Vascular System

ARTERIAL SYSTEM

Thoracic Aorta

•       T4 – T12

•       Branches

–      Pericardial

–      Bronchial 2 left bronchial

–      Esophageal 4-5

–      Mediastinal

–      Posterior intercostal for lower 9 ICS

                             upper 2 from costo-cervical trunk

–      Superior phrenic

–      Subcostal

Abdominal Aorta

•       Extent – aortic  hiatus T12 – L4 ( line joining highest point of iliac crest)

•       Branches

–      Visceral

•       unpaired

–      Celiac trunk

–      Superior mesenteric artery

–      Inferior mesenteric artery

•       paired

–      Middle suprarenal artery

–      Renal artery

–      Gonadal artery

–      Posterior branches

•       Inferior phrenic  arteries

•       Lumbar arteries

•       Median sacral artery

•       Internal Iliac Artery

Branch of CIA (external and internal iliac arteries)

IIA

•       Anteriomedial to SIJ

•       Anterior and Posterior trunks

•       Posterior trunk

–      Lower posterior abdominal and pelvic wall and gluteal region

–      Branches

•       Iliolumbar a.

•       Lateral sacral a.

•       Superior gluteal a.

•       Anterior trunk

–      Pelvic viscera, perineum, gluteal region, adductor region of thigh and placental in fetus

–      Branches

•       Umbilical a.

•       Superior vesical a.

•       Inferior vesical a.

•       Middle rectal a.

•       Obturator a.

•       Internal pudendal a.

•       Inferior gluteal a.

•       Uterine a.

SPUERIOR VENACAVA

•       Right 1^st to 3^rd costal cartilage

•       Lower half inside pericardial sac

•       Tributaries

–      Azygos v.

–      Pericardial v.

–      Mediastinal v.

Pelvic veins

•       Follow the branches of arteries except for umbilical artery and ilio-lumbar artety.

•       Drain into internal iliac vein.

•       Plexus on the surface of viscera bladder, rectum, prostate, uterus and vagina. PELVIC PLEXUS

INFERIOR VENACAVA

•       Extent  L5 – T8

•       Structures crossing anteriorly

–      Right common iliac artery

–      Root of mesentery

–      Gonadal artery

–      Duodenum

–      Head of pancreas

–      Bile duct

–      Portal vein

–      Liver

•       Tributaries

–      Common iliac v.

–      Lumbar v.

–      Right gonadal v.

–      Renal v.

–      Right suprarenal v. 

–      Inferior phrenic v.

–      Hepatic v.

•       5^th lumbar v.– iliolumbar– CIV

•       3^rd /4^th – IVC

•       1^st /2^nd – Ascending lumbar v.

•       Ascending lumbar vein connects

–      EIV, Iliolumbar and lumbar vein

                             with azygos and hemiazygos v.

   

AZYGOS VEIN

•       Right ascending lumbar

              and right subcostal vein at  L1/2

                             or

             A direct branch of IVC joined by

             common trunk of right ascending lumbar

             vein and right subcostal vein.

•       Aortic hiatus

•       Joins SVC at T4

•       Tributaries

–      Right superior intercostal v.(2-4)

–      5^th -11^th posterior intercostal v.

–      Hemiazygos v.

–      Accessory hemiazygos v.

–      Esophageal v.

–      Mediastinal v.

–      Pericardial v.

–      Right bronchial v.

HEMIAZYGOS VEIN

•       Left ascending lumbar + left sub-costal v.

•       Right crus or aortic hiatus

•       Enters azygos vein

•       Tributaries

–      Left lower 4 or 5 PICV

–      Oeosphageal v.

–      Mediastinal v.

ACCESSORY HEMIAZYGOS VEIN

•       Descends from superior of posterior mediastinum to T8

•       Crosses vertebral column to join azygos vein or hemiazygos v. or both.

•       Tributaries

–      4^th – 8^th left posterior intercostal veins

–      Left bronchial v. (occasionally)

•       External Iliac Artery