Vascular System

What is the first major anterior branch of the abdominal aorta?

The celiac trunk.

What is another name for the celiac trunk?

Celiac Axis

Where does the celiac trunk originate?

Anteriorly from the abdominal aorta

What are the three branches of the celiac trunk?

Splenic artery, common hepatic artery, and left gastric artery

Which celiac trunk branch can be difficult to identify?

The left gastric artery

The SMA is ___ to the celiac trunk?

Inferior

What is the characteristic transverse appearance of the celiac trunk?

A seagull appearance

What is the sonographic appearance of the celiac trunk lumen?

Anechoic

What is the largest of the three branches of the celiac trunk?

The splenic artery

What is the characteristic shape/course of the splenic artery?

It is tortuous and can be difficult to follow

Where does the splenic artery run relative to the pancreas?

It forms the superior border of the pancreas

What is the common hepatic artery’s sonographic appearance?

Anechoic lumen, anterior and to the right of the celiac trunk.

What structures make up the portal triad?

Portal vein, hepatic artery, and bile duct

What does the common hepatic artery branch into?

Gastroduodenal artery and proper hepatic artery.

What does the proper hepatic artery divide into?

Right and left hepatic arteries

What do the gastroduodenal and right gastric arteries supply?

The duodenum and stomach

What does the hepatic artery supply?

The liver

What does the left hepatic artery supply?

The caudate and left lobe of the liver

What does the right hepatic artery supply?

The gallbladder through the cystic artery and the liver

What does the left gastric artery supply?

The lower esophagus and stomach

What does the splenic artery supply

The spleen

What is the second major anterior branch of the abdominal aorta?

The superior mesenteric artery

Where does the SMA originate?

Anteriorly from the aorta, posterior to the pancreas, and just inferior to the celiac trunk.

Which 2 anatomic variants have a common origin?

The SMA and celiac axis

The SMA feeds the?

Intestines

Mesenteric=?

Intestines/small bowel

How does the SMA travel relative to the aorta?

It travels inferiorly and parallel to the aorta

What is the SMA lumen’s sonographic appearance?

Anechoic

What is notable about the SMA border?

It is highly echogenic (brighter)

What surrounds the SMA?

Retroperitoneal fascia

Where does the inferior mesenteric artery arise?

From the anterior aspect of the aorta, inferior to the SMA

True or False, The IMA is sonographically difficult to identify.

True

What is seen in long as a small tubular structure inferior to the SMA?originating from the anterior aortic wall.

IMA

What are the lateral branches of the abdominal aorta listed?

Phrenic, renal, gonadal, and lumbar arteries

Where do the renal arteries arise?

From the lateral border of the aorta, inferior to the SMA

What is the landmark to find the renal arteries?

SMA

What is the anatomic variant of the renal arteries?

Duplication of the renal arteries

Which renal artery is longer?

The right renal artery

The right renal artery is located ___ to the IVC

Posterior

Renal arteries pass ___ to the renal vein

Transverse

What is the course of the right renal artery?

From the aorta posterior to the IVC and anterior to the vertebral column, in a posterior and slightly caudal direction, to the right renal hilus.

How do the renal arteries appear in a slight decubitus coronal view?

They can be seen arising from the lateral wall of the aorta

What is the renal artery lumen’s sonographic appearance?

Anechoic

Where should the renal arteries be located relative to the SMA origin?

Inferior to the SMA origin

Where do the renal arteries arise from the aorta?

The lateral aspect

How does the right renal artery appear on transverse imaging?

As a small circle posterior to the IVC

Which renal artery courses from the AO directly to the left kidney?

Left renal artery

How is the IVC formed?

BY union of the common iliac veins posterior to the right common iliac artery

Where does the IVC return blood to?

The right atrium

In what cavity is the IVC located?

The retroperitoneal cavity

Where is the IVC relative to the vertebral column?

Anterior to it

Where is the IVC relative to midline and the aorta?

Right of midline and right of the aorta

Where is the IVC relative to the liver?

Posterior to the liver

What happens to the IVC at the diaphragm?

It pierces the diaphragm

What relationship is given between the aorta and diaphragm?

The aorta is posterior to the diaphragm.

What are the 3 major anterior hepatic tributaries of the IVC?

The right, middles, and left hepatic veins

What are the 3 lateral tributaries of the IVC?

Right suprarenal vein, renal veins, and right testicular or ovarian vein

Where does the left suprarenal vein drain?

Into the left renal vein

What are the 5 abdominal wall tributaries of the IVC?

The inferior phrenic vein and four lumbar veins

What are the three veins of origin listed for the IVC?

The two common iliac veins and the median sacral vein

How does the IVC differ from the aorta sonographically?

The IVC is collapsible and has thinner walls

What happens to the IVC during Valsalva maneuver?

It expands

What is the IVC lumen’s sonographic appearance?

Anechoic

What may be seen swirling within the IVC lumen?

Echogenic foci associated with slow-moving blood.

What is the transverse shape of the IVC?

Almond-shaped

What structure is anterior to the IVC?

The head of the pancreas

What is the anatomical variant where a body part/ organ is located on the opposite side of the body than where it's supposed to be. Ex: heart on rt. side. Ex: IVC on Lt. side.

Situs inversus

What is a missing segment of the IVC where the azygos vein takes over?

Interrupted IVC segment

What is the typical relationship of the renal veins to the renal arteries?

Renal veins are anterior to renal arteries

At what approximate level are the renal veins seen?

About the same level as the renal arteries

What landmark is useful for imaging the renal veins?

The SMA

Where is the left renal vein relative to the SMA and aorta?

Posterior

Where is the left renal vein relative to the aorta?

Anterior

The left renal vein is ___ and ___ compared to the right?

Longer and larger

What is the sonographic appearance of the left renal vein transversely?

Anechoic tubular structure

What is the longitudinal appearance of the left renal vein?

A small circular structure between the SMA and aorta

How does the right renal vein compare with the left?

It is shorter and smaller

What is the right renal vein’s transverse sonographic appearance?

Anechoic tubular structure

What is the right variant where the left renal vein passes posterior to the abdominal aorta and anterior to the spine?

Retroaortic left renal vein

What is a ring-like variant where the left renal vein splits, with one part anterior and one part posterior to the aorta?

Circumaortic renal vein.

What are the largest visceral tributaries of the IVC?

The hepatic veins

Where do the hepatic veins originate?

Between the segments of the liver

Where do the hepatic veins drain?

Posteriorly into the IVC at the level of the diaphragm

What type of blood do the hepatic veins return from the liver?

Unoxygenated blood

Which hepatic vein drains the right lobe of the liver?

The right hepatic vein

Which hepatic vein drains the caudate lobe?

Thee middle hepatic vein

Which hepatic vein drains the left lobe of the liver?

The left hepatic vein

Which hepatic veins may fuse together before emptying into the inferior vena cava

The middle and left hepatic veins

How do hepatic veins change in caliber as they approach the diaphragm?

They increase in caliber

The hepatic veins drain into the ___ at the level of the ____

IVC, diaphragm

How do the hepatic veins differ from portal veins acoustically?

Hepatic veins are not surrounded by bright acoustic reflections, while portal veins have echogenic borders

What does hepatopretal flow mean?

Flow toward the liver

What does hepatofugal flow mean?

Flow away from the liver

What is a nonresistive vessel?

A vessel with a high diastolic component that supplies an organ requiring constant perfusion

What vessels are examples of nonresistive vessels?

Internal carotid, hepatic, and renal arteries

What is a resistive vessel?

A vessel with very little or reversed flow during diastole that supplies an organ that does not need constant blood supply.

What vessels are examples of resistive vessels?

External carotid, iliac, and brachial arteries

What does the resistive index quantify?

Vessel impedance

What is the resistive index ratio?

Peak systole is compared with minimum diastole to quantify a vessel’s impedance

How does aortic flow vary?

It varies at different levels