Download a. iliaca interna

ARTERIAL SUPPLY
OF ORGANS
David Kachlík
Organs with complicated supply
• 5 supplying vessels: stomach
• 4 supplying vessels : vagina
• 3 supplying vessels : pancreas,
duodenum, rectum, suprarenal gland…
• many small branches: oesophagus,
trachea, ureter…
• lungs and liver (functional and nutritive
circulation)
Brain
Pharynx
a. carotis externa
• a. maxillaris  r. pharyngeus, a. canalis
pterygoidei, a. palatina descendens
• a. pharyngea ascendens
• a. facialis  a. palatina ascendends. rr.
tonsillares
• a. lingualis  rr. dorsales linguae
a. subclavia
• a. thyroidea inferior
Tonsillae
• Tonsilla pharyngea
– a. maxillaris  r. pharyngeus, a. canalis pterygoidei,
a. palatina descendens
– a. facialis a. palatina ascendens
– a. pharyngea ascendens
• Tonsilla palatina
– r. tonsillaris a. facialis / sometimes from a. pharyngea
ascendens
– additional branches from all surrounding arteries
•
•
•
•
a. pharyngea asc.  r. tonsillaris
a. lingualis  rr. dorsales linguae
a. maxillaris  a. palatina major
a. facialis  a. palatina ascendens
Oesophagus
• a. thyroidea inferior  pars cervicalis
• (arcus aortae)
• aorta thoracica  4-5 branches pars
thoracica
• a. gastrica sinistra  pars abdominalis
• a. phrenica inferior sinistra  pars
abdominalis
Stomach
truncus coeliacus
•  aa. gastrica sin.
•  a. hepatica communis
–  a. hepatica propria  a. gastrica dx.
–  a. gastroduodenalis  a. gastroomentalis
dx.
•  a. splenica  a. gastroomentalis sin.,
aa. gastricae breves (fundus), a. gastrica
posterior (80 %)
Duodeum + pancreas
• truncus coeliacus  a. hepatica communis  a.
gastroduodenalis  a. pancreaticoduodenalis
sup. post. + sup. ant. + aa. retroduodenales
• a. mesenterica sup.  a. pancreaticoduodenalis
inf.  ramus ant. + r. post.
Body and tail of pancreas:
• truncus coelicacus  a. splenica  rr.
pancreatici
– a. pancreatica magna, posterior et inferior,
– a. caudae pancreatis, a. prepancreratica
Small intestine
• a. mesenterica superior 
aa. jejunales + ileales + aa. ileocolica
 arcades (parallel artery of Dwight)
 arteriolae rectae
Colon
• a. mesenterica sup.
–  a. ileocolica  a.
ceacalis ant. + post., a.
appendicularis
–  a. colica dx. (colon
ascendens)
–  a. colica media (colon
transversum)
• a. mesenterica inf.
–  a. colica sin. (colon
descendens)
–  aa. sigmoideae (3-4)
arteria marginalis Drummondi
anastomosis magna Halleri =
arcus Riolani
Rectum
• a. mesenterica sup.  a. rectalis
sup.
• a. iliaca int.  a. rectalis media
(tunica adventitia only)
• a. iliaca int.  a. pudenda int. 
a. rectalis inf.
Liver and gallbladder
• truncus coeliacus  a. hepatica
communis  a. hepatica propria  r.
dx.+sin.  aa. interlobulares
– a. hepatica accessoria/aberrans
Gallbladder
• truncus coelicacus  a. hepatica
communis  a. hepatica propria  r. dx.
 a. cystica
BORDERS:
•
•
•
border of
the liver
ductus
cysticus
ductus
hepaticus
communis
CONTENT:
a. cystica
ligation
Kidneys
• arteria renalis
– paired visceral branch of the abdominal aorta, at the
level of the intervertebral disc L1/L2
– the left artery is slightly higher
• arteria renalis accessoria (30%)
– branch of the abdominal aorta / a. iliaca communis /
a. iliaca interna
• flow rate: 1,2-1,3 l blood/min
• the arteries are terminal = no arterio-arterial
anastomosis
•  segments (r. ant + post)
Suprarenal gland
from aorta abdominalis
• a. phrenica inferior → a. suprarenalis
superior
• a. suprarenalis media – branch of the
abdominal aorta
• a. renalis → a. suprarenalis inferior
vena suprarenalis – only one vein
– on the left into v. renalis sinistra
– on the right directly into do v. cava inferior
Ureter
•
•
•
•
•
a. renalis
aorta abdominalis
a. testicularis ♂ / ovarica ♀
a. ductus deferentis ♂ / uterina ♀
a. vesicalis inferior
 rr. ureterici
Urinary bladder
• a. iliaca interna
– a. umbilicalis  aa. vesicales superiores
– a. vesicalis inferior
– (a. obturatoria, a. glutea inf., a. uterina, a.
vaginalis)  rr. vesicales
Ovaries and uterine tubes
• aorta abdominalis → a. ovarica / r.
tubarius
• a. iliaca int. → r. ovaricus / r. tubarius
both rami ovarici anastomose to form the
ovarian arcade
Uterus
• a. iliaca interna → a. uterina
– ventral to the ureter
= „water under the bridge“
– approaching the cervix laterally,
then courses superiorly on the
lateral aspect of the uterus
– sinusoid course
– bleeding in rupture
Vagina
• a. iliaca interna
→ a. vaginalis (sometimes missing)
→ a. uterina → r. vaginalis
→ a. rectalis media → r. vaginalis
→ a. pudenda interna → r. vaginalis
Testes + epididymis
• aorta abdominalis
 a. testicularis
the branches enter the lobules in
the periphery, not from the
center !
• a. iliaca interna
 a. umbilicalis
 a. ductus deferentis
• a. iliaca externa
 a. epigastrica inferior
 a . cremasterica
mutual anastomoses
Prostate + vesiculous glands
• a. iliaca interna
 a. ductus
deferentis
 a. vesicalis
inferior
 a. rectalis
media
Penis / clitoris
a. pudenda interna
 a. dorsalis penis / clitoridis
 a. profunda penis / clitoridis
 a. urethralis
 a. bulbi penis / vestibuli
3 last  aa. helicinae (+ Ebner‘s
cushions)  vv. cavernosae
Nasal cavity
arteria carotis interna
• a. ophthalmica  a. ethmoidalis ant. + post.
arteria carotis externa
• a. maxillaris  a. sphenopalatina  rr.
nasales posteriores lat. + rr. septales
posteriores
• a. maxillaris  a. palatina descendens  a.
palatina major  větev přes canalis incisivus
• a. facialis  a. labialis superior (vestibulum)
Thyroid gland and larynx
•
a. carotis ext.  a. thyroidea sup.  a.
laryngea sup.
a. subclavia  a. thyroidea inf. (crossing
n. laryngeus recurrens)  a. laryngea
inf.
•
r. cricothyroideus of both sides anastomose under the
cricoid cartilage (! tracheotomia superior !)
•
a. thyroidea ima (2 %) - !! tracheotomia
superior !!
–
from arcus aortae (70 %)
–
truncus brachiocephalicus, a. carotis communis, a. thoracica interna,
a. subclavia dextra, a. thyroidea inferior, truncus thyrocervicalis
Trachea
• a. thyroidea inferior  rr. tracheales
• aorta thoracica  rr. bronchiales
• (a. thyroidea ima – 2 %)
neonates and children – branches from
thymic arteries
Bronchi and lungs – nutritive circulation
aorta thoracica
 rami bronchiales
1 on the right – most often from a.
intercostalis tertia
2 on the left from the aorta thoracica
 along the bronchi up to the respiratory
bronchi
(rami bronchiales accessorii in lig. pulmonale)
Lungs – functional circulation
• right atrium  truncus pulmonalis 
arteriae pulmonales dx.+ sin.  the
branching corresponds to the bronchi
– hypoarterial bronchus on the left,
eparterial bronchus on the right
• elastic (low-pressure circulation, muscle
only in fetus, in adults only in calibers <
1mm), deoxygenated blood !!!
Lungs – functional circulation
• capillaries  veins independent on the
arteries in the septi between alveoles 
4 venae pulmonales (2 dx., 2 sin.) 
left atrium (oxygenated blood!!!)
• arteriovenous (+ a-a, v-v) anastomoses
• in hypoxic states in the adult, the
muscular layer of the pulmonary arteries
proliferates  pulmonary hypertension
 right ventricular hypertrophy
Heart
arteria coronaria dextra (ACD)
sinus aortae (Valsalvae) dexter →
• r. coni arteriosi → Vieussens‘ circle
• r. nodi sinuatrialis (65%)
• rr. atriales
• r. marginalis dexter (RMD)
• r. interventricularis posterior (RIP)
• r. nodi atrioventricularis (80%)
• r. posterolateralis dexter (RPLD)
Heart
arteria coronaria sinistra (ACS)
sinus aortae (Valsalvae) sinister → short→
• r. interventricularis ant. (RIA)
– r. coni arteriosi → Vieussens‘ ring
– r. diagonalis (RD)
• r. circumflexus (RC)
– rr. atriales
– r. marginalis sinister (RMS)
• r. intermedius (RIM) – 25%, from ACS
bifurcation
Heart – coronary arteries
Spleen
• truncus coeliacus  a. splenica
 rr. splenici  aa. trabeculares  aa. vaginatae
(within PALS)  aa. centrales (within noduli
lymphoidei)  aa. penicillares (SchweiggerSeidel‘s sheath)  sinus splenis (within red
pulp)
Thymus
• branches from a. thyroidea inferior, arcus
aortae, thoracica interna
• ( a. pericardiacophranica)
Diaphragm
arcus aortae → a. subclavia → a. thoracica
interna
• a. pericardiacophrenica
• a. musculophrenica, (a. epigastrica superior)
aorta thoracica
• aa. intecostales posteriores IX.-XI.
• aa. phrenicae superiores (rudimentary)
aorta abdominalis
• aa. phrenicae inferiores
• aa. lumbales
(3 on the left, 2 on the right)
Intercostal spaces
arcus aortae → a. subclavia → a. thoracica interna
• aa. intercostales anteriores (I.-VI.)
• a. musculophrenica
– aa. intercostales anteriores (VII.-IX.)
arcus aortae → a. subclavia → truncus
costocervicalis → a. intercosalis suprema
• aa. intercostales posteriores (I.,II.)
(arcus aortae → a. subclavia → a. axillaris → a.
thoracica superior → I. a II. intercostal spaces)
aorta thoracica
• aa. intercostales posteriores (III.-IX.)
Mammary gland
arcus aortae → a. subclavia → a. thoracica
interna
• aa. intercostales anteriores (I.-V./VI.) →
rr. perforantes
arcus aortae → a. subclavia → a. axillaris
→ a. thoracica superior
→ (r. pectoralis a. thoracoacromialis, a.
thoracica lat., a. subscapularis)
aorta thoracica
• aa. intercostales posteriores (II.-V.) →
rr. perforantes /II. strongest/
Pituitary gland
branches from arteria carotis interna
• a. hypophysialis superior
(pars
cerebralis a. carotis internae)
– primary capillary network in the infundibulum
– secondary portal network in the anterior lobe
= hypothalamo-hypophyseal portal system
• a. hypophysialis inferior
(pars cavernosa a. carotis internae)
– capillary network in the posterior lobe
Pituitary gland
Spinal cord
•
longitudinal vessels
•
a. spinalis anterior
•
•
•
•
•
unpaired, ventrally
originate from short paired branches from a. vertebralis
anterior 2/3 of spinal cord
aa. sulcocommissurales → gray matter
aa. spinales posteriores
• paired, dorsally (sometimes doubled)
• branch from a. basilaris → a. inf. post. cerebelli
•
transverse vessels (segmental)
•
rr. spinales → a. radicularis anterior et posterior → join
the longitudinal arteries → vasocoronae (encircling the
medulla spinalis)
• aa. periphericae → white matter
Origins of rr. spinales
•
•
•
•
a. vertebralis
a. cervicalis ascendens
a. cervicalis profunda
aa. intercostales
posteriores
• aa. lumbales
• a. iliolumbalis
• aa. sacrales laterales
aa. radiculares
• irregular
• 5-9
• a. radicularis magna
Adamkiewiczi
 Tympanic cavity 
arteria carotis externa
• a. maxillaris /pars mandibularis/ fissura
petrotympanica Glaseri  a. tympanica anterior
• a. maxillaris /pars mandibularis/  a. meningea
media  foramen spinosum  canalis nervi
petrosi minoris  a. tympanica superior
• a. pharyngea ascendens  canaliculus
tympanicus Jacobsoni  a. tympanica inferior
• a. auricularis posterior  a. stylomastoidea 
canalis nervi facialis Falloppii  canaliculus
chordae tympani (posterior)  a. tympanica
posterior
arteria carotis interna (pars petrosa)  canaliculi
caroticotympanici  rr. caroticotympanici