. portae; 6 - v. cava inferior; 7 - a. gastrica sinistra; 8 - truncus coeliacus; 9 - aorta abdominalis; 10 - stomach; 11 - pancreas; 12 - a. gastroepiploica sinistra; 13 - a. gastroepiploica dextra; 14 - a. lienalis; 15 - a. hepatica communis; 17 - ductus cysticus; 18 - ductus hepaticus communis; 19 - right lobe of the liver; 20 - vesica fellea

Left gastric artery, a. gastrica sinistra, initially passes behind the parietal peritoneum, goes up and to the left to the place where the esophagus enters the stomach, where it penetrates the thickness of the lesser omentum, turns 180°, descends along the lesser curvature of the stomach towards the right gastric artery. From the left gastric artery branches extend to the anterior and posterior walls of the body and the cardiac part of the stomach, anastomosing with the arteries of the esophagus, the right gastric and short arteries of the stomach.

Common hepatic artery, a. hepatica communis, directed to the right of the celiac trunk, located behind and parallel to the pyloric part of the stomach. At the beginning of the duodenum, the common hepatic artery divides into the gastroduodenal artery, a. gastroduodenalis, and the hepatic artery itself, a. hepatica propria. From the latter originates the right gastric artery, a. gastrica dextra. The proper hepatic artery at the porta hepatis divides into right and left branches. The cystic artery departs from the right branch to the gallbladder, a. cystica. A. gastroduodenalis, penetrating between the pyloric part of the stomach and the head of the pancreas, is divided into two arteries: the superior pancreatic-duodenal, a. pancreaticoduodenalis superior, and the right gastroepiploic artery, 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.

Splenic artery, a. lienalis, passes behind the stomach along the upper edge of the pancreas and at the hilum of the spleen is divided into 3-6 branches. From it depart: branches of the pancreas, rami pancreatici, short gastric arteries, aa. gastricae breves, - to the fundus of the stomach, left gastroepiploic artery, a. gastroepiploica sinistra, - to the greater curvature of the stomach and the greater omentum, anastomosing with the right gastroepiploic artery.

2. Superior mesenteric artery, a. mesenterica superior, unpaired, arises from the anterior surface of the aorta at the level of the first lumbar vertebra (Fig. 156). The beginning of the artery is located between the head of the pancreas and the lower horizontal part of the duodenum. At the lower edge of the latter, the artery enters the root of the mesentery of the small intestine at the level of the II lumbar vertebra. The superior mesenteric artery gives off the following branches: the inferior pancreatic-duodenal artery, a. pancreaticoduodenalis inferior, anastomosing with the superior artery of the same name; arteries of the jejunum and ileum, aa. jejunales et ilei, going in the mesentery to the loops of the jejunum and ileum; ileocecal artery, a. iliocolica, - to the cecum; it gives rise to the artery of the vermiform appendix, a. appendicular is, which is located in the mesentery of the process. The right colic artery, a., departs from the superior mesenteric artery to the ascending colon. colica dextra, to the transverse colon - middle colic artery, a. colica media, which runs deep into the mesocolon. The listed arteries anastomose with each other.

Rice. 156. Arteries and veins of the small and large intestines in front; the loops of the small intestine are retracted to the left; The transverse colic is pulled upward; the visceral layer of the peritoneum is partially removed (according to R. D. Sinelnikov). 1 - omentum majus; 2 - a. colica sinistra; z - a. mesenterica superior; 4 - v. mesenterica superior; 5 - aa. et vv. jejunales; 6 - aa. intestinales; 7 - appendix vermiformis; 8 - a. appendicularis; 9- aa. et vv. ilei; 10 - colon ascendens; 11 - a. et v. iliocolicae; 12 - a. Colica dextra; 13 - ascending branch a. colicae dextrae; 14 - a. et v. colica media; 15 pancreas; 16 - right branch a. colicae mediae; 17 - colon transversum

3. 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 third lumbar vertebra. The main trunk of the artery and its branches are located behind the parietal layer of the peritoneum. It is divided into three large arteries: the left colon, a. colica sinistra - to the descending colon; sigmoid arteries, aa. sigmoideae, - to the sigmoid colon; upper rectum, a. rectalis superior, - to the rectum. All arteries anastomose with each other. The anastomosis between the middle and left colic arteries is especially important, since it connects the beds of the superior and inferior mesenteric arteries.

4. Inferior phrenic artery, a. phrenica inferior, steam room, is separated immediately after the aorta exits through the diaphragmatic opening. A special branch departs from it to the adrenal gland - the superior adrenal artery, a. suprarenalis superior, supplying blood to the diaphragm and adrenal gland; anastomoses with the upper arteries of the same name, lower intercostal and internal thoracic arteries (see Fig. 154).

5. Middle adrenal artery, a. suprarenalis media, steam room, branches from the lateral surface of the aorta at the level of the lower edge of the first lumbar vertebra. In the thickness of the adrenal gland, it anastomoses with the superior and inferior adrenal arteries.

6. Renal artery, a. renalis, steam room, 7-8 mm in diameter (see Fig. 154). The right renal artery is 0.5-0.8 cm longer than the left. In the renal sinus, the artery divides into 4-5 segmental arteries, which form an intraorgan branching system. At the hilum of the kidney, the inferior adrenal arteries, aa, depart from the renal arteries. suprarenales inferiores, supplying blood to the adrenal gland and the fatty capsule of the kidney.

7. Testicular artery, a. testicularis, steam room, branches at the level of the II lumbar vertebra behind the root of the mesentery of the small intestine (see Fig. 154). Branches of the fatty membrane of the kidney and ureter extend from it in the upper part. In women, this artery is called the ovarian artery, a. ovarica; supplies blood to the corresponding sex gland.

8. Lumbar arteries, aa. lumbales, paired, with 4-5 branches branching from the posterior wall of the abdominal aorta. They supply blood to the muscles and skin of the back, the spinal cord and its membranes.

9. Median sacral artery, a. sacralis mediana, is an unpaired branch of the aorta (see Fig. 154). It arises from the aorta at the site of its division into two common iliac arteries. Supplies blood to the sacrum, surrounding muscles and rectum.

Pelvic arteries (human anatomy)

The abdominal aorta at the level of the IV lumbar vertebra is divided into two common iliac arteries, aa. iliacae communes, 1.3-1.4 cm in diameter, following along the medial edge of m. psoas major. At the level of the upper edge of the sacroiliac joint, these arteries are divided into the external and internal iliac arteries.

Internal iliac artery, a. iliaca interna, steam room, lies on the lateral wall of the small pelvis. At the upper edge of the greater sciatic foramen, the artery divides into parietal and visceral branches (Fig. 157).

Rice. 157. Parietal and splanchnic arteries of the left part of the male pelvis. The bladder and rectum are turned to the right and downwards. 1 - branches a. circumflexae ilium profundae to m. transversus abdominis; 2, 6 - a. epigastrica inferior; 3 - branches to m. iliacus; 4 - a. testicularis; 5 - a. circumflexa ilium profunda; 7 - a. obturatoria; 8 - a. umbilicalis; 9 - a. vesicalis superior; 10 - additional branch to the bladder; 11 - a. vesicalis inferior; 12 - ductus deferens sinister; 13 - vesicula seminalis; 14 - a. recta-lis media and its branch a. ductus deferentis; 15 - a. glutea inferior; 16 - a. pudenda interna; 17 - a. sacralis lateralis; 18 - a. glutea superior; 19 - a. iliaca externa; 20 - a. iliaca interna; 21 - a. iliaca communis sinistra; 22 - a. iliaca communis dextra

The parietal branches of the internal iliac artery are as follows:

1. Iliopsoas artery, a. iliolumbalis, passes behind n. obturatorius, a. iliaca communis and under m. psoas major is divided into two branches: the lumbar, ramus lumbalis, and the iliac, ramus iliacus. The first vascularizes the lumbar muscles, spine and spinal cord, the second - the ilium and the muscle of the same name.

2. Lateral sacral artery, a. sacralis lateralis, steam room, is located near the anterior sacral foramina, through which its branches penetrate into the sacral canal.

3. Obturator artery, a. obturatoria, steam room, penetrates through the obturator canal into the medial part of the thigh between m. pectineus and m. obturatorius externus. Supplies blood to the pubis, adductor muscles of the thigh, ischium and femoral head. In 1/3 of cases, the obturator artery arises from a. epigastrica inferior and runs along the lower edge of the fossa inguinalis medialis, which must be taken into account during operations for inguinal hernias.

4. Superior gluteal artery, a. glutea superior, steam room, penetrates the gluteal region through the foramen suprapiriforme. Supplies blood to the gluteus minimus and medius muscles.

5. Inferior gluteal artery, a. glutea inferior, steam room, exits to the posterior surface of the pelvis through the foramen infrapiriforme. Supplies blood to the gluteus maximus muscle and the sciatic nerve. All parietal branches of the internal iliac artery anastomose with each other.

The visceral branches of the internal iliac artery are as follows.

1. Umbilical artery, a. umbilicalis, steam room, is located under the parietal peritoneum on the sides of the bladder, then rises into the umbilical cord and reaches the placenta. After birth, part of it from the navel side is obliterated. The superior cystic artery, a., departs from the initial section of the artery to the apex of the bladder. vesicalis superior.

2. Inferior cystic artery, a. vesicalis inferior, steam room, goes down and forward, enters the wall of the bottom of the bladder. It also supplies the prostate gland, seminal vesicles, and vagina with blood.

3. Artery of the vas deferens, a. ductus deferentis, steam room, supplies the duct with blood.

4. Uterine artery, a. uterina, steam room, penetrates the base of the broad uterine ligament and at the cervix gives off a branch to the upper part of the vagina, then rises upward and in the thickness of the broad uterine ligament gives off branches to the cervix and body of the uterus. Its terminal branch accompanies the fallopian tube and ends at the hilum of the ovary.

5. Middle rectal artery, a. rectalis media, steam room, enters the lateral surfaces of the organ. Anastomoses with the superior and inferior rectal arteries.

6. Internal pudendal artery, a. Pudenda interna, steam room, is the terminal branch of the visceral trunk. Through the foramen infrapiriforme it exits to the posterior surface of the pelvis, and then through the foramen ischiadicum minus it penetrates into the fossa ischiorectalis, where it gives off branches to the perineum, rectum and external genitalia (a. perinei. a. dorsalis penis, a. rectalis inferior).

External iliac artery, a. iliaca externa, steam room, has a diameter of mm, m. psoas major reaches the lacuna vasorum, where at the lower edge of the inguinal ligament it continues into the femoral artery (see Fig. 157). In the pelvic cavity, the external iliac artery gives two branches:

1. Inferior epigastric artery, a. epigastrica inferior, steam room, begins 1-1.5 cm above lig. inguinale, located behind the parietal layer of the peritoneum medial to the deep inguinal ring, near which the spermatic cord crosses the artery. Here a begins from it. cremasterica to the muscle that suspends the testicle. The inferior epigastric artery, near the lateral border of the rectus abdominis muscle, reaches the umbilicus. Anastomoses with the superior epigastric, lumbar, and inferior intercostal arteries.

2. Deep artery surrounding the ilium, a. circumflexa ilium profunda, steam room, begins distal to the beginning of the inferior epigastric artery. Accompanies the inguinal ligament and reaches the iliac crest. Supplies blood to the transverse and internal oblique abdominal muscles. Forms a connection with the superficial artery surrounding the ilium and the iliopsoas artery.

The thoracic aorta (Fig. No. 104, 106, 114, 115) is a continuation of the aortic arch. It lies in the posterior mediastinum on the thoracic spine. After passing through the aortic opening of the diaphragm, it continues into the abdominal aorta.

The branches of the thoracic aorta supply the walls of the chest, all organs of the chest cavity (except for the heart) and are divided into parietal (parietal) and visceral (visceral). The parietal branches of the thoracic aorta include:

1) posterior intercostal arteries in the number of 10 pairs (the first two pairs depart from the subclavian artery) provide blood to the walls of the chest and partially abdominal cavity, spine and spinal cord;

2) superior phrenic arteries - the right and left go to the diaphragm, supplying blood to its upper surface.

The splanchnic branches of the thoracic aorta include:

1) the bronchial branches pass into the lungs through their gates and form numerous anastomoses in them with the branches of the pulmonary artery of the pulmonary trunk emerging from the right ventricle;

2) esophageal branches go to the esophagus (its walls);

3) mediastinal (mediastinal) branches supply blood to the lymph nodes and tissue of the posterior mediastinum;

4) pericardial branches go to the posterior part of the pericardium.

The abdominal aorta (Fig. No. 104, 106, 116, 117, 118, 119) lies in the retroperitoneal space of the abdominal cavity

on the spine, next to the inferior vena cava (left). It gives off a number of branches to the walls (parietal branches) and to the organs (visceral branches) of the abdominal cavity.

The parietal branches of the abdominal aorta are:

1) the inferior phrenic artery (paired) supplies blood to the lower surface of the diaphragm and gives off a branch to the adrenal gland (superior suprarenal artery);

2) lumbar arteries - four paired arteries supply the lumbar spine, spinal cord, psoas muscles and abdominal wall.

The internal branches of the abdominal aorta are divided into paired and unpaired depending on which abdominal organs they supply with blood. There are 3 pairs of paired splanchnic branches of the abdominal aorta:

1) middle adrenal artery;

2) renal artery;

3) testicular artery in men and ovarian artery in women.

The unpaired splanchnic branches include the celiac trunk, superior and inferior mesenteric arteries.

1) The celiac trunk begins from the abdominal aorta at the level of the XII thoracic vertebra and with its branches supplies blood to the unpaired organs of the upper abdominal cavity: the stomach, liver, gall bladder, spleen, pancreas and partially the duodenum (left gastric, common hepatic and splenic arteries) .

2) The superior mesenteric artery arises from the abdominal aorta at the level of the first lumbar vertebra and with its branches supplies blood to the pancreas, duodenum (partially), jejunum, ileum, cecum with appendix, ascending and transverse colon.

3) The inferior mesenteric artery begins from the abdominal aorta at the level of the third lumbar vertebra and with its branches supplies blood to the descending and sigmoid colons and the upper part of the rectum.

All branches going to the internal organs, especially to the intestines, strongly anastomose with each other, forming a single system of arteries of the abdominal organs.

18. Terminal branches of the abdominal aorta(Fig. No. 104, 106, 119, 120, 121,122)

The continuation of the aorta into the small pelvis is the thin median sacral artery, unpaired, which is a developmentally delayed continuation of the aorta (caudal aorta). The abdominal aorta itself at the level of the IV lumbar vertebra bifurcates into two terminal branches (Fig. No. 119): the common iliac arteries, each of which in turn at the level of the sacroiliac joint is divided into the internal and external iliac arteries.

The internal iliac artery goes to the small pelvis, where it splits into parietal branches and splanchnic branches that supply blood to the walls and organs of the small pelvis. The parietal branches supply blood to the gluteal muscles, hip joint, and medial group of thigh muscles (superior and inferior gluteal arteries, obturator artery). The visceral branches supply blood to the rectum, bladder, internal and external genitalia and the perineum.

The external iliac artery is the main artery carrying blood to the entire lower limb. In the pelvic area, branches depart from it that nourish the muscles of the pelvis and abdomen, the membranes of the testicle and the labia majora. Having passed under the inguinal ligament, it is called the femoral ligament (Fig.

No. 120). The femoral artery descends along the anteromedial side of the thigh down to the popliteal fossa, where it becomes the popliteal artery. It gives off a number of branches that supply blood to the thigh, the anterior wall of the abdomen, and the external genitalia. The largest branch of this artery is the deep femoral artery.

The popliteal artery lies deep in the popliteal fossa along with the popliteal vein and tibial nerve (NeVA - nerve, vein, artery). Having given 5 branches to the knee joint (knee arteries), it passes to the back surface of the leg and immediately divides into 2 terminal branches: the anterior and posterior tibial arteries. The anterior tibial artery passes through the hole in the interosseous membrane onto the anterior surface of the leg, descends to the ankle joint and passes to the back of the foot called the dorsalis pedis artery. Both of these arteries supply blood to the front of the leg and the back of the foot.

The posterior tibial artery runs between the superficial and deep muscles of the posterior group of leg muscles and supplies them with blood (Fig. No. 121 and 122). A large branch departs from it - the peroneal artery, which supplies the muscles of the lower leg of the posterior and lateral groups, the fibula. Behind the medial ankle, the posterior tibial artery passes to the plantar surface of the foot and divides there into the medial and lateral plantar arteries, which, together with the dorsalis pedis artery, supply the foot with blood. The lateral plantar artery forms with the plantar branch of the dorsal artery of the foot a deep plantar arch, from which four plantar metatarsal arteries depart, passing into the common plantar digital arteries, each dividing into two own plantar digital arteries that supply the toes. Another superficial dorsal arch is formed as a result of the fact that an arcuate artery departs from the dorsal artery of the foot to the lateral side, from which the dorsal metatarsal arteries begin, and from them the dorsal digital arteries depart.

anatomy, topography, branching areas.

There are parietal and visceral branches of the thoracic aorta.

Parietal branches of the thoracic aorta. 1. Upper diaph- ragmal artery,a. phrenica superior, steam room, starts from the aorta directly above the diaphragm, goes to the lumbar part of the diaphragm and the pleura covering it.

2. Posterior intercostal arteries,ah.intercostales posteridres (Fig. 56), paired, 10 vessels on each side, are directed to the corresponding intercostal spaces (from the third to the twelfth), supplying blood to the intercostal muscles, ribs, and skin of the chest. Each posterior intercostal artery is located at the lower edge of the overlying rib, in its groove between the external and internal intercostal muscles. The lower intercostal arteries also supply blood to the muscles of the anterior abdominal wall.

The following branches are separated from each of the posterior intercostal arteries: 1) dorsal branch, G.dorsalis, departs from the lower edge of the rib head and follows the muscles and skin of the back. She gives spinal branch, g.spinalis, penetrating through the adjacent intervertebral foramen to the spinal cord, its membranes and the roots of the spinal nerves;

2 lateral cutaneous branch, G.cutaneus laterlis, And

3 medial cutaneous branch, G.cutaneus medialis, they are directed to the skin of the chest and abdomen. From the fourth to sixth posterior intercostal arteries the medial and lateral branches of the mammary glandrr. mammarii medialis et laterdles. The twelfth posterior intercostal artery, located under the lower edge of the XII rib, is called subcostal artery,a. subcostalis.

Visceral branches of the thoracic aorta.

1. Bronchial branches,rr. bronchiales (2-3), go to the trachea and bronchi, anastomosing with the branches of the pulmonary artery. They supply blood to the walls of the bronchi and adjacent lung tissue.

2Esophageal branches,gg.oesophageales (1-5), depart from the aorta at the level of the IV to VIII thoracic vertebrae, and go to the walls of the esophagus. The lower esophageal branches anastomose with the branches of the left gastric artery.

3Pericardial branches,rr. pericardiaci, follow to the posterior part of the pericardium.

4Mediastinal branchesgg.mediatindles, They supply blood to the connective tissue of the posterior mediastinum and the lymph nodes located in it.

The branches of the thoracic aorta form anastomoses with arteries originating from other sources. The bronchial branches anastomose with the branches of the pulmonary artery, the spinal branches (from the posterior intercostal arteries) with the same branches of the other side passing in the spinal canal. Along the spinal cord there is an anastomosis of spinal branches arising from the posterior intercostal arteries and spinal branches from the vertebral, ascending cervical and lumbar arteries. The posterior intercostal arteries III-VIII anastomose with the anterior intercostal branches from the internal mammary artery, and the posterior intercostal arteries IX-XI - with the branches of the superior epigastric artery from the internal mammary artery.

97. Parietal and visceral (paired and unpaired) branches of the abdominal aorta. Features of their branching and anastomoses.

Parietal branches of the abdominal aorta.

1. Inferior phrenic artery,a. phrenica inferior, - the first branch of the abdominal aorta, the steam room, departs from it in the aortic opening of the diaphragm at or above the celiac trunk (truncus coe- liacus). On the way to the diaphragm, the artery gives off from 1 to 24 superior adrenal arteries, aa.suprarendles superiores.

2. Lumbar arteries,ah.lumbdles (4 pairs), depart from the posterior semicircle of the aorta and go to the abdominal muscles. In their branching they correspond to the posterior intercostal arteries. Each artery gives off dorsal branch, d.dorsalis, to the muscles and skin of the back in the lumbar region. Departs from the dorsal branch spinal branch, g.spinalis, penetrating through the intervertebral foramen to the spinal cord.

Visceral branches of the abdominal aorta. Among the visceral branches of the abdominal aorta, unpaired and paired branches are distinguished. The unpaired branches include the celiac trunk, superior and inferior mesenteric arteries. The paired branches of the abdominal aorta include the middle adrenal, renal, and testicular (ovarian) arteries.

Unpaired visceral branches of the abdominal aorta:

1. celiac trunk,truncus coelidcus (Fig. 57), - a short vessel 1.5-2 cm long, starts from the anterior semicircle of the aorta at the level of the XII thoracic vertebra. Above the upper edge of the body of the pancreas, the celiac trunk is divided into three arteries: the left gastric, common hepatic and splenic.

1Left gastric artery,a. gdstrica sinistra, follows up and to the left, towards the cardiac part of the stomach, then lies along the lesser curvature of the stomach (between the leaves of the lesser omentum), where it anastomoses with the right gastric artery. The left gastric artery gives off esophageal branches, gg.oesophageales, to the abdominal part of the esophagus. The branches extending from the left gastric artery on the lesser curvature of the stomach run along the anterior and posterior surfaces of the organ and anastomose with the branches of the arteries following along the greater curvature.

2Common hepatic arterya. hepdtica communis, It is directed from the celiac trunk to the right and is divided into two arteries: the proper hepatic and gastroduodenal arteries. Proper hepatic artery a. hepdtica propria, follows in the thickness of the hepatoduodenal ligament to the liver and gives off at its gate right and left branches, d.dexter et r. sinister. Branches off from the right branch gallbladder artery,a. cystica, heading towards the gallbladder. A thin artery arises from the proper hepatic artery right gastric artery,a. gastrica dextra, which anastomoses with the left gastric artery on the lesser curvature of the stomach. Gastroduodenal artery, a. gastroduodendlis, passes behind the pylorus of the stomach and divides into the right gastroepiploic and superior pancreaticoduodenal arteries. Right gastroepiploic artery,a. gastroepiploica [ gastromentalis] dextra, which goes to the left along the greater curvature of the stomach, anastomoses with the left artery of the same name, giving numerous branches to the stomach and greater omentum (omental branches),rr. epiploici [ omentdles]. Superior posterior and anterior pancreatoduodenal arteries, aa.pancreaticoduodendles superiores anterior et poste­ rior, give branches to the duodenum - duodenal branches,rr. duodendles, and to the pancreas - pancreatic branches,rr. pancredtici.

3) splenic artery,a. lienalis [ splenica], the largest of the branches of the celiac trunk. Along the upper edge of the body of the pancreas it goes to the spleen, giving to the bottom of the stomach short gastric arteries, aa.gdstricae [ gdstrici] breves, and branches to the pancreas - pancreatic branches,rr. pancredtici. Having entered the hilum of the spleen, the splenic artery branches into vessels of smaller diameter. At the hilum of the spleen it arises from the splenic artery left gastroepiploic artery,a. gastroepiploica [ gastromentalis] sinist­ ra, which goes along the greater curvature of the stomach to the right.

On its way it gives branches to the stomach - gastric branches,rr. gastrici, and to the oil seal - omental branches,rr. epiploici . The terminal section of the left gastroepiploic artery at the greater curvature of the stomach anastomoses with the right gastroepiploic artery.

2. superior mesenteric artery,a. mesenterica superior (Fig. 58), departs from the abdominal part of the aorta behind the body of the pancreas at the level of the XII thoracic - I lumbar vertebra. Following down between the head of the pancreas and the lower part of the duodenum, this artery enters the root of the mesentery of the small intestine, where it gives off the following branches:

1 inferior pancreaticoduodenal arteries, ah.pancreaticoduodendles inferiores, depart from the superior mesenteric artery 2 cm below its beginning and go to the head of the pancreas and to the duodenum, where they anastomose with the superior pancreaticoduodenal arteries (branches of the gastroduodenal artery);

2 jejunal arteries, ah.jejunates, and sub-ileointestinal arteries, ah.ileales, 12-18 in number depart from the left semicircle of the superior mesenteric artery. They are directed to the loops of the mesenteric part of the small intestine, forming in the mesentery, on the way to the intestinal wall, arched anastomoses convex towards the intestine - arcades (Fig. 59), ensuring a constant flow of blood to the intestine during its peristalsis;

3 ileocolic artery, A.ileocolica, follows down and to the right to the cecum and appendix. On her way she gives anterior and posterior cecal arteries, aa.caecales anterior et posterior, and artery of the appendix,a. appendicularis, And colonic branch, g.colicus, to the ascending colon;

4 right colon artery, a. colica dextra, begins slightly higher than the previous one (sometimes departs from it), goes to the right to the ascending colon, anastomoses in this colon with the colon branch of the ileocolic artery and with the branches of the middle colic artery;

5 middle colon artery, a. colica media, departs from the superior mesenteric artery above the beginning of the right colon, follows upward to the transverse colon, supplying blood to the latter and the upper part of the ascending colon. The right branch of the middle colic artery anastomoses with the right colic artery, and the left one forms an anastomosis along the colon with the branches of the left colic artery (from the inferior mesenteric artery).

3. inferior mesenteric artery,a. mesenterica inferior, starts from the left semicircle of the abdominal aorta at the level of the third lumbar vertebra, goes behind the peritoneum down and to the left and gives off a number of branches to the sigmoid, outgoing colon and left part of the transverse colon (Fig. 60). A number of branches arise from the inferior mesenteric artery:

1left colon artery, a. colica sinistra, nourishes the descending colon and the left transverse colon. This artery anastomoses with a branch of the middle colic artery (a. colica media), forming a long arc along the edge of the colon (riolan arch);

2 sigmoid arteries, aa. sigmoideae (2-3), go to the sigmoid colon;

3 superior rectal artery, a. rectalis superior, - the terminal branch of the inferior mesenteric artery, descends down into the small pelvis, where it supplies the upper and middle sections of the rectum. In the pelvic cavity, the superior rectal artery anastomoses with the branches of the middle rectal artery - a branch of the internal iliac artery.

Paired visceral branches of the abdominal aorta:

1Middle adrenal artery,a. suprarenalis media, departs from the aorta at the level of the first lumbar vertebra, goes to the gate of the adrenal gland. On its way, it anastomoses with the superior adrenal arteries (from the inferior phrenic artery) and with the inferior adrenal artery (from the renal artery).

2renal artery,a. renalis (Fig. 61), departs from the aorta at the level of the I-II lumbar vertebrae, slightly below the previous artery. Directed laterally to the hilum of the kidney. The right renal artery passes behind the inferior vena cava. On its way, the renal artery gives off inferior adrenal artery,a. suprarenalis inferior, And ureteral branches, gg.ure­ terici, to the ureter. In the renal parenchyma, the renal artery branches according to the segments and lobes of the kidney.

3Testicular (ovarian) artery,a. testiculdris (a. ovdri-sa),- a thin long vessel that extends from the aorta at an acute angle below the renal artery. The right testicular (ovarian) artery may be a branch of the right renal artery. The testicular artery goes through the inguinal canal as part of the spermatic cord to the testicle, and the ovarian artery in the thickness of the ligament that suspends the ovary reaches the ovary. The testicular artery gives off ureteral branches,rr. ureterici, And adnexal branches,rr. epididymdles, anastomoses with the cremasteric artery (from the inferior epigastric artery) and with the artery of the vas deferens (from the umbilical artery). The ovarian artery gives off ureteral branches,rr. ureterici, And pipe branches,rr. tubdrii, anastomoses with the ovarian branch of the uterine artery (see below).

At the level of the middle of the IV lumbar vertebra, the abdominal part of the aorta divides into two common iliac arteries, forming aortic bifurcation,bifurcdtio aortae, and itself continues into a thin vessel - median sacral artery,a. sacralis mediana, extending down the pelvic surface of the sacrum into the small pelvis.

The branches of the abdominal aorta are connected by numerous anastomoses both among themselves and with the branches of the thoracic aorta and the branches of the iliac arteries (Table 4).