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The abdominal aorta is the largest blood vessel in the abdomen. It has a number of important relationships and branches, which very commonly appear in exam questions and anatomy spotters. I hope this anatomy guide is helpful.THE ABDOMINAL AORTA IN A NHELL

  • the abdominal aorta is a continuation of the descending thoracic aorta
  • it supplies all of the abdominal organs, and its terminal branches go on to supply the pelvis and lower limbs. It also supplies the undersurface of the diaphragm and parts of the abdominal wall.
  • it begins at T12 and ends at L4, where it divides into the right and left common iliac arteries
  • it enters the abdomen through the aortic opening of the diaphragm, which is located beneath the median arcuate ligament between the crura of the diaphragm at T12
  • it is accompanied through the aortic opening by the azygos vein and the thoracic duct
  • it is located on the posterior abdominal wall in the retroperitoneal space of the abdomen
  • it descends on the left of the inferior vena cava, over the anterior surface of the bodies of the lumbar vertebrae, and follows the curvature of the lower spine
  • because it lies slightly to the left of the midline, and due to the presence of the IVC next to it, right-sided arteries are longer than their left-sided equivalents, as they have further to travel. This means that, for example, the right renal artery is longer than the left.
  • running parallel to the aorta on its right-hand side are the inferior vena cava, the cisterna chyli, the beginning of the azygos vein, and the para-aortic lymph nodes
  • running on its left-hand side are the left sympathetic trunk and the para-aortic lymph nodes
  • organs situated directly in front of the aorta include the stomach, duodenum and pancreas
  • it is also crossed anteriorly by the splenic vein and the left renal vein
  • the normal diameter of the abdominal aorta is <2cm. It increases slightly in size with age, but if the diameter reaches >3cm, the patient has an abdominal aortic aneurysm (AAA). These are usually due to atherosclerosis, and if >5.5cm in size they are at high risk of spontaneously rupturing with massive internal haemorrhage.
  • trauma to the abdominal aorta can result from either blunt trauma (e.g. a car accident) or penetrating injuries (e.g. stabbings and gunshot wounds)
  • bleeding from the abdominal aorta tends to be catastrophic, with rapid exsanguination unless the patient gets to theatre very quickly to “turn off the tap”

.BRANCHES OF BDOINAL AORTA

This diagram summarises the arrangement of the branches of the abdominal aorta:

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.aorta geeky medics


Some key points to take away from this diagram are:

  • the abdominal aorta has 3 single anterior visceral branches (coeliac, SMA, IMA), 3 paired lateral visceral branches  (suprarenal, renal, gonadal), 5 paired lateral abdominal wall branches (inferior phrenic and four lumbar), and 3 terminal branches (two common iliacs and the median sacral)
  • for some reason, there are 3 suprarenal arteries. These supply the adrenal glands. The superior branch is derived from the inferior phrenic artery, the middle branch originates directly from the aorta, and the inferior branch comes off the renal artery.
  • the IVC runs parallel to the aorta on its right-hand side
  • because the IVC is in the way, the right renal artery has to pass behind it to get to the right kidney
  • the gonadal arteries (testicular in men, ovarian in women) are situated surprisingly high up in the abdomen, considering that the organs they supply are either dangling in the scrotum or way down in the pelvis. This is because during early fetal life, the gonads begin to develop up next to the kidneys before migrating downwards to their proper positions. They get their blood supply from where they started, not from where they end up.
  • the lumbar arteries arise posteriorly and will not be easily visible on most anatomical prosections
  • the fifth lumbar arteries on either side arise from the median sacral artery

ROMY: RADIOLOGY.

aorta angiogram reconstruction

CT angiogram of the whole aorta with 3D reconstruction – there is widespread calcification and a large 7.1cm infrarenal abdominal aortic aneurysm extending into the right common iliac artery. You can see how all the arteries are a lot wigglier in real life than are they on diagrams! How many of the main branches can you find? (image from Kim et al 2011 – full article available at http://tiny.cc/dfw6cx

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abdominal aorta post-stent 1

CT angiogram of the same patient following endovascular aneurysm repair. A bifurcated stent graft has been inserted percutaneously via the femoral artery. The right internal iliac artery was embolised preoperatively to prevent any leakage around the graft. The patient made a good recovery. (image from Kim et al 2011 – full article available at http://tiny.cc/dfw6cx)

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SPECIALIST REVIEW

Mr Avinash Sewpaul – ST8 in HPB & Transplant Surgery


References

  • Kim W; “Crossing the limbs (Ballerina position): a useful adjunct for successful implantation of the Endurant stent graft in a patient with an angulated tortuous neck and a splayed left common iliac artery”, Korean Society of Intervential Cardiology 2011. Available from: http://www.kscvi.org/eng/sub05-01-view.html?idx=215&mode=3&year=&gubun_num=&sel=&subject=&keyword=&searchWhere=&searchKeyword=&no=419
  • Netter FH; Atlas of Human Anatomy, 5th Edition” – Elsevier Saunders 2010. This is in my opinion the absolute best anatomy atlas out there. The illustrations are lifelike, extremely accurate and weirdly beautiful. Plus the cover is shiny. It’s worth every penny.
  • Sinnatamby CS; Last’s Anatomy, 12th Edition” – Churchill Livingstone 2011
  • Snell RS; “Clinical Anatomy by Regions, 9th Edition” – Lippincott Williams and Wilkins 2011