Iliac Arteries and Abdominal Aorta 13

Stefania Daniele, Paolo Iovine

L. Romano, M. Silva, S. Fulciniti, A. Pinto (eds.) MDCT Anatomy – Body 95 © Springer-Verlag Italia 2011 96 S. Daniele, P. Iovine

Gastric fundus

Inferior Abdominal aorta vena cava

Liver Spleen

a

Splenic artery Celiac trunk Inferior vena cava Splenic vein

b

Superior mesenteric artery

Right portal vein Splenic artery

Pancreas tail

c

Fig. 13.1 a The suprarenal abdominal aorta is located between the diaphragm and the emergence of the celiac trunk. This aortic tract lies in front of the 12° thoracic vertebra and the 1° lumbar verte- bra. Along the right side of the suprarenal abdominal aorta lie the inferior vena cava and left gas- tric fundus. b The celiac trunk is the first collateral branch arising from the anterior surface of the abdominal aorta, at the level of the 12° dorsal vertebra. It is divided into three main branches: he- patic artery, splenic artery, and left gastric artery. c The superior mesenteric artery is the second branch of the abdominal aorta. It originates approximately 2 cm below the celiac trunk and cours- es downwards along the posterior surface of the pancreas 13 Iliac Arteries and Abdominal Aorta 97

Right renal artery

Inferior vena cava

a

Left renal artery

Right renal artery Pancreas tail

Inferior vena cava Left renal hilum

b

Inferior mesenteric artery

c

Fig. 13.2 a The infrarenal abdominal aorta is located between the origin of the two renal arteries. The right renal artery arises from the right anterolateral wall of the aorta, almost 1 cm below the superior mesenteric artery. The left renal vein passes in front of the aorta and superior mesenteric artery and then drains into the inferior vena cava. b The left renal artery arises from the lateral sur- face of the aorta to course behind the pancreas, where it reaches the left renal hilum. c The distal aortic tract is formed by the subrenal abdominal aorta, which is localized anterior to the 3° and 4° lumbar vertebrae. At this level, is the inferior mesenteric artery, the 5° abdominal aortic branch. It is localized 6 cm above the bifurcation of the iliac artery 98 S. Daniele, P. Iovine

Inferior mesenteric artery

3° lumbar vertebra

a

Right lumbar Left lumbar artery artery

Psoas muscle Psoas muscle

b

Iliac bifurcation 4° lumbar vertebra

c

Fig. 13.3 a The inferior mesenteric artery descends diagonally downwards and to the left, giving rise to collateral branches. b The four lumbar arteries arise from the abdominal aorta. They surround the lumbar vertebral bodies and course behind the psoas muscle. c At the level of the 4° lumbar vertebra, the abdominal aorta divides into the two common iliac arteries 13 Iliac Arteries and Abdominal Aorta 99

Right common Left common iliac artery iliac artery 5° lumbar vertebra

a

Right external Left external iliac artery iliac artery

b

Left external Right external iliac artery iliac artery Left internal Right internal iliac artery iliac artery Uterus

c

Fig. 13.4 a The common iliac arteries (right and left) are directed obliquely downwards and form an angle opening below, anterolateral to the body of the 5° lumbar vertebra. b The two common iliac arteries are directed towards the sacroiliac joints, with each artery dividing into external and inter- nal iliac arteries. c The internal iliac artery originates at the level of the sacral promontory (sacrover- tebral angle), courses downwards and posteriorly in the small pelvis, and divides into several mus- cular and visceral branches 100 S. Daniele, P. Iovine

Inferior epigastric Inferior epigastric vessels vessels Right external Left external iliac artery iliac artery

Uterus

a

Right external Left external iliac artery iliac artery

Right external Left external iliac vein iliac vein

b

Right common Left common femoral artery femoral artery

Right common Left common femoral vein femoral vein

c

Fig. 13.5 a The main branches of the external iliac artery are the inferior epigastric artery and the deep circumflex iliac artery. They supply the muscles of the lower anterior abdominal wall and anastomose with branches of the superior epigastric and phrenic arteries. b The external iliac artery is joined with the external iliac vein, which is located behind the artery. The two vessels lie along the internal border of the ileopsoas muscle. c Below the inguinal ligament, the external iliac artery continues as the femoral artery, which supplies branches to the lower limb, abdominal wall, and external genitalia. The femoral artery lies lateral to the femoral vein 13 Iliac Arteries and Abdominal Aorta 101

Left gastric artery

Celiac trunk Splenic artery

Hepatic artery

a

Right renal artery Left renal artery

Superior mesenteric Inferior mesenteric artery artery

b

Left common Inferior mesenteric iliac artery artery

Aortic bifurcation Left internal iliac artery Right external Left external iliac artery iliac artery c

Fig. 13.6 a Volume reconstructions of the abdominal aorta and its main branches shows the celiac trunk and its branches: hepatic artery, splenic artery, and left gastric artery; b the two renal arter- ies, which are directed laterally towards the corresponding renal hilum; the superior mesenteric artery, with its branches supplying the small intestine and right half of the colon; the inferior mesen- teric artery, which originates just above the iliac bifurcation, supplying the left colon, the sigmoid colon, and rectum; and c the two common iliac arteries, which divide into the internal and exter- nal iliac arteries