Vesseles of post abdominal wall Asst prof Dr

Vesseles of post. abdominal wall Asst. prof. Dr. Alaa Jamel Cabs, rcsi, mbchb

Abdominal aorta Beginning; diaphragmatic opening at lower border of T 12 as a continuation of descending thoracic aorta. Course; descend infront of upper 4 lumber vertebra. Termination; lower border of L 4 BY dividing to rt & lf common iliac art.

Relations; Anterior; from above downward; 1 - coeliac trunk 2 - body of pancreas and 3 structures behind to it *splenic v * lf renal v* origin of sup. Mesenteric art. 3 - 3 rd part of duod. & origin of inf. mes. art. 4 -upper part of root of mesentery 5 -paraital peritoneum separating it from coil of small intestine.

Posterioly ; 1 - upper 4 lumber vertebra & intervertebral disc 2 -ant. longitudinal ligament 3 - 3 rd and 4 th lumber veins

Rt and lf relation of a. a On rt ; cisterna chyli & thorasic duct , lower part of RT crus of diaphragm azygous vein , RT coeliac ganglion , & IVC On lf --- lf crus of diaphragm , lf coeliac ganglia, lf sympathetic chain, body of pancreas, inf. mesenteric v.

BRANCHEAS OF A. A; Single branches 1 - coeliac trunk upper of L 1 2 - sup. Mesenteric A lower of L 1 3 - inf. Mesenteric A. L 3 4 - median sacral art. From back of aorta as a continuation of A.

Paired branches; 1 -Rt & lf inferior phrenic A. ; upper L 1 2 - rt&lf middle supra renal A. lower. L 1 3 - rt&lf renal art. L 2 4 - rt& lf gonodal art. L 3 5 - rt& lf common iliac A. lower L 4. + 4 pairs of lumber arteries from back of A. from l 1 to l 4

MEDIAN SACRAL ART. It arise from the back aorta, just above its bifurcation. descend in front of L 4&L 5. It enter the pelvis in front of sacral promontory. Branches; 1 - 5 th pair of lumber arteries 2 - twigs to the sacral canal 3 - twigs to the rectum

Inf. phrenic arteries rt&lf; Arise from side of aa at level of L 1 upper border Ascend upward to diaphragm Rt A pass behind ivc Lf pass behind the oesophagus Each artery give suprarenal art.

Middle suprarenal art rt&lf Arise; from the side of AA at lower border of L 1. then go to supplying the suprarenal glands Renal arteries rt &lf; Origin; side of AA at L 2 level Reach kidney infront of renal pelvis and ureter Rt one is longer and pass behind ivc, rt renal vein& head of pancreas Lf one shorter pass behind the lf renal vein &and body of pancreas

Branches; 1 - inf suprarenal art, 2 - terminal branches 5 3 - ureteric branches to the upper end of ureter

Gonodal arteries ; They are testicular or ovarian art. they arise from anterio lateral aspect of AA. At level of L 3. TERMINATION; Testicular a. reach deep ing. ring then superfascial ing. ring pass through ing. canal as a constitution of spermatic cord to reach the testis.

Ovarian art. it cross the ext. ilic vessels to enter the suspensory lig. of ovary to reach the broad ligament then reach the ovary via mesoovarium.

Lumber arteries 4 pairs arise from back of AA. They supply ; muscles of post abdominal wall Muscles of lat. abdominal wall Spinal cord 5 th paird arise from median sacral a.

Inferior vena cava Beginning; in front body of vertebra L 5 (AORTA L 4) by union rt&lf common iliac v. Course ascend up rt to the aorta and pierce diaphragm at level of t 8 Termination; open to the lower part of rt atrium.

Relations s. Anterioly; Below the duodenum; 1 - RT common iliac art. 2 - root of mesentery and sup. mesentric vessels 3 - RT gonodal vessel At the duodenum 1 - 3 rd part of duod. 2 -head of pancreas and cbd 3 - 1 st part of duod. which separate from ivc by cbd , gastroduod. art. &portal vein

Above the duodenum; 1 -The epiploic foramen ; which separate the ivc from the margin of lesser omentum and its contents( portal v, hepatic art. &cbd) 2 -Post. surface of rt lobe of liver Post relation; A- the lower part of ivc is related to 1 - bodies of lower 3 l. vertbra 2 -Rt psoas major m 3 -Rt sympathetic chain

Upper part of ivc is related to ; 1 - RT crus of diaphragm but separated from it by ; a- RT coeliac ganglion B- 3 arteries; *RT inf phrenic art *RT middle supra renal art *RT renal art.

Rt side relation to ivc; * rt lobe of the liver(in the upper part) *medial border of rt kidney( in middle part) *rt ureter ( in the lower part) Lf side related to *caudate of the liver( in upper part) *RT crus of diaphragm (in middle part) *abdominal aorta( in the lower part)

Tributaries of ivc 1 - 2 common iliac v. 22 pair of lumber veins ( 3 rd &4 th) 32 renal v (rt&lf) 42 rt side v. (rt suprarenal & rt gonodal) 52 inf phrenic v. 62 hepatic veins

Renal veins 2 large vein open to the ivc Rt – short and lies behind 2 nd part of duod. Lf vein-- longer in 3 times, pass infront of aorta and behind body of pancreas , splenic vein It receive 2 tributaries 1 - lf gonodal vein ( LF VARICOCELE MORE COMMON) 2 - lf supra renal vein

Collateral venous anastemosis between svc & ivc Sites ; A- in the ant abdominal wall; 1 - the thoroco- epigastric v; long vein it connect a-lat thoracic v of axillary v(svc) B-superfascial epigastric v of femoral v (ivc) 2 - sup. epigastric v of internal mammary v. (svc) anastemose inside the rectus sheath with inf epigastric v of ext. iliac v. (ivc)

B- in the post abdominal wall 1 - the azygous vein. from ivc to svc direct connection. 2 - inf hemiazygous v. 3 - the vertebral plexus of veins; Present inside vertebral canal it connect A-lumber veins (ivc) B- post. intercostal v (tributaries of azygous and hemiazygous v tri. Of svc in the thorax)

Applied anatomy why the varicocele more common on the left side? Which is more dangerous anterior aortic aneurysm rapture or posterior aneurysm?

Thank you