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StatPearls . Treasure Island (FL): StatPearls Publishing; 2021 Jan-.


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Anatomy, Abdomen and also Pelvis, Posterior Abdominal wall surface Arteries

Noah Wright; Bracken Burns.

Author Information
The aorta overcome the aortic hiatus at the T12 level v the diaphragm and descends anterior come the vertebral column. The aorta branches into the right and also left usual iliac arteries in ~ L4. The aorta gives rise come the worse phrenic arteries just listed below the aortic hiatus. This vessels supply the diaphragm and additionally give rise to the suprarenal vessels.
The renal arteries arise native the aorta just inferior to the origin of the premium mesenteric artery. The right renal artery is longer and also a tiny inferior to the left renal artery and traverses behind the inferior vena cava (IVC). The left renal artery passes posterior come the left renal vein.
Testicular or ovarian arteries descend right into the retroperitoneum and run laterally ~ above the psoas major muscle and throughout the ureter. The testicular artery accompanies the ductus deferens right into the scrotum. Right here it gives blood come the epididymis, testis, and also spermatic cord. The ovarian artery traverses with the suspensory ligament that the ovary, gives the ovary, and also anastomosis v the ovarian branch of the uterine artery.
Lumbar arteries covers 4 or 5 pairs that originate native the ago of the aorta. This vessels need ligation once performing aortic aneurysm surgery. They run posterior come the sympathetic trunk, the IVC (on the ideal side), the quadratus lumborum, and psoas significant muscles. The lumbar vessels offer off numerous tiny anterior branches and also accompany the dorsal primary rami of the matching spinal nerves and divide right into spinal and also muscular branches.
The middle sacral artery comes turn off the posterior the the aorta, just over the bifurcation; the vessel then runs down the anterior of the sacrum and ends in ~ the coccygeal body. It offers the anal canal and rectum and joins the superior and inferior rectal arteries.
IVC is created by the union the the two usual iliac veins just to the right of L5. The bifurcation of the IVC is nearly always lower than the bifurcation that the aorta in the pelvis. Together it ascends, the IVC stays to the appropriate of the aorta. At the diaphragm, the ascends through the IVC hiatus in ~ T8 and enters the appropriate atrium. Through its course, it receives venous blood indigenous the adrenals, renal veins, best gonads, hepatic veins, and inferior phrenic veins.
The cisterna chyli, developed by the lumbar and also intestinal lymphatics, lies just posterior and also to the ideal of the aorta. That is normally located in between the 2 crura that the diaphragm and ascends through the aortic hiatus in the diaphragm.  The cisterna chyli is the worse collecting sac the the thoracic duct, which returns chyle come the venous system at the left brachiocephalic vein, whereby the left subclavian and left interior jugular veins converge.
The para-aortic lymph nodes deserve to divide into subgroups, which include the preaortic, retroaortic, and lateral aortic groups. The preaortic nodes are located next to the origin of the celiac trunk, superior and inferior mesenteric arteries.

Surgeons, radiologists, and other health professionals need come be familiar with this vessels as multiple pathologic conditions may develop, causing untoward after-effects from vessel injury.


Structure and also Function

The branches of the ab aorta space as follows, in addition to their function:


Inferior phrenic arteries are paired arteries the supply the diaphragm and also branch to become the remarkable suprarenal artery to help supply the adrenal glands.
The usual hepatic artery branches right into the hepatic artery suitable to supply the gallbladder via the cystic artery and the right and also left hepatic arteries to it is provided the liver. The usual hepatic artery additionally branches right into the gastroduodenal artery, i m sorry branches right into the right gastroepiploic/right gastro-omental artery and also superior pancreaticoduodenal artery. This branches it is provided the greater curvature and pancreas and duodenum, respectively.
The splenic artery runs remarkable to the pancreas. In addition to supplying the spleen, it offers branches come the pancreas. This short gastric artery supplies the fundus and also greater curvature of the stomach, the left gastroepiploic/gastro-omental artery that supplies the higher curvature that the stomach, and also the posterior gastric artery, which as the surname denotes, provides the posterior element of the stomach.
Middle suprarenal arteries space bilateral arteries that contribute to the it is provided of the adrenal glands.
Lumbar arteries: There space usually four paired lumbar arteries, and they it is provided the Quadratus lumborum muscle bilaterally.
The superior mesenteric artery supplies the tiny bowel (duodenum, jejunum, ileum) approximately the proximal two-thirds of the transverse colon and also supplies the pancreas.
The inferior mesenteric artery provides the distal one-third the the transverse colon come the upper element of the rectum.
The median sacral artery branches from the abdominal aorta prior to it bifurcates and also supplies the sacrum and lumbar vertebrae.

The abdominal muscle aorta bifurcates at L4 to end up being the right and left usual iliac arteries, i m sorry eventually become the interior (hypogastric artery) and external iliac arteries that supply the pelvis and lower extremities, respectively.


Preaortic lymph nodes drain lymphatics native the spleen, gastrointestinal (GI) tract, gallbladder, pancreas, and also liver.

Physiologic Variants

The lumbar arteries are commonly four paired vessels. However, a fifth pair may exist as branches that the median sacral artery.


Surgical Considerations

Pringle maneuver, or the clamping the hepatoduodenal ligament, which consists of the hepatic artery proper, the portal vein, and also the common bile duct, can help determine the resource of intraabdominal bleeding either in a trauma emergency setup or a much more controlled elective hepatic surgical procedure. If intraabdominal bleeding continues after clamping the hepatoduodenal ligament in a trauma setting, it is crucial to interrogate the worse vena cava and also hepatic vein as potential sources of bleeding. The Pringle exercise can also be used during elective surgeries to control blood loss once the liver is a target of surgical intervention.


Clinical Significance

Abdominal Aortic Aneurysm (AAA)

Major risk determinants for occurring AAA incorporate cigarette smoking and also hypertension. Additionally, people with Marfans or Ehlers-Danlos space at risk of emerging AAAs. Men are at better risk. The majority of AAAs develop listed below the renal artery branches the the abdominal muscle aorta. Routine screening using abdominal muscle ultrasound for AAAs (in the united States) is done for guys over the period of 65 year old who have actually a background of cigarette smoking or who are present smokers. If the abdominal muscle aorta has actually a diameter greater than 3 cm, this is considered AAA. However, surgical treatment is scheduled for AAAs that grow to greater than 5.5 centimeters or if the AAA grows greater than 1 centimeter within one year if doing ultrasound monitoring of a known AAA. Surgical intervention have the right to be open repair or v the use of endovascular repair.<2><3><4>

Nutcracker Syndrome

The left renal vein runs between the premium mesenteric artery (SMA) and the abdominal muscle artery ~ above its method to drainpipe into the worse vena cava (IVC), and the left renal vein have the right to be compressed between the SMA and ab aorta, potentially resulting in hematuria and left-sided flank pain. The ideal renal vein does not cross the aorta to drainpipe into the IVC and also is as such not at risk to compression in between the SMA and abdominal aorta.<5><6>

Splenic Artery Aneurysm

If over there is one aneurysm the the splenic artery, over there is potential for top GI bleeding as the quick gastric artery will have a buildup of backpressure.

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Other Issues

Although rare, utilizing Bacillus Calmette-Guerin (BCG) intravesical treatment for bladder cancer has actually disseminated and also led to mycotic aneurysms the posterior wall vessels, including the typical iliac arteries and ab aorta.