Vascular: Abdominal Vasculature

Abdominal Arterial Supply

Splanchnic Supply

  • High Variation in Flow
    • Shock/Hypovolemia: 10% of Cardiac Output
    • Fasting: 25% of Cardiac Output
    • After a Large Meal: 35% of Cardiac Output
  • 70-80% of Flow Supplies the Mucosa/Submucosa

Abdominal Aorta Branches

  • Inferior Phrenic
    • Superior Suprarenal
  • Celiac Trunk
    • Left Gastric
    • Common Hepatic
    • Splenic
  • Middle Suprarenal
  • Superior Mesenteric (SMA)
  • Renals
    • Inferior Suprarenal
    • *Right Renal Artery Passes Posterior to IVC
  • Gonadals
  • Inferior Mesenteric (IMA)
  • First-Fourth Lumbars
  • Common Iliacs

Branches of the Abdominal Aorta

Suprarenal Arteries

Celiac Trunk Branches

  • Left Gastric
    • Esophageal Branch
  • Common Hepatic
    • Right Gastric
    • Gastroduodenal (GDA)
      • Supraduodenal
      • Right Gastroepiploic
      • Superior Pancreaticoduodenal
        • Anterior Branch
        • Posterior Branch
    • Proper Hepatic
      • Left Hepatic
      • Right Hepatic
        • Cystic
  • Splenic
    • Pancreatic Branches
    • Short Gastrics
    • Left Gastroepiploic

Celiac Artery 1

Celiac Artery (Behind Stomach) 1

Mesenteric Branches

  • Superior Mesenteric (SMA)
    • Inferior Pancreaticoduodenal
      • Anterior Branch
      • Posterior Branch
    • Middle Colic
    • Intestinal Branches
    • Right Colic
      • Marginal Artery
    • Ileocolic
  • Inferior Mesenteric (IMA)
    • Left Colic
    • Sigmoid Branches
    • Superior Rectal
  • Connections:
    • Marginal Artery of Drummond – Along Margin of Colon
    • Arc (Arch) of Riolan (Meandering Mesenteric Artery) – Direct Connection of SMA & IMA
    • Arc (Arch) of Barkow – Anastomosis of the Right & Left Gastroepiploic Arteries
      • Has Multiple Ascending Branches That Supply the Transverse Colon
    • Arc (Arch) of Buhler – Anastomosis Directly Between the Celiac Artery & SMA
      • Travels Posterior to the Pancreas, Directly Anterior to the Aorta
      • Present in 1-4% of Individuals

SMA Branches 1

IMA Branches 1

Common Iliac Artery (CIA) Branches

  • Internal Iliac Artery (IIA)
    • Posterior Division
      • Iliolumbar Artery
      • Lateral Sacral Artery
      • Superior Gluteal Artery
    • Anterior Division
      • Obturator Artery
      • Inferior Gluteal Artery
      • Umbilical Artery
      • Uterine Artery
      • Vaginal Artery
      • Middle Rectal Artery
      • Internal Pudendal Artery
        • Inferior Rectal Artery
        • Perineal Artery
        • Posterior Scrotal/Labial Artery
        • Artery of the Bulb of the Penis/Vestibule
        • Dorsal Artery of the Penis/Clitoris
        • Deep Artery of the Penis/Clitoris
  • External Iliac Artery (EIA)
    • Inferior Epigastrics
      • Anastomose to Superior Epigastrics
    • Deep Circumflex Iliac Artery
    • Common Femoral Artery (Terminal Branch After Passing Inguinal Ligament)

Iliac Artery Branches 1

Watershed Areas

  • Region that Receives Dual Blood Supply
  • Ischemia Effects
    • Protected from Arterial Blockage (Atherosclerosis/Embolus) – Blood from Second Supply
    • Vulnerable from Systemic Hypoperfusion – Supplied by Most Distal Branches
  • Sites
    • Griffith’s Point: Splenic Flexure (SMA/IMA)
    • Sudeck’s Point: Rectosigmoid Junction (SRA/MRA/IRA)
    • Right Colon – Poorly Developed Marginal Artery in 50% of Patients
      • Less Common
    • Also Found in Brain

Abdominal Venous Drainage

Portal Drainage

  • Inferior Mesenteric Vein (IMV) Enters Splenic Vein
  • Splenic Vein & Superior Mesenteric Vein (SMV) Combine to Form Portal Vein
  • Portal Vein Branches into Left & Right Portal Veins into the Liver
  • Coronary Veins (From Left Gastric Vein)
    • Shunt from Portal Vein to Lower Esophagus & Azygous System
    • Cause of Esophageal Varices

Inferior Vena Cava (IVC) Drainage

  • Inferior Phrenic Veins
  • Hepatic Veins
    • Segment I – Drains Directly into IVC
    • Left Hepatic Vein
      • Middle Hepatic Vein – Drains into Left Hepatic Vein
    • Right Hepatic Vein
  • Right Suprarenal Vein – Drains into the IVC
  • Renal Veins
    • Left Suprarenal Vein – Drains into the Left Renal Vein
    • Left Gonadal Vein – Drains into the Left Renal Vein
    • *Left Renal Vein Passes Anterior to Aorta, Posterior to SMA
  • Right Gonadal Vein – Drains into the IVC
  • Lumbar Veins (#1-4)
  • Common Iliacs

Portal Drainage 1

IVC Drainage 1

References

  1. Gray H. Anatomy of the Human Body (1918). Public Domain.