Blood Vessels of the Abdomen and Pelvis

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The pancreas | Main Anatomy Index | Innervation & lymphatics of abdomen and pelvis

Last updated 30 March 2006

Blood Vessels of the Abdomen and Pelvis

Arterial Supply of the Abdomen

The Abdominal Aorta

This is obviously the continuation of the thoracic aorta.

It begins at the aortic hiatus in the diaphragm at the level of the intervertebral disc between T12 and L1.
It ends around the level of L4 vertebra by dividing into two common iliac arteries.

Throughout its course, it lies against the vertebral bodies.

Relations of the Abdominal Aorta

Anteriorly, the abdominal aorta is related to:

The coeliac trunk and its branches;
The coeliac plexus;
The omental bursa;
The pancreas;
The left renal vein;
The ascending part of the duodenum;
The root of the mesentery;
And the intermesenteric plexus of nerves.

Posteriorly, the abdominal aorta descends anterior to:

The bodies of L1 to L4 vertebrae;
The intervening intervertebral discs;
And the corresponding part of the anterior longitudinal ligament.

On the right, of the abdominal aorta is the IVC. Related superiorly to the abdominal aorta on the right is:

The cisterna chyli;
The thoracic duct;
And the right crus of the diaphragm.

On the left, the abdominal aorta is related superiorly to the left crus of the diaphragm and the left coeliac ganglion.
The duodenojejunal flexure is on its left, opposite L2 vertebra.
The sympathetic trunk runs along its left side.

Surface Anatomy of the Abdominal Aorta

This is represented by a broad band (about 2 cm wide), extending from a median point, about 2.5 cm superior to the transpyloric plane, to a point slightly inferior and to the left of the umbilicus.
The latter point represents the level of bifurcation of the aorta to the common iliac arteries.

The aortic bifurcation is just to the left of the midpoint of the line joining the highest points of the iliac crests.

Branches of the Abdominal Aorta (from Ashwell)

Ventral Branches (unpaired)

Click here to go to the ventral branches.

Coeliac trunk
Superior mesenteric artery
Inferior mesenteric artery

Lateral (paired)

Click here to go to the lateral branches.

Inferior phrenic
Middle suprarenal
Renal
Gonadal (ovarian or testicular)

Posterior (paired and unpaired)

Click here to go to the posterior branches.

Lumbar (paired)
Median sacral (unpaired)

Terminal (paired)

Common iliac

Ventral Branches

There are anastomoses between these arteries and with their branches.

Left gastric artery branches with the aortic oesophageal branches around the lower oesophagus.
Anterior and posterior superior pancreaticoduodenal arteries (coeliac trunk) with the inferior pancreaticoduodenal (superior mesenteric branch) around the head of the pancreas and 2^nd part of the duodenum.
The marginal artery anastomosis between the middle colic and the left colic.
The superior rectal artery (inferior mesenteric) with the middle rectal (internal iliac) and/or the inferior rectal (internal pudendal from internal iliac).

Lateral Branches

Inferior Phrenic Artery

These are two small arteries that help supply the diaphragm and some small parts of the spleen and liver.
They arise separately, as a common trunk or from the coeliac trunk.

Each artery ascends anterior to the crus of the diaphragm medial to the suprarenal gland.
These arteries anastomose with the musculophrenic, posterior intercostal, and pericardiacophrenic arteries.

They give off the superior suprarenal arteries.

Middle Suprarenal Artery

These arise level with the superior mesenteric artery.
The right passes behind the IVC.
Both are related to the coeliac ganglion of the respective sides.
These anastomose with the suprarenal branches of the inferior phrenic and renal arteries.

Renal Artery

These two larger arteries branch from the aorta, just inferior to the level of the superior mesenteric artery.

The right is longer and passes posterior to the IVC, right renal vein, body of the pancreas and descending part of the duodenum.
The left passes posterior to the left renal vein, body of the pancreas and splenic vein.
Each of these divides into 4 or 5 branches.

Each renal artery gives off an inferior suprarenal branch and supplies the ureter in its upper extent.

Testicular Artery

These two arise anteriorly from the aorta, slightly inferior to the renal artery.
Each passes anterior to the psoas major behind the parietal peritoneum.
They then pass to the deep inguinal ring and enter the spermatic cord, finally passing into the scrotum.

The testicular artery supplies the testis, perirenal fat, ureter, iliac lymph nodes and cremaster.

Ovarian Artery

These correspond to the testicular arteries but are obviously in the female.
They enter the pelvis to supply the ovaries.
After entering the suspensory ligament of the ovary, they continue into the broad ligament of the uterus.

Branches are given off to the ovary, ureter, uterine tubes and one branch passes to the side of the uterus to anastomose with the uterine artery.
Other branches follow the round ligament of the uterus to the inguinal ligament and supply the skin of the labium majus.

Dorsal Branches

Lumbar Arteries

There are usually 4 on each side.
These pass anterior to the 4 upper lumbar vertebral bodies, pass behind the sympathetic trunks to the posterior abdominal wall.

The right arteries pass posterior to the IVC.
The branches of each artery include:

Spinal (to the vertebral canal and contents)
Ventral (to body wall)
Dorsal (to dorsal muscles, joints and skin)

Median Sacral Artery

This is a small posterior branch.
It leaves the aorta slightly above its bifurcation and descends anterior to the midline of L4, L5, the sacrum and ends in the coccyx.

Terminal Branches of the Abdominal Aorta

The abdominal aorta bifurcates anterior to the left side of L4 into the common iliac arteries.
These two arteries diverge and further divide into the internal and external iliac arteries on each side at the level of the lumbosacral intervertebral disc.

The external iliac artery gives off the inferior epigastric and deep circumflex iliac arteries and continues as the femoral artery in the lower limb.
The internal iliac artery gives many branches and these are divided into anterior and posterior trunk divisions.

Branches of the External Iliac Artery

Inferior Epigastric Artery

This arises from the external iliac just proximal to the inguinal ligament.

It ascends medial to the deep inguinal ring (raising the parietal peritoneum as it does so to form the lateral umbilical fold).
It then pierces the transversalis fascia passing anterior the posterior layer of the rectus sheath.

It divides into numerous branches, some of which anastomose with the superior epigastric and posterior intercostal arteries.

Deep Circumflex Iliac Artery

This arises almost opposite the inferior epigastric artery.
It ascends the iliac crest anastomosing with the ascending branches of the lateral circumflex femoral, lumbar and inferior epigastric arteries.

Branches from the Anterior Trunk of Internal Iliac Artery

The superior vesical artery with several branches. It was derived from the umbilical artery of the foetus.

The inferior vesical artery (in males).

The middle rectal artery.

The uterine artery (in females).

The vaginal artery (corresponds to the inferior vesical artery of males).

The obturator artery. This leaves to the pelvis via the obturator foramen.

The internal pudendal artery. This leaves the pelvis between the piriformis and coccygeus muscles.
It passes deep to the sacrotuberous ligament to enter the pudendal canal in the lateral wall of the ischiorectal fossa.
The artery has several branches including the inferior rectal artery.

The inferior gluteal artery. This leaves the pelvis below the piriformis muscle through the greater sciatic foramen.

Branches of the Posterior Trunk of the Internal Iliac Artery

The iliolumbar trunk ascends to the medial border of the psoas major muscle.

The lateral sacral arteries.

The superior gluteal artery. This leaves the greater sciatic foramen above the piriformis muscle.

Venous Drainage of the Abdomen

There is general portal circulation for the intraperitoneal part.
In contrast, there are systemic veins for the extraperitoneal part.

Portal Circulation

The Portal Vein

The portal vein is about 8 cm long and valveless, as are its tributaries, in adult life.

It begins at the level of L2 by the junction of the splenic and superior mesenteric veins.
As it reaches the porta hepatis it divides into left and right branches, which supplies the corresponding halves of the liver.

The right branch supplies the right half of the liver and usually receives the cystic vein.
The left branch divides into branches to the caudate, quadrate and left lobes.
As the left branch enters the living, it is joined by paraumbilical veins, the ligamentum teres and is connected to the IVC by the ligamentum venosum.

The tributaries of the portal vein are the splenic, superior mesenteric, left gastric, right gastric, paraumbilical and cystic veins.

Tributaries of the Splenic Vein

Short gastric vein
Left gastro-omental (gastroepiploic) vein
Pancreatic veins
Inferior mesenteric (receives the left colic and sigmoid veins)

Tributaries of the Superior Mesenteric Vein

Right gastro-omental (gastroepiploic) vein
Pancreaticoduodenal vein
Jejunal and ileal veins
Ileocolic vein
Right colic vein
Middle colic vein

Portal-Systemic Anastomoses

Site	Portal Tributaries	Systemic Tributaries
Oesophagus	Left gastric oesophageal branches	Oesophageal branches to azygos, accessory hemiazygos veins
Umbilicus	Ligamentum teres veins (paraumbilical veins)	Epigastric veins
Anal canal	Superior rectal veins	Middle and inferior rectal veins
Retroperitoneal	Venous radicles of colon and bare area of liver	Retroperitoneal veins
Liver	Patent ductus venosus (branch of left portal vein branch)	IVC

Systemic Veins

This consists of the inferior vena cava and its tributaries in the abdomen.

Lumbar Veins

There are 4 pairs of these draining the lumbar region and posterior abdominal wall.
Near the vertebral column, they drain the vertebral venous plexus and are connected by the ascending lumbar veins to the common iliac and iliolumbar veins.

Testicular Veins

These drain the epididymis and testis.
They unite to form the pampiniform plexus and ascend with the testicular artery.

The right one enters the IVC just below the renal veins.
The left one enters the left renal vein.

Ovarian Veins

These arise from a plexus in the broad ligament to ascend with the ovarian artery much like the testicular veins.

Hepatic Veins

These enter the IVC as it passes through the superior aspect of the liver.

Other Veins

The renal veins.
The suprarenal veins.
The inferior phrenic veins.