Vasculature of Abdomen and Pelvis

imaging arteries

• CT

• catheter angiogram

• ultrasound

• MR

imaging veins

• ultrasound

• CT

• MR

imaging lymphatics

• lymphoscintigraphy

• lymphangiogram

• MR

layers of arteries

• adventitia (external)

• tunica media (middle)

• tunica intima (inner)

internal iliac arteries

originate posteriorly from common iliac arteries

aorta

• largest artery

• branches: celiac, superior mesenteric, renal, inferior mesenteric

• bifurcation: L4/L5

aorta

celiac artery

superior mesenteric artery

inferior mesenteric artery

renal arteries

common iliac arteries

internal iliac artery

external iliac artery

celiac artery (supply)

supplies stomach, spleen, liver, pancreas, duodenum

superior mesenteric artery (supply)

supplies small bowel, right and transverse colon

renal arteries (supply)

supply kidneys

inferior mesenteric artery (supply)

supplies left colon, sigmoid

normal aorta (and branches)

aortic aneurysm

calcifications (of the abdominal aorta)

kink (in aorta)

aortic aneurysm

ruptured aortic aneurysm

celiac artery

• supplies: stomach, liver, gallbladder, pancreas, duodenum, spleen

• branches: left gastric, splenic, common hepatic

• origin: T12/L1

ruptured aortic aneurysm

celiac artery variants

• no celiac artery

• LGA, splenic, CHA originate directly from aorta

• left hepatic artery originates from LGA

superior mesenteric artery

• supplies: small and large bowel

• branches: inferior, pancreaticoduodenals, middle colic, multiple jejunal branches, right colic, ilieocolic

• origin: L1

renal arteries

• supply: kidneys, adrenal glands

• can be multiple

• should be smooth

• origin: L1/L2

fibromuscular dysplasia

• one of the most common diseases in the kidneys

• abnormal growth in the arterial wall

• not atherosclerosis

• not inflammatory vasculitis

• causes stenoses and aneurysms, HTN (in renal arteries due to obstructed blood flow to kidneys)

inferior mesenteric artery

branches: left colic, sigmoid, superior rectal

iliac arteries

• supply: pelvis, lower extremities

• importance: pelvic trauma, peripheral vascular disease

common iliac artery

from aortic bifurcation

external iliac artery

• continues past pelvis to leg

• becomes femoral artery after inguinal ligament

internal iliac artery (supply)

supplies pelvis, gluteal muscles, bladder, uterus/vagina, penis/prostate/scrotum, ovaries/testicles, part of rectum

inferior epigastric artery

• supplies rectus muscles

• last branch of external iliac artery

• implicated in bleeding, plastic surgery

lymphatic system

separate circulatory system of lymphatic vessels and lymph nodes

interstitial fluid return

~3L back to heart per day

lymph

fluid, lymphocytes

immune function of lymphatic system

clears cellular debris and bacteria

veins

• thin wall

• distensible

• low flow —> bleeding stops

• prone to blood clots

• often parallel arteries

systemic veins

drain directly to heart via IVC

portal venous system

• drain blood from bowel into liver where it is detoxified

• provides nutrients to liver

• increased pressure (HTN) from cirrhosis can lead to varices (bleed varices are life-threatening)

cirrhosis

• portal HTN

• fluid buildup in abdomen

• bleeding varices

• treatment is to reduce portal pressure - TIPS (transjugular intrahepatic portosystemic shunt)

external iliac arteries

internal and external iliac arteries

aorta

inferior mesenteric artery

renal arteries

superior mesenteric artery

celiac trunk

splenic artery

common hepatic artery

gastroduodenal artery

proper hepatic artery

left hepatic artery

right hepatic artery

celiac artery

left gastric artery

splenic artery

common hepatic artery

left hepatic artery

right hepatic artery

proper hepatic artery

common hepatic artery

celiac artery

left gastric artery

splenic artery

splenic artery

celiac artery

left gastric artery

splenic artery

left hepatic artery (normal variant off of left gastric artery)

common hepatic artery

gastroduodenal artery

right hepatic artery

left gastric artery

gastroduodenal artery

gastroepiploic artery

gastroepiploic artery

common hepatic artery

gastroduodenal artery

celiac artery

left gastric artery

splenic artery

common hepatic artery

gastroduodenal artery

left hepatic artery

right hepatic artery

gastroepiploic artery

common hepatic artery

gastroduodenal artery

proper hepatic artery

right hepatic artery

left hepatic artery

left hepatic artery

proper hepatic artery

common hepatic artery

left gastric artery

splenic artery