Abdominal Vasculature

I. ABDOMINAL AORTA (Figure 8-1)

A. Major branches

1. Celiac trunk, superior mesenteric artery, renal arteries, gonadal arteries, inferior mesenteric artery, and common iliac arteries. The celiac trunk is located at vertebral level T12 and supplies the viscera that derive embryologically from the foregut (i.e., intraabdominal portion of esophagus, stomach, upper part of duodenum, liver, gallbladder, and pancreas). It further branches into the following structures:

a. Left gastric artery b. Splenic artery c. Common hepatic artery

2. The superior mesenteric artery is located at vertebral level LI and supplies the viscera that derive embryologically from the midgut (i.e., lower part of duodenum, jejunum, ileum, cecum, appendix, ascending colon, and proximal two-thirds of the transverse colon).

3. The renal arteries supply the kidneys.

4. The gonadal arteries supply the testes or ovaries.

5. The inferior mesenteric artery is located at vertebral level L3 and supplies the viscera that derive embryologically from the hindgut (i.e., distal one-third of transverse colon, descending colon, sigmoid colon, and upper portion of rectum). The common iliac arteries are the terminal branches of the abdominal aorta.

B. Clinical considerations

1. Abdominal aortic aneurysm (AAA) typically is seen below vertebral level LI (i.e., below the renal arteries and superior mesenteric artery) in elderly men with atherosclerosis. The most common site of a ruptured AAA is below the renal arteries in the left posterolateral wall (retroperitoneal). In a patient with a ruptured AAA, the first step is immediate compression of the aorta against the vertebral bodies above the celiac trunk. During a transabdominal surgical approach to correct a ruptured AAA, the left renal vein is put in jeopardy. The inferior mesenteric artery usually lies in the middle of an AAA. Clinical findings include: sudden onset of severe, central abdominal pain that may radiate to the back; a pulsatile, tender abdominal mass; and hypotension and delirium, if rupture occurs. Surgical complications include: ischemic colitis as a result of ligation of the inferior mesenteric artery and spinal cord ischemia as a result of ligation of the great radicular artery (artery of Adamkiewicz; see Chapter 2 II D).

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