THORACIC

ARTERIES,AORTA
&VEINS
TAKUNDA JOHN MAKONDO
171914
Aorta

• The aorta is the main arterial trunk that

delivers oxygenated blood from the left
ventricle of the heart to the tissues of the
body. It is divided for purposes of
description into the following parts:
ascending aorta, arch of the aorta,
descending thoracic aorta, and
abdominal aorta
THORACIC AORTA & ARTERIES
Ascending Aorta
• The ascending aorta begins at
the base of the left ventricle
• runs upward and forward at the
level of the sternal angle, where
it becomes continuous with the
arch of the aorta
• it possesses three bulges, the
sinuses of the aorta
• Branches
• the right coronary artery arises
from the anterior aortic sinus,
and the left coronary artery
arises from the left
• posterior aortic sinus
Branches of arch of aorta

• brachiocephalic artery, it divides into the right subclavian and right

common carotid arteries behind the right sternoclavicular joint.
• left common carotid artery
• left subclavian artery
Thoracic aorta
• The thoracic aorta is contained in the
• posterior mediastinal cavity.
• it begins at the lower border of the fourth thoracic vertebra where it
is continuous with the aortic arch, and ends in front of the lower
border of the twelfth thoracic vertebra, at the aortic hiatus in the
diaphragm where it becomes the abdominal aorta.
• At its commencement, it is situated on the left of the vertebral
column; it approaches the median line as it descends; and, at its
termination, lies directly in front of the column.
• In relation anteriorly from the downward with the root of the left
lung, the pericardium, the esophagus, and the diaphragm; posteriorly,
with the vertebral column and the azygos vein; on the right side, with
the hemizygous veins and thoracic duct; on the left side, with the left
pleura and lung.
• The aorta then arches back over the right pulmonary artery. Three
vessels come out of the aortic arch: the brachiocephalic artery, the
left common carotid artery, and the left subclavian artery. These
vessels supply blood to the head, neck, thorax and upper limbs
Braches of thoracic aorta
Visceral braches
• Bronchial- esophageal artery:
• Origin:
• rises at the sixth thoracic vertebra from aorta-it descends over the
right face of the aorta towards bifurcation of trachea and divided into
bronchial anaoesophagial branches.
• Bronchial Artery:
• it crosses the left face of esophagus to the bifurcation of trachea
where it divides into right and left branches. Each enter into holus of
corresponding lung.
esophageal Artery

• The esophageal arteries four or five in number, arise from the front of
the aorta, and pass obliquely downward to the esophagus, forming a
chain of anastomoses along that tube, anastomosing with the
esophageal branches of the inferior thyroid arteries above, and with
ascending branches from the left inferior phrenic and left gastric
arteries below. These arteries supply the middle third of the
esophagus.
Pericardial branches

• small branches of thoracic aorta distributed to the pericardium, in the

region of the oblique pericardial sinus, and to posterior mediastinal
lymph nodes.
Mediastinal branches
• The mediastinal branches are numerous small vessels which supply
the lymph glands and loose areolar tissue in the posterior
mediastinum.
Branches of thoracic aorta
Parietal branches
• Superior phrenic artries:
• The superior phrenic arteries are small and arise from the lower part
of the thoracic aorta; they are distributed to the posterior part of the
upper surface of the diaphragm, and anastomose with the
musculophrenic and pericardiacophrenic
Posterior intercostal arteries
• The posterior intercostal arteries are arteries
• that supply blood to the intercostal spaces.
• There are eleven posterior intercostal arteries on each side.
• The 1st and 2nd posterior intercostal arteries arise from the supreme
intercostal artery, a branch of the cost cervical trunk of the subclavian
artery.
• The lower nine arteries are the aortic intercostal, so called because
they arise from the back of the thoracic aorta.
Subcostal branches
• The subcostal arteries, so named because they lie below the last ribs,
constitute the lowest pair of branches derived from the thoracic
aorta, and are in series with the intercostal arteries.
• Each passes along the lower border of the twelfth rib behind the
kidney and in front of the Quadratus labarum muscle, and is
accompanied by the twelfth thoracic nerve.
Intercostal Arteries and Veins
• Each intercostal space contains a large single posterior intercostal
artery and two small anterior intercostal arteries and anterior and
posterior intercostal veins
Posterior intercostal arteries
• The posterior intercostal arteries of the first two spaces are
branches from the superior intercostal artery, a branch of the
cost cervical trunk of the subclavian artery.
• The posterior intercostal arteries of the lower nine spaces are
branches of the descending thoracic aorta
Branches of posterior intercostal arteries
1.Dorsal branch
• supply the vertebrae, spinal cord and meninges
2 Collateral branch
• it arises near the costal angle and anastomoses with an anterior intercostal
branch of the internal thoracic or musculophrenic artery.
3.Muscular branches
• Muscular branches supply intercostal and pectoral muscles
4.Mammary branches in the second to fourth spaces supply the mammary gland
5.Lateral cutaneous branch
• supply of the skin of the lateral trunk.
6 .Branches supply the parietal pleura
Posterior intercostal veins
• The posterior intercostal veins drain backward into the azygos or hemizygous
veins
• On both sides, the first posterior intercostal vein ascends anterior to the
neck of the first rib to end in the ipsilateral brachiocephalic vein.
• On the right side; the 2nd and 3rd veins form a right superior intercostal
vein joining the arch of the azygos vein.
• Veins from the 4th to 11th drain directly to the azygos vein.
• On the left; the 2nd and 3r veins form a left superior intercostal vein which
drain in the left brachiocephalic vein Veins from the 4th to 8th end in the
accessory hemizygous vein (superior hemizygous)
• Veins from the 9th to the 11th end in the hemizygous vein
Azygos Veins
• The azygos veins consist of the main azygos vein, the inferior
hemizygous vein, and the superior hemizygous vein. They drain
blood from the posterior parts of the intercostal spaces, the
posterior abdominal wall, the pericardium, the diaphragm, the
bronchi, and the esophagus
Azygos Vein
• The origin of the azygos vein is variable. It is often formed by the union of the
right ascending lumbar vein and the right subcostal vein or it may arises
from the inferior vena cava
• It ascends through the aortic opening in the diaphragm on the right side of the
aorta to the level of the fifth thoracic vertebra. Here it arches forward above
the root of the right lung to empty into the superior vena cava
Tributaries,
• The eight lower right intercostal veins
• The right superior intercostal vein
• The superior and inferior hemizygous veins
• Mediastinal veins.
Inferior Hemizygous Vein
• The inferior hemizygous vein is often formed by the union of the left
ascending lumbar vein and the left subcostal vein.
• At about the level of the eighth thoracic vertebra turns to the right
and joins the azygos vein
Tributaries
• Lower left intercostal veins (from 9th to 11th )
• Mediastinal veins.
Superior Hemizygous Vein
• The superior hemizygous vein is formed by the union of the fourth to
the eighth intercostal veins.
• It joins the azygos vein at the level of the seventh thoracic vertebra
Anterior intercostal arteries
• The anterior intercostal arteries of the first six spaces are branches of
the internal thoracic artery and which arises from the first part of the
subclavian artery.
• The anterior intercostal arteries of the lower spaces are branches
of the musculophrenic artery, one of the terminal branches of the
internal thoracic artery.
Anterior intercostal veins
• The anterior intercostal veins drain forward into the internal
thoracic and musculophrenic veins
Internal thoracic artery
• The internal thoracic artery supplies the anterior wall of the body
from the clavicle to the umbilicus.
Beginning It is a branch of the first part of the subclavian artery in the
neck.
Course It descends vertically on the pleura behind the costal
cartilages, a fingerbreadth lateral to the sternum,
Termination it ends in the 6th intercostal space by dividing into the
superior epigastric and musculophrenic arteries.
 Branches of internal thoracic artery
• Two anterior intercostal arteries for the upper six intercostal spaces
• Perforating arteries which accompany the terminal branches of the
corresponding intercostal nerves
• The pericardiacophrenic artery which accompanies the phrenic nerve
and supplies the pericardium
• Mediastinal arteries to the contents of the anterior mediastinum (e.g.,
the thymus)
• The superior epigastric artery which enters the rectus sheath of the
anterior abdominal wall and supplies the rectus muscle as far as the
umbilicus
• The musculophrenic artery which runs around the costal margin of the
diaphragm and supplies the lower intercostal spaces and the diaphragm
Internal Thoracic Vein
• The internal thoracic vein accompanies the internal thoracic artery
and drains the brachiocephalic vein on each side
Lymph Drainage of the Thoracic Wall
• The lymph drainage of the skin of the anterior chest wall
passes to the anterior axillary lymph nodes.
• The lymph drainage of the skin of the posterior chest wall
passes to the posterior axillary nodes.
• The lymph drainage of the intercostal spaces passes forward
to the internal thoracic nodes, situated along the internal
thoracic artery, and posteriorly to the posterior intercostal
nodes and the para-aortic nodes in the posterior mediastinum.