 Section 22 of GRAY'S ANATOMY, PART III. The owner artery, the larger of the two terminal branches of the brachial, begins a little below the bend of the elbow and, passing obliquely downward, reaches the ulnar side of the forearm at a point about midway between the elbow and the wrist. It then runs along the ulnar border to the wrist, crosses the transverse carpal ligament on the radial side of the pisiform bone, and immediately beyond this bone divides into two branches, which enter into the formation of the superficial and deep, volar arches. Relations A. in the forearm. In its upper half, it is deeply seated, being covered by the pronator terees, flexor carpi radialis, palmaris longus, and flexor digitorum sublimus. It lies upon the brachialis and flexor digitorum profundus. The median nerve is in relation with the medial side of the artery for about 2.5 cm, and then crosses the vessel, being separated from it by the ulnar head of the pronator terees. In the lower half of the forearm, it lies upon the flexor digitorum profundus, being covered by the integument and the superficial and deep fasci, and placed between the flexor carpi ulnaris and flexor digitorum sublimus. It is accompanied by two viny cometantes, and is overlapped in its middle third by the flexor carpi ulnaris. The ulnar nerve lies on the medial side of the lower two thirds of the artery, and the palmar cutaneous branch of the nerve descends on the lower part of the vessel to the palm of the hand. B. At the wrist, the ulnar artery is covered by the integument and the volar carpal ligament, and lies upon the transverse carpal ligament. On its medial side is the pisiform bone, and somewhat behind the artery, the ulnar nerve. Peculiarities The ulnar artery varies in its origin in the proportion of about 1 in 13 cases. It may arise about 5 to 7 cm below the elbow, but more frequently higher, the brachial being more often the source of origin than the auxiliary. Lines in the position of this vessel are more common than in the radial. When its origin is normal, the course of the vessel is rarely changed. When it arises high up, it is almost invariably superficial to the flexor muscles in the forearm, lying commonly beneath the fascia, more rarely between the fascia and integument. In a few cases, its position was subcutaneous in the upper part of the forearm and subaponeurotic in the lower part. Branches The branches of the ulnar artery may be arranged in the following groups. In the forearm, anterior recurrent, posterior recurrent, common enterosius. At the wrist, volar carpal, dorsal carpal, deep volar. In the hand, muscular, superficial volar arch. The anterior ulnar recurrent artery, A recurrence ulnaris anterior, arises immediately below the elbow joint, runs upward between the brachialis and pronator tereis, supplies twigs to those muscles and in front of the medial epicondyle, anastomoses with the superior and inferior ulnar collateral arteries. The posterior ulnar recurrent artery, A recurrence ulnaris posterior, is much larger and arises somewhat lower than the preceding. It passes backward and medial word on the flexor digitorum profundus behind the flexor digitorum sublimus and ascends behind the medial epicondyle of the humerus. In the interval between this process and the olocranin, it lies beneath the flexor carpal ulnaris and ascending between the heads of that muscle in relation with the ulnar nerve, it supplies the neighboring muscles and the elbow joint and anastomoses with the superior and inferior ulnar collateral and the enterosius recurrent arteries. The common enterosius artery, A enterosia communus, about one centimeter in length, arises immediately below the tuberosity of the radius and passing backward to the upper border of the enterosius membrane divides into two branches, the volar and dorsal enterosius arteries. The volar enterosius artery, A enterosia volaris anterior enterosius artery passes down the forearm on the volar surface of the enterosius membrane. It is accompanied by the volar enterosius branch of the median nerve and overlapped by the contiguous margins of the flexor digitorum profundus and flexor polisus longus, giving off in this situation muscular branches and the nutrient arteries of the radius and ulnar. At the upper border of the pronator quadratus, it pierces the enterosius membrane and reaches the back of the forearm, where it anastomoses with the dorsal enterosius artery. It then descends, in company with the terminal portion of the dorsal enterosius nerve, to the back of the wrist to join the dorsal carpal network. The volar enterosius artery gives off a slender branch, the arterior mediana, which accompanies the median nerve and gives off sets to its substance. Enterosius artery is sometimes much enlarged and runs with the nerve into the palm of the hand. Before it pierces the enterosius membrane, the volar enterosius sends a branch downward behind the pronator quadratus to join the volar carpal network. The dorsal enterosius artery, A enterosia dorsalis posterior enterosius artery passes backward between the oblique cord and the upper border of the enterosius membrane. It appears between the contiguous borders of the supinator and the abductor polisus longus and runs down the back of the forearm between the superficial and deep layers of muscles to both of which it distributes branches. Where it lies upon the abductor polisus longus and the extensor polisus brevis, it is accompanied by the dorsal enterosius nerve. At the lower part of the forearm and anastomoses with the termination of the volar enterosius artery and with the dorsal carpal network. It gives off near its origin the enterosius recurrent artery which ascends to the interval between the lateral epicondyle and olocranin on or through the fibers of the supinator but beneath the anconius and anastomoses with the radial collateral branch of the profunda brachii, the posterior ulnar recurrent, and the inferior ulnar collateral. Muscular branches, rami muscularis, are distributed to the muscles along the ulnar side of the forearm. The volar carpal branch, ramus carpius volaris, anterior ulnar carpal artery, is a small vessel which crosses the front of the carpus beneath the tendons of the flexor digitorum profundus and anastomoses with the corresponding branch of the radial artery. The dorsal carpal branch, ramus carpius dorsalis posterior ulnar carpal artery, arises immediately above the pisiform bone and winds backward beneath the tendon of the flexor carpi ulnaris. It passes across the dorsal surface of the carpus beneath the extensor tendons to anastomose with a corresponding branch of the radial artery. Immediately after its origin it gives off a small branch which runs along the ulnar side of the fifth metacarpal bone and supplies the ulnar side of the dorsal surface of the little finger. The deep volar branch, ramus volaris profundus profunda branch, passes between the abductor digiti quinti and flexor digiti quinti brevis and through the origin of the oponens digiti quinti it anastomoses with the radial artery and completes the deep volar arch. The superficial volar arch, arcus volaris superficialis superficial palmar arch, is formed by the ulnar artery and is usually completed by a branch from the abolaris endocyst radialis but sometimes by the superficial volar or by a branch from the aprincipus pollicis of the radial artery. The arch passes across the palm describing a curve with its convexity downward. Relations. The superficial volar arch is covered by the skin, the palmaris brevis and the palmar aponeurosis. It lies upon the transverse carpal ligament, the flexor digiti quinti brevis and oponens digiti quinti, the tendons of the flexor digitorum sublimus, the lumbar cows and the divisions of the median and ulnar nerves. Three common volar digital arteries, AA digitalis volaris communis, palmar digital arteries arise from the convexity of the arch and proceed downward on the second, third and fourth lumbricals. Each receives the corresponding volar metacarpal artery and then divides into a pair of proper volar digital arteries, AA digitalis volaris propae, collateral digital arteries which run along the contiguous sides of the index, middle, ring and little fingers behind the corresponding digital nerves. They anastomose freely in the subcutaneous tissue of the fingertips and by smaller branches near the interphalangeal joints. Each gives off a couple of dorsal branches which anastomose with the dorsal digital arteries and supply the soft parts on the back of the second and third phalanges including the matrix of the fingernail. The proper volar digital artery for medial side of the little finger springs from the ulnar artery under cover of the palmaris brevis. End of section 22, recording by Leanne Howlett. Section 23 of Grey's Anatomy, Part 3. This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer, please visit LibriVox.org. Recording by Mary Ann Coleman Hibkins. Anatomy of the human body, Part 3 by Henry Gray. Arteries of the trunk, descending aorta, thoracic aorta. The descending aorta is divided into two portions, the thoracic and abdominal in correspondence with the two great cavities of the trunk in which it is situated. One, the thoracic aorta, aorta thoracolus. 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 at the aortic hiatus in the diaphragm. 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. The vessel describes a curve which is concave forward and as the branches given off from it are small, its diminuton in size is inconsiderable. Relations. It is in relation anteriorly from above downward with the root of the left lung, the pericardium, the esophagus and the diaphragm posteriorly with the vertebral column and the hemiasagus veins on the right side. With the azagus vein and thoracic duct on the left side with the left pleura and lung, the esophagus with its accompanying plexus of nerves lies on the right side of the aorta above but at the lower part of the thorax. It is placed in front of the aorta and, close to the diaphragm, is situated on its left side. Peculiarities. The aorta is occasionally found to be obliterated at the junction of the arch with the thoracic aorta just below the ductus arteriosus. Whether this is the result of disease or of congenital malformation is immaterial to our present purpose. It affords an interesting opportunity of observing the resources of the collateral circulation. The cause of the anastomosing vehicles by which the blood is brought from the upper to the lower part of the artery will be found well described in an account of two cases in the pathological transactions volumes 8 and 10. In the former, Sydney Jones thus sums up the detailed description of the anastomosing vessels. The principal communications by which the circulation was carried on were 1. The internal mammary anastomosing with the intercostal arteries with the inferior phrenic of the abdominal aorta by means of the musculophrenic and periocardiacophrenic and largely with the inferior epigastro 2. The costos cervical trunk anastomosing anteriorly by means of a large branch with the first aortic intercostal and posteriorly with the posterior branch of the same artery 3. The inferior thyroid by means of a branch about the size of an ordinary radial forming a communication with the first aortic intercostal 4. The transverse cervical by means of a very large communications with the posterior branches of the intercostals 5. The branches of the subclavian and auxiliary going to the side of the chest were large and anastomosed freely with the lateral branches of the intercostals 6. In the second case Wood describes the anastomoses in a somewhat similar manner adding the remark that the blood which was brought into the aorta through the anastomosis of the intercostal arteries appeared to be expanded principally in supplying the abdomen and pelvis while the supplier to the lower extremities had passed through the internal memory and epigastrics. In a few cases an apparently double descending thoracic aorta has been found the two vessels lying side by side and eventually fusing to form a single tube in the lower part of the thorax or in the abdomen. One of them is the aorta. The other represents a descending aortic aneurysm which has become canalised opening above and below into the true aorta and at first sight presenting the appearances of a proper blood vessel. The other is the anastomoses of the thoracic aorta, visceral, pericardial, bronchial, esophageal, mediastinal, parietal, intercostal, subcostal, superior phrenic. The pericardial branches ramy pericardiac consist of a few small vessels which are distributed to the posterior surface of the pericardium. The bronchial arteries, a.a. bronchialis, vary in number, size and origin. There is as a rule only one right bronchial artery which arises from the first aortic intercostal or from the upper left bronchial artery. The left bronchial arteries are usually two in number and arise from the thoracic aorta. The upper left bronchial arises opposite the fifth thoracic vertebra, the lower just below the level of the left bronchus. Each vessel runs on the back part of its bronchus, dividing and subdividing along the bronchial tubes, supplying them the areola tissue of the lungs, the bronchial lymph glands and the esophagus. The esophageal arteries, a.a. esophageal, four or five in number, arise from the front of the aorta and pass obliquely downward to the esophagus, forming a chain of anastomosis along that tube. Anastomosis with the esophageal branches of the inferior thyroid arteries above and with ascending bronches from the left inferior phrenic and left gastric arteries below. The mediastinal branches, rami, mediastinales, are numerous small vessels which supply the lymph glands and lose areola tissue in the posterior mediastinum. Intercostal arteries, a.a. intercostales. There are usually nine pairs of aortic intercostal arteries. They arise from the back of the aorta and are redistributed to the lower nine intercostal spaces. The first two spaces being supplied by the highest intercostal artery, a branch of the costoservical trunk of the subclavian. The right aortic intercostals are longer than the left, on account of the position of the aorta on the left side of the vertebral column. They pass across the bodies of the vertebrae behind the esophagus, thoracic duct, and vena acygos, and are covered by the right lung and pleura. The left aortic intercostals run backward on the sides of the vertebrae and are covered by the left lung and pleura. The upper two vessels are crossed by the highest left intercostal vein, the lower vessels by the hemizygos veins. The further course of the intercostal arteries is practically the same on both sides. Opposite the heads of the ribs, the sympathetic trunk passes downward in front of them and the splannic nerves also descend in front by the lower arteries. Each artery then divides into an anterior and a posterior ramus. The anterior ramus crosses the corresponding intercostal space obliquely toward the angle of the upper rib and thence is continued forward in the costal groove. It is placed at first between the pleura and the posterior intercostal membrane, then it passes this membrane and lies between it and the intercostalis externus as far as the angle of the rib. From this onward it runs between the intercostales externus and internus and anastomoses in front with the intercostal branch of the internal memory or musculophrenic each artery is accompanied by a vein and a nerve. The former been above and the latter below the artery except in the upper spaces where the nerve is at first above the artery. The first aortic intercostal artery anastomoses with the intercostal branch of the costoservical trunk and may form the chief supply of the second intercostal space. The lower two intercostal arteries are continued anteriorly from the intercostal spaces into the abdominal wall and anastomose with the subcostal superior epigastric and lumbar arteries. Branches the anterior rame give off the following branches collateral intercostal muscular lateral cutaneous mammary. The intercostal branch comes off from the intercostal artery near the angle of the rib and descends to the upper border of the rib below along which it courses to anastomose with the intercostal branch of the internal mammary. Muscular branches are given to the intercostales and pectorales and to the seratis anterior they anastomize with the highest and lateral thoracic branches of the auxiliary artery. The lateral cutaneous branches accompany the lateral cutaneous branches of the thoracic nerves. Mammary branches are given off by the vessels in the third, fourth and fifth spaces. They supply the mammar and increase considerably in size during the period of lactation. The posterior ramus runs backward through a space which is bounded above and below by the necks of the ribs medially by the body of a vertebra and laterally by an anterior costo transverse ligament. It gives off a spinal branch which enters the vertebral canal through the intervertebral foreman and is distributed to the medulla spinalis and its membranes and the vertebrae. It then courses over the transverse process with the posterior division of the thoracic nerve supplies branches to the muscles of the back and cutaneous branches which accompany the corresponding cutaneous branches of the posterior division of the nerve. The subcostal arteries so named because they lie below the last ribs constitute the lowest pair of branches derived from their 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 lumborum muscle and is accompanied by the twelfth thoracic nerve. It then pierces the posterior aponeurosis of the transversus abdominis and passing forward between this muscle and the obliquus internus and astromoses with the superior epigastric lower intercostal and lumbar arteries. Each subcostal artery gives off a posterior branch which has a similar distribution to the posterior ramus of an intercostal artery. The superior phrenic branches 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 an astromose with the musculophrenic and the periocardiac phrenic arteries. A small aberrant artery is sometimes found arising from the right side of the thoracic aorta near the origin of the right bronchiol. It passes upward into the right behind the trachea and the esophagus and may anastomose with the highest right intercostal artery. It represents the remains of the right dorsal aorta and in a small proportion of cases is enlarged to form the first part of the right subclavian artery. End of section 23 recording by Miriam Coleman-Hipkins section 24 of Grey's Anatomy part 3. This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer please visit LibriVox.org. Recording by Miriam Coleman-Hipkins. Anatomy of the Human Body part 3 by Henry Gray. The abdominal aorta part 1. 5A2. The abdominal aorta. Aorta abdominalis. The abdominal aorta begins at the aortic hiatus of the diaphragm in front of the lower border of the body of the last thoracic vertebra and descending in front of the vertebral column ends on the body of the fourth lumbar vertebra commonly a little to the left of the middle line. Footnote. Footnote 103. Lord Lister having accurately examined 30 bodies in order to ascertain the exact point of termination of this vessel found it either absolutely or almost absolutely mesial in 15 while in 13 it deviated more or less to the left and in 2 was slightly to the right. System of surgery edited by T Holmes second edition verse 652 end of footnote by dividing into the two common iliac arteries it diminishes rapidly in size in consequence of the many large branches which it gives off as it lies upon the bodies of the vertebrae. The curve which it describes is convex forward the summit of the convexity corresponding to the third lumbar vertebra. Relations. The abdominal aorta is covered anteriorly by the lesser momentum and stomach behind which are the branches of the celiac artery and the celiac plexus below these by the lionel vein the pancreas the left renal vein the inferior part of the duodenum the mesentery and aortic plexus posteriorly it is separated from the lumbar vertebrae and intervertebral fibrocatellages by the anterior longitudinal ligament and left lumbar veins. On the right side it is in relation above with the ozygous vein cisterna chile thoracic duct and the right crust of the diaphragm. The last separating it from the upper part of the inferior vena cava and from the right celiac ganglion the inferior vena cava is in contact with the aorta below on the left side are the left crusts of the diaphragm the left celiac ganglion the ascending part of the duodenum and some cores of the small intestine. Collateral circulation. The collateral circulation would be carried on by the anastomoses between the internal mammary and the inferior epigastric by the free communication between the superior and inferior mesenterics if the ligature replaced between these vessels or by the anastomoses between the inferior mesenteric and the internal pudino when as is more common the point of ligature is below the origin of the inferior mesenteric and possibly by the anastomoses of the lumbar arteries with the branches of the hypogastric. Branches. The branches of the abdominal aorta may be divided into three sets visceral, parietal and terminal. Visceral branches celiac, superior mesenteric, inferior mesenteric, middle suprarenos renos, internal spermatics, ovarian and the female. Parietal branches, inferior phrenics, lumbars, middle sacral. Terminal branches, common iliacs. Of the visceral branches the celiac artery and the superior and inferior mesenteric arteries are unpaired while the suprarenos renos internal spermatics and ovarian are paired. Of the parietal branches the inferior phrenics and lumbars are paired. The middle sacral is unpaired. The terminal branches are paired. The celiac artery a celiosa celiac axis is a short thick trunk about 1.25 centimeters in length which arises from the front of the aorta just below the aortic hiatus of the diaphragm and passing nearly horizontally forward divides into three large branches the left gastric, the hepatic and the spleenic. It occasionally gives off one of the inferior phrenic arteries. Relations. The celiac artery is covered by the lesser omentum. On the right side it is in relation with the right celiac ganglion and the caudate process of the liver. On the left side with the left celiac ganglion and the cardiac end of the stomach. Below it is in relation to the upper border of the pancreas and the lienol vein. 1. The left gastric artery a gastrica sinestra gastric or coronary artery. The smallest of the three branches of the celiac artery passes upward and to the left posterior to the omental bursa to the cardiac orifice of the stomach. Here it distributes branches to the esophagus which anastomose with the aortic esophageal arteries. Others supply the cardiac part of the stomach anastomosing with branches of the lienol artery. It then runs from left to right along the lesser curvature of the stomach to the pylorus between the layers of the lesser omentum. It gives branches to both surfaces of the stomach and anastomoses with the right gastric artery. 2. The hepatic artery a hepatica. In the adult is intermediate in size between the left gastric and lienol. In the fetus it is the largest of the three branches of the celiac artery. It is first directed forward and to the right to the upper margin of the superior part of the duodenum forming the lower boundary of the epitloic foreman. Foreman of Winslow. It then crosses the portal vein anteriorly and ascends between the layers of the lesser omentum and in front of the epitloic foreman to the portal hepatus where it divides into two branches right and left which supply the corresponding lobes of the liver accompanying the ramifications of the portal vein and hepatic ducts. The hepatic artery in its course along the right border of the lesser omentum is in relation with the common bile duct in portal vein. The ducts line to the right of the artery and the vein behind its branches are right gastric right gastric epitloic gastro duodenal superior pancreatic oduodenal cystic. The right gastric artery a gastric dextra pyloric artery arises from the hepatic above the pylorus descends to the pyloric into the stomach and passes from right to left along its lesser curvature supplying it with branches and anastomosing with the left gastric artery. The gastro duodenal artery a gastro duodenalis is a short but large branch which descends near the pylorus between the superior part of the duodenum and the neck of the pancreas and divides at the lower border of the duodenum into two branches the right gastric epitloic and the superior pancreatic oduodenal. Previous to its division it gives off two or three small branches to the pyloric end of the stomach and to the pancreas. The right gastric epitloic artery a gastro epitloca dextra runs from right to left along the greater curvature of the stomach between the layers of the greater omentum and anastomosing with the left gastro epitloic branch of the lienal artery except at the pylorus where it is in contact with the stomach it lies about a finger's breadth from the greater curvature this vessel gives off numerous branches some of which are seen to supply both surfaces of the stomach while others descend to supply the greater omentum and anastomose with branches of the middle colic. The superior pancreatic oduodenal artery a pancreatic oduodenala superior descends between the contiguous margins of the duodenum and pancreas it supplies both these organs and anastomosis with the inferior pancreatic oduodenal branch of the superior mesenteric artery and with the pancreatic branches of the lienal artery. The cystic artery a cystica usually a branch of the right hepatic passes downward and forward along the neck of the gallbladder and divides into two branches one of which ramifies on the free surface the other on the attached surface of the gallbladder the lienal or splina artery a lienalis the largest branch of the cilia artery is remarkable for the tortuosity of its course it passes horizontally to the left side behind the stomach and the omental bursa of the peritoneum and along the upper border of the pancreas accompanied by the lienal vein which lies below it it crosses in front of the upper part of the left kidney and on arriving near the spleen divides into branches some of which enter the hilus of that organ between the two layers of the funicol lienal ligament to be distributed to the tissues of the spleen some are given to the pancreas while others pass to the greater curvature of the stomach between the layers of the gastro-lienal ligament its branches are pancreatic short gastric left gastropebloic the pancreatic branches rami pancreaticii are numerous small vessels derived from the lienal as it runs behind the upper border of the pancreas supplying its body and tail one of these larger than the rest is sometimes given off near the tail of the pancreas it runs from left to the right near the posterior surface of the gland following the course of the pancreatic duct and is called the arteria pancreatica magna these vessels are customized with the pancreatic branches of the pancreatic duodenal and superior mesenteric arteries the short gastric arteries a a gastroke bravers vasa brevia consist of from five to seven small branches which arrives from the end of the lienal artery and from its terminal divisions they pass from left to right between the layers of the gastro-lienal ligament and are distributed to the greater curvature of the stomach and is demosing with the branches of the left gastric and left gastropebloic arteries the left gastropebloic artery a gastroepiploica sinistra the largest branch of the lienal runs from left to right about a finger's breadth or more from the greater curvature of the stomach between the layers of the greater omentum and anastomosis with the right gastroepiploic in its course it distributes several ascending branches to both surfaces of the stomach others descend to supply the greater omentum and anastomose with branches of the middle colic the superior mesenteric artery a mesenterica superior is a large vessel which supplies the whole length of the small intestine except the superior part of the duodenum it also supplies the casein and the ascending part of the colon and about one half of the transverse part of the colon it arises from the front of the air water about 1.25 centimeters below the celiac artery and is crossed at its origin by the lienal vein and the neck of the pancreas it passes downward and forward anterior to the processus umkinatus of the head of the pancreas and inferior part of the duodenum and descends between the layers of the mesenteri to the right iliac fossa where considerably diminished in size it anastomoses with one of its own branches this the ilio colic in its course it crosses in front of the inferior vena cava the right ureta and sois major and forms an arch the convexity of which is directed forward and downward to the left side the concavity backward and upward to the right it is accompanied by the superior mesenteric vein which lies to its right side and it is surrounded by the superior mesenteric plexus of nerves branches its branches are inferior pancreatico duodenum intestinal ilio colic right colic medocolic the inferior pancreatico duodenal artery a pancreatico duodenolus inferior is given off from the superior mesenteric or from its first intestinal branch opposite the upper border of the inferior part of the duodenum it courses to the right between the head of the pancreas and duodenum and then ascends to anastomose with the superior pancreatico duodenal artery it distributes branches to the head of the pancreas and to the descending and inferior parts of the duodenum the intestinal arteries a a intestinalis vasa intestini tennis arise from the convex side of the superior mesenteric artery they are usually from 12 to 15 in number and are distributed to the jejunum and ilium they run nearly parallel with one another between the layers of the mesenteri each vessel dividing into two branches which unite with adjacent branches forming a series of arches the convexities of which are directed toward the intestine from this first set of arches branches arise which unite with similar branches from above and below and thus a second series of arches is formed from the lower branches of the artery a third a fourth or even a fifth series of arches may be formed diminishing in size the nearer they approach the intestine in the short upper part of the mesenteri only one set of arches exists but as the depth of the mesenteri increases second third fourth or even fifth groups are developed from the terminal arches numerous small slight vessels the rise which encircle the intestine upon which they are distributed ramifying between its coats from the intestinal arteries small branches are given off to the lymph glands and other structures between the layers of the mesenteri the iliocolic artery a iliocollica is the lowest branch arising from the concavity of the superior mesenteric artery it passes downward and to the right behind the peritoneum toward the right iliac fossa where it divides into a superior and an inferior branch the inferior anastomosis with the end of the superior mesenteric artery the superior with the right colic artery the inferior branch of the iliocolic runs toward the upper border of the iliocolic junction and supplies the following branches a colic which pass upward on the ascending colon B anteria and posterior cecal which are distributed to the front and back of the cecum C an appendicular artery which descends behind the termination of the ilium and enters the mesenterio of the veriform process it runs near the free margin of this mesenterio and ends and branches which supply the veriform process and D ilio which run upward and to the left on the lower part of the ilium and anastomose with the termination of the superior mesenteric the right colic artery a colicard extra arises from the middle of the concavity of the superior mesenteric artery or from a stem common to it and the iliocolic it passes to the right behind the peritoneum and in front of the right internal spermatic or ovarian vessels the right ureter and the psoas major toward the middle of the ascending colon sometimes the vessel lies at a higher level and crosses the descending part of the duodenum and the lower end of the right kidney at the colon it divides into a descending branch which anastomoses with the iliocolic and an ascending branch which estomoses with the middle colic these branches form arches from the convexity of which the vessels are distributed to the ascending colon the middle colic artery a colica media arises from the superior mesenteric just below the pancreas and passing downward and forward between the layers of the transverse mesocolon divides into two branches right and left the former anastomoses with the right colic the latter with the left colic a branch of the inferior mesenteric the arches thus formed are placed about two fingers breadth from the transverse colon to which they distribute branches end of section 24 recording by maryanne colman hipkins section 25 of graze anatomy part 3 this is a libra vox recording all libra vox recordings are in the public domain for more information or to volunteer please visit libra vox.org recording by maryanne colman hipkins anatomy of the human body part 3 by henry gray the abdominal aorta part 1 five a two the abdominal aorta aorta abdominalis the inferior mesenteric artery a mesenterica inferior supplies the lift half of the transverse part of the colon the whole of the descending and iliac parts of the colon the sigmoid colon and the greater part of the rectum it is smaller than the superior mesenteric and arises from the aorta about three or four centimeters above its division into the common iliacs and close to the lower border of the inferior part of the duodenum it passes downward posterior to the peritoneum lying at first anterior to and then on the left side of the aorta it crosses the left common iliac artery and is continued into the lesser pelvis under the name of the superior hemorrhoidal artery which descends between the two layers of the sigmoid mesocolon and ends on the upper part of the rectum branches its branches are left colic sigmoid superior hemorrhidal the left colic artery a colica sinestra runs from the left behind the peritoneum and in front of the size major and after a short but variable course divides into an ascending and a descending branch the stem of the artery or its branches cross the left ureter and left internal spermatic vessels the ascending branch crosses in front of the left kidney and ends between the two layers of the transverse mesocolon by anastomosing with the middle colic artery the descending branch anastomoses with the highest sigmoid artery from the arches formed by these anastomoses branches are distributed to the descending column and the left part of the transverse colon the sigmoid arteries a a sigmodia two or three in number run obliquely downward and to the left behind the peritoneum and in front of the size major ureter and internal spermatic vessels their branches supply the lower part of the descending colon the iliac colon and the sigmoid or pelvic colon anastomosing above for the left colic and below with the superior hemorrhidal artery the superior hemorrhidal artery a hemorrhid a lis superior the continuation of inferior mesenteric descends into the pelvis between the layers of the mesenteric of the sigmoid colon crossing in its course the left common iliac vessels it divides opposite the third sacral vertebra into two branches which descend one on either side of the rectum and about 10 or 12 centimeters from the anus break up into several small branches these pierce the muscular coat of the bowel and run downward as straight vessels placed at regular intervals from each upper in the wall of the gut between its muscular and mucus coats to the level of the sphincter ani internus here they form a series of loops around the lower end of the rectum and communicate with the middle hemorrhidal branches of the hypogastric and with the inferior hemorrhidal branches of the internal pudendo the middle supra renal arteries a a supra renalis media middle capsular arteries supra renal arteries are two small vessels which arise one from either side of their otter opposite the superior mesenteric artery they pass lateral wood and slightly upward over the cura of the diaphragm to the supra renal glands where they anastomose with the supra renal branches of the inferior phrenic and renal arteries in the fetus these arteries are of large size the renal arteries a a renalis are two large trunks which arise from the side of the aorta immediately below the superior mesenteric artery each is directed across the crust of the diaphragm so as to form nearly a right angle with the aorta the right is longer than the left on account of the position of the aorta it passes behind the inferior fenocava the right renal vein the head of the pancreas and the descending part of the duodenum the left is somewhat higher than the right it lies behind the left renal vein the body of the pancreas and the hyena vein and is crossed by the inferior mesenteric vein before reaching the hyalis of the kidney each artery divides into four or five branches the greater number of these lie between the renal vein and ureter the vein being in front the ureter behind but one or more branches are usually situated behind the ureter each vessel gives off small inferior supra renal branches to the supra renal gland the ureter and the surrounding cellular tissue and muscle one or two accessory renal arteries are frequently found more especially on the left side they usually arise from the aorta and may come off above or below the main artery the former being the more common position instead of entering the kidney at the hyalis they usually pass the upper or lower part of the gland the internal spermatic arteries aas spermaticae interne spermatic arteries are distributed to the testes they are two slender vessels of considerable length and arise from the front of the aorta a little below the renal arteries each passes obliquely downward and lateral ward behind the peritoneum resting on the psoas major the right spermatic line in front of the inferior vena cava and behind the middle colic and ilio colic arteries and the terminal part of the ilium the left behind the left colic and sigmoid arteries and the iliac colon each crosses obliquely over the ureter and the lower part of the external iliac artery to reach the abdominal and anguinal ring through which it passes and accompanies the other constituents of the spermatic cord along the anguinal canal to the scrotum where it becomes tortuous and divides into several branches two or three of these accompany the ductus deferens and supply the epidermis and estimosing with the artery of the ductus deferens others pierce the back of the tunica albuginia and supply the substance of the testes the internal spermatic arteries supplies one or two small branches to the ureter and in the anguinal canal there's one or two twigs to the creme master the ovarian arteries AA ovarice are the corresponding arteries from the female to the internal spermatic in the male they supply the ovaries are shorter than the internal spermatics and do not pass out of the abdominal cavity the origin and course of the first part of each artery are the same as those of the internal spermatic but on arriving at the upper opening of the lesser pelvis the ovarian artery passes inward between the two layers of the ovario pelvic ligament and of the broad ligament of the uterus to be distributed to the ovary small branches are given to the ureter and the uterine tube and one passes on to the side of the uterus and unites with the uterine artery the other offsets are continued on the round ligament of the uterus through the anguinal canal to the entanglement of the labium, mages and groin at an early period of fetal life when the testes or ovaries lie by the side of the vertebral column below the kidneys the internal spermatic or ovarian arteries are short but with the descent of these organs into the scrotum or lesser pelvis the arteries are gradually lengthened the inferior phrenic arteries AA phrenicae in very aries are two small vessels which supply the diaphragm but present much variety in their origin they may arise separately from the front of the aorta immediately above the celiac artery or by a common trunk which may spring either from the aorta or from the celiac artery sometimes one is derived from the aorta and the other from one of the renal arteries they really arise as separate vessels from the aorta they diverge from one another across the corura of the diaphragm and then run obliquely upward and lateral wood upon its surface the left phrenic passes behind the esophagus and runs forward on the left side of the esophageal hiatus the right phrenic passes behind the inferior vena cava and along the right side of the foremen which transmit that vein near the back part of the central tendon each vessel divides into a medial and a lateral branch the medial branch curves forward and anastomoses with its fellow of the opposite side and with the musculophrenic and pericardiacophrenic arteries the lateral branch passes toward the side of the thorax and anastomoses the lower intercostal arteries and with the musculophrenic the lateral branch of the right phrenic gives off a few vessels to the inferior vena cava and the left one some branches to the esophagus each vessel gives off superior superrenal branches to the superrenal gland of its own side the spleen and the liver also receive a few twigs from the left and the right vessels respectively the lumbar arteries are in series with the intercostals they are usually four in number on either side and arise from the back of the aorta opposite the bodies of the upper four lumbar vertebrae a fifth pair small in size is occasionally present when they arise from the middle sacral artery they run lateral ward and backward on the bodies of the lumbar vertebrae behind the sympathetic trunk to the intervals between the adjacent transverse processes and are then continued into the abdominal wall the arteries of the right side pass behind the inferior vena cava and the upper two on each side run behind the corresponding crust of the diaphragm the arteries of both sides pass beneath the tenderness arches which give origin to the size major and are then continued behind this muscle and the lumbar plexus they now cross the quadratus lumborum the upper three arteries running behind the last usually in front of the muscle at the lateral border of the quadratus lumborum they pierce the posterior aponeurosis of the transversus abdominis and are carried forward between this muscle and the obliques internus they anestimize with the lower intercostal the subcostal the ilio lumbar the deep iliac circumflex and the inferior epigastric arteries branches in the interval between the adjacent transverse processes each lumbar artery gives off a posterior ramus which is continued backward between the transverse processes and is distributed to the muscles and skin of the back it finishes a spinal branch which enters the vertebral canal and is distributed in a manner similar to the spinal branches of the posterior rame of the intercostal arteries muscular branches are supported from each lumbar artery and from its posterior ramus to the neighboring muscles the middle sacral artery a sacralis media is a small vessel which arises from the back of the aorta a little above its bifurcation it descends in the middle line in front of the fourth and fifth lumbar vertebrae the sacrum and coxics and ends in the glomus coxigium coxigial gland from it minute branches are said to pass to the posterior surface of the rectum on the last lumbar vertebrae adenostomoses with the lumbar branch of the ilio lumbar artery in front of the sacrum adenostomoses with the lateral sacral arteries and sends offshoots into the interior sacral foramina it is crossed by the left common iliac vein and is accompanied by a pair of vene con metantes these unite to form a single vessel which opens into the left common iliac vein end of section 25 recording by maryan colman hipcans www.thisvoice4u.com section 26 of gray's anatomy part three this is a libra vox recording all libra vox recordings are in the public domain for more information or to volunteer please visit the libra vox.org anatomy of the human body part three by henry gray the common iliac arteries a iliac communes the abdominal aorta divides on the left side of the body of the fourth lumbar vertebra into the two common iliac arteries each is about five centimeters in length they diverge from the termination of the aorta pass downward and lateral word and divide opposite the invertebral fibocartilage between the last lumbar vertebrae and the sacrum into two branches the external iliac and hypogastric arteries the former supplies the lower extremity the latter the viscara and parietes of the pelvis the right common iliac artery is somewhat longer than the left and passes more obliquely across the body of the last lumbar vertebrae in front of it are the peritoneum the small intestines branches of the sympathetic nerves and at its point of division the ureter behind it is separated from the bodies of the fourth and fifth lumbar vertebrae and the intervening fibocartilage by the terminations of the two common iliac veins and the commencement of the inferior vena cava laterally it is in relation above with the inferior vena cava and the right common iliac vein and below with the psoces major medial to it above is the left common iliac vein the left common iliac artery is in relation in front with the peritoneum the small intestines branches of the sympathetic nerves and the superior hemorrhoidal artery and it is crossed at the point of bifurcation by the ureter it rests on the bodies of the fourth and fifth lumbar vertebrae and the intervening fibocartilage the left common iliac vein lies partly medial to and partly behind the artery laterally the artery is in relation with the psoces major branches the common iliac arteries give off small branches to the peritoneum psoas major ureters and the surrounding areolar tissue and occasionally give origin to the ilial lumbar or accessory renal arteries peculiarities the point of origin varies according to the bifurcation of the aorta in three-fourths of a large number of cases the aorta bifurcated either upon the fourth lumbar vertebrae or upon the fibocartilage between it and the fifth the bifurcation being in one case out of nine below and in one out of 11 above this point in about 80 of the cases the aorta bifurcated within 1.5 centimeters above or below the level of the crest of the ilium more frequently below than above the point of division is subject to great variety in two-thirds of a large number of cases it was between the last lumbar vertebrae and the upper border of the sacrum being above that point in one case out of eight and below it in one case out of six the left common iliac artery divides lower down more frequently than the right the relative lengths also of the two common iliac arteries vary the right common iliac was the longer in 63 cases the left in 52 while they were equal in 53 the length of the arteries varied in five sevenths of the cases examined from 3.5 to 7.5 centimeters in about half of the remaining cases the artery was longer and in the other half shorter the minimum length being less than 1.5 centimeters the maximum 11 centimeters and rare instances the right common iliac has been found wanting the external iliac and hypogastric arising directly from the aorta collateral circulation the principal agents in carrying on the collateral circulation after the application of alligature to the common iliac are the astimoses of the hemorrhoidal branches of the hypogastric with a superior hemorrhoidal from the inferior mesenteric of the uterine ovarian vestical arteries of the opposite sides of the lateral sacral with the middle sacral artery of the inferior epigastric with the internal mammary inferior intercoastal and lumbar arteries of the deep iliac circumflex with the lumbar arteries of the ilial lumbar with the last lumbar artery of the obturator artery by means of its pubic branch with the vessel of the opposite side and with the inferior epigastric end of section 26 recording by david laurance in brampton ontario july the fourth 2009 section 23 of grace anatomy parts 3 this is a liprevox recording all liprevox recordings and the public domain for more information or to volunteer please visit liprevox.org recording by ellie a anatomy of the human body parts 3 by henry gray one the hypogastric artery the terior hypogastrica internal iliac artery the hypogastric artery supplies the walls and the viscera of the pelvis the buttock the generative organs and the medial side of the thigh it is a short sick vessel smaller than the external iliac about four centimeters in length it arises at the bifurcation of the common iliac opposite the lumbosacral articulation and passing downward to the upper margin of the greater sciatic foramen divides into two large trunks an anterior and the posterior relations it is in relation in front with the ureter behind is the internal iliac vein the lumbosacral trunk and the piriformis muscle laterally near its origin with the external iliac vein which lies between it and absorbs major muscle lower down is the obturator nerve in the fetus the hypogastric artery is twice as large as the external iliac and is the direct continuation of the common iliac it descends along the side of the bladder and runs downward on the back of the interior wall of the abdomen to the umbilicus converging towards its fellow of the opposite side having passed through the umbilical opening the two arteries now termed umbilical enter the umbilical cord where they are coiled around the umbilical rein and ultimately ramify in the placenta at birth when the placental circulation ceases the pelvic portion only of the artery remains patent and constitute the hypogastric and the first part of the superior vesicle artery of the adult the remainder of the vessel is converted into a solid fibros cord the lateral umbilical ligament obliterated hypogastric artery which extends from the pelvis to the umbilicus peculiarities as regards lengths in two thirds of a large number of cases the lengths of the hypogastric were at between 2.25 and 3.4 centimeters in the remaining third it was more frequently longer than shorter the maximum length being about 7 centimeters the minimum about 1 centimeter the lengths of the common iliac the hypogastric arteries be an inverse proportion to each other the hypogastric artery being long and the common iliac is short and vice versa as regards its place of division the place of division of the hypogastric varies between the upper margin of the sacrum and the upper border of the craters chaotic foramen the right and left hypogastric arteries in a series of cases often differed in lengths but neither seemed constantly to exceed the other collateral circulation the circulation of the ligature of the hypogastric artery is carried on by the anestomosis of the uterine and ovarian arteries of the vesical arteries of the two sides of the hemorrhoidal branches of the hypogastric with those from the inferior mesenteric of the obturator artery by means of its pubic branch with the vessel of the opposite side and with the inferior epigastric and medial femoral circumflex of the circumflex and perforating branches of the profunda femoris with the inferior gluteal of the superior gluteal is the posterior branches of the lateral sacral arteries of the ilio lumbar is the last lumbar of the lateral sacral is the middle sacral and of the ilioxioconflex is the ilio lumbar and superior gluteal branches the branches of the hypogastric artery are from the anterior trunk superior vesical middle vesical inferior vesical middle hemorrhoidal obturator internal pedental inferior gluteal in the female uterine vaginal from the posterior trunk ilio lumbar lateral sacral superior gluteal the superior vesical artery a theory vesical is superior supplies numerous branches to the upper part of the bladder from one of these slender vessel the artery of the ductus deferens takes origin and the company is deducted in its course to the testis where it anastomosis is the internal spammatic artery other branches supply the ureter the first part of the superior vesical artery represents the terminal section of the pervious portion of the fatal hypogastric artery the middle vesical artery arterio vesical is medialis usually a branch of the superior is distributed to the fundus of the bladder and the vesicule seminalis the inferior vesical artery artery vesical is inferior frequently arises in common with the middle hemorrhoidal and is distributed to the fundus of the bladder the prostate and the vesicule seminalis the branches of the prostate communicate with the corresponding vessels of the opposite side the middle hemorrhoidal artery arterial hemorrhoidal is medial usually arises with the preceding vessel it is distributed to the rectum anastomosing is the inferior vesical and with the superior and inferior hemorrhoidal arteries it gives offsets to the vesicule seminalis and prostate the uterine artery arterio uterina springs from the anterior division of the hypogastric and runs medial rod on the levata ani and toward the cervix artery about two centimeters from the cervix it crosses a bathroom in front of the ureter to which it supplies a small branch reaching the side of the uterus it descends in a tortuous manner between the two layers of the broad ligament to the junction of the uterine tube and uterus it then runs lateral rod toward the highlands of the ovary and ends by joining the ovarian artery it supplies branches to the cervix uteri and others which descend to the vagina the latter anastomoses branches of the vaginal arteries and form with them two medial and longer to the null vessels the acycas arteries of the vagina one of which runs down in front of the vagina and the other behind it supplies numerous branches of the body of the uterus and from its terminal portion clicks are distributed to the uterine tube and the round ligament of the uterus the vaginal artery arterio vaginalis usually corresponds to the inferior vesicule in the male it descends upon the vagina supplying it some coarse membrane and sends branches to the bulb of the vestibule the fundus of the bladder and the contiguous part of the rectum it assists in forming the acycas arteries of the vagina and is frequently represented by two or three branches the obturator artery arterio obturatoria passes forward and downward on the lateral wall of the pelvis and to the upper part of the obturator foramen and escaping from the pelvic cavity through the obturator channel it divides into an anterior and posterior branch in the pelvic cavity this vessel is in relation laterally is the obturator fascia medially is the urator ductus deferens and peritoneum while a little below it is the obturator nerve branches inside the pelvis the obturator artery gives off the iliac branches to the iliac fossa which supplied bone and the iliacus and anestomose is the iliolumbar artery a vesicule branch which runs backwards to supply the bladder and the public branch which is given off from the vessel just before it leaves the pelvic cavity the public branch ascends upon the back of the pubis communicating with the corresponding vessel of the opposite side and with the inferior epigastric artery outside the pelvis the obturator artery divides at the upper margin of the obturator foramen into an anterior and a posterior branch which encircle the foramen under the cover of the obturator externus the anterior branch which runs forward on the outer surface of the obturator membrane and then curves downward along the interior margin of the foramen distributes branches to the obturator externus, pectineus, aductoris and gracilis and anestomosis is the posterior branch and is the medial femoral circumflex artery the posterior branch follows the posterior margin of the foramen and turns downward on the inferior ramus of the ischium where it anestomoses with the interior branch it gives tweaks to the muscles attached to the ischial tuberosity and anestomosis is the inferior gluteal it also supplies an articular branch which enters the hip joint through the acetabular notch ramifies in the fat of the bottom at the acetabulum and sends a tweak along the ligamentum teres to the head of the femur peculiarities the obturator artery sometimes arises from the main stem or from the posterior trunk of the hypogastric or it may spring from the superior gluteal artery occasionally it arises from the external iliac in about two out of every seven cases it springs from the inferior epigastric and descends almost vertically to the upper part of the obturator foramen the artery in its course usually lies in contact is the external iliac vein and on the lateral side of the femoral ring in such cases it would not be endangered in the operation for strangulated femoral hernia occasionally however it curves along the free margin of the lanucular ligament and if in such circumstances a femoral hernia occurred the vessel would almost completely encircle the neck of the hernia sac and would be in great danger of being wounded if an operation were performed by strangulation the internal protental artery arterial protente internal internal pubic artery is the smaller of the two terminal branches of the interior trunk of the hypogastric and supplies the external organs of generation though the course of the artery is the same in the two sexes the vessel is smaller in the female than in the male and the distortion of its branch is somewhat different the description of its arrangement in the male will first be given and subsequently the difference which it presents in the female will be mentioned the internal protental artery in the male passes downward and outward of the lower border to the greater sciatic foramen and emerges from the pelvis between the pre-reformis and the coccygous it then crosses the ischial spine and enters the perineum through the lesser sciatic foramen the artery now crosses the obturator internus along the lateral wall of the ischiorectal fossa being situated about four centimeters above the lower margin of the ischial tuberosity it gradually approaches the margin of the inferior ramus of the ischium and passes forward between the two layers of the vestia of the urogenital diaphragm it then runs forward along the medial margin of the inferior ramus of the pubis and about 2.25 centimeters behind the pubic accurate ligament it pierces the inferior vestia of the urogenital diaphragm and divides into the dorsal and deep arteries of the penis relations is in the pelvis it lies in front of the pre-reformis muscle the sacral plexus of nerves and the inferior gluteal artery as it crosses the ischial spine it is covered by the gluteus maximus and overlapped by the sacro tuberous ligament here the potential nerve flies to the medial side and the nerve of the obturator internus to the lateral side of the vessel in the perineum it lies on the lateral wall of the ischiorectal fossa in a canal alcox canal formed by the splitting of the obturator vestia it is accompanied by a pair of venecomitantes and the potential nerve peculiarities the internal potential artery is sometimes smaller than usual or fails to give off one or two of its usual branches in such cases the deficiency is supplied by branches derived from an additional vessel the accessory potential which generally arises from the internal potential artery before its exit from the greater sciatic foramen it passes downward along the lower part of the bladder and across the side of the prostate to the root of the penis where it perforates the urogenital diaphragm and gives off the branches usually derived from the internal potential artery the deficiency most frequently met with is that in which the internal potential ends is the artery of the urethral barb the dorsal and deep arteries of the penis being derived from the accessory potential the internal potential artery may also end as the perineal the artery of the urethral barb being derived is the other two branches from the accessory vessel occasionally the accessory potential artery is derived from one of the other branches of the hypogastric artery most frequently the inferior vesicle or the obturator branches the branches of the internal potential artery are muscular inferior hemorrhoidal perineal artery of the urethral barb urethral deep artery of the penis dorsal artery of the penis the muscular branches consist of two sets one given off in the pelvis the other as the vessel crosses the ischial spine the former consists of several small offsets which supply the levato anni the obturator internus the piriformis the coxigus the branch is given off outside the pelvis are distributed to the adjacent parts of the gluteus maximus the external rotator muscles the anestomosis branches of the inferior gluteal artery the inferior hemorrhoidal artery arterial hemorrhoidal is inferior arises from the internal potential as it passes above the ischial tuberosity piercing the wall of alcox canal it divides into two or three branches which cross the ischial rectal fossa and are distributed to the muscles and entanglement of the anal region and send off shots around the lower edge of the gluteus maximus to the skin of the buttock the anestomose is the corresponding vessels of the opposite side is the superior and the middle hemorrhoidal and with the perineal artery the perineal artery arteria perinei superficial perineal artery rises from the internal podenta in front of the preceding branches and turns upward crossing either over or under the transversus perinei superficialis and runs downward parallel to pubic arch in the interspace between the bialybal cavernosis and the ischial cavernosis both of which it supplies and finally divides into several posterior scrotal branches which are distributed to the skin and are tunic of the scrotum as it crosses the transversus perinei superficialis it gives off the transverse perineal artery which runs traversely on the cutaneous surface of the muscle and anestomosis with the corresponding vessel of the opposite side and with the perineal and inferior hemorrhoidal arteries supplies the transversus perinei superficialis the structures between the anus and the urethral bulb the artery of the urethral bulb arterial bulb urethrae is a short vessel of a large glibber which arises from the internal podenta between the two layers of festia of the urogenital diaphragm it passes medial ward pierces the inferior festia of the urogenital diaphragm and gives off branches which ramify in the bulb of the urethra and in the posterior part of the corpus cavernosum urethrae it gives off a small branch to the bulb urethral gland the urethral artery arterial urethralis arises a short distance in front of the artery of the urethral bulb it runs forward and medial ward pierces the inferior festia of the urogenital diaphragm it enters the corpus cavernosum urethrae in which it is continued forward to the cleanse penis the deep artery of the penis arterial profunda penis artery of the corpus cavernosum one of the terminal branches of the internal podenta arises from that vessel while it is situated between the two festia of the urogenital diaphragm it pierces the inferior festia and entering the cruse penis obliqually runs forward in the center of the corpus cavernosum penis to which its branches are distributed the dorsal artery of the penis arterial dorsalis penis ascends between the cruse penis and the pubic symphysis and piercing the inferior festia of the urogenital diaphragm passes between the two layers of the suspensory ligament of the penis and runs forward on the dorsum of the penis to the cleanse where it divides into two branches which supply the cleanse and the prepuse on the penis it lies between the dorsal nerve and the deep dorsal vein the former being on its lateral side it supplies the entanglement and fibrosis of the corpus cavernosum penis sending branches through the sheaths to anastomers with the preceding vessel the internal podental artery in the female is smaller than in the male its origin cause is similar and there is considerable analogy in the distribution of its branches the perineal artery supplies the labia podendi the artery of the bulb supplies the bulbous vestibuli and the erectile tissue of the vagina and the deep artery of the clitoris supplies the corpus cavernosum clitoris and the dorsal artery of the clitoris supplies the dorsum of the organ and ends in the cleanse and prepubes of the clitoris the inferior internal cluteal artery a terioclutea inferior sciatic artery the larger of the two terminal branches of the interior trunk of the hypogastric is distributed chiefly to the buttock and back of the thigh it passes down on the sacral plexus of nerves and the piriformis behind the internal podental artery the lower part of the greatest sciatic foramen through which it escapes from the pelvis between the piriformis and the coxigos it then descends in the interval between the crater trochanter of the femur and tuberosity of the ischium accompanied by the sciatic and posterior femoral cluteus nerves and covered by the cluteus maximus and this continued down the back of the thigh supplying the skin and anastomosis with the branches of the perforating arteries inside the pelvis it distributes branches to the piriformis coxigos and levato anni some branches which supply the fat around the rectum and occasionally take the place of the middle hemorrhoidal artery and vesicular branches to the fundus of the bladder vesicular seminalis and prostate outside the pelvis it gives off the following branches muscular coxigar committance nervi ischiatici anastomotic articular cutainus the muscular branches supply the cluteus maximus anastomosing with superior cluteal artery in the substance of the muscle the external rotators anastomosing with the internal potential artery and the muscles attached to the tuberosity of the ischium anastomosing with posterior branch of the obturator in the medial femoral circumflex arteries the coxigal branches run medial ward pierce the sacroduperous ligament and supply the cluteus maximus the entecument and other structures on the back of the coxic the arterial committance nervi ischiatici a long slender vessel which accompanies the ischiatic nerve for a short distance it then penetrates it and runs in its substance to the lower part of the thigh the anastomotic is directed downward across the external rotators and assists in forming the so-called crucial anastomosis by joining with the first perforating and medial and lateral femoral circumflex arteries the articular branch generally derived from the anastomotic is distributed to the capsule of the hip joint the cotaneous branches are distributed to the skin of the buttock and back of the thigh the ilio lumbar artery arterio ilio lumbalis a branch of the posterior trunk of the hypogastric turns upward behind the obturator nerve and the external iliac vessel to the medial border of the psorias major behind which it divides into a lumbar and an iliac branch the lumbar branch ramos lumbalis supplies the psorias major and the quadratus lumborum anastomosis with the last lumbar artery and sends a small spinal branch through the intervertebral foramen between the last lumbar vertebra and the sacrum into the vertebral canal to supply the cauda equina the iliac branch ramos iliacus descends to supply the iliacus some offsets running between the muscle and the bone anastomosis the iliac branch is of the obturator one of these enters an oblique canal to supply the bone which others run along the crest of the ilium distributing branches to the gluteal and abdominal muscles and anastomosing in their cores is the superior gluteal iliac circumflex and lateral femoral circumflex arteries the lateral sacral arteries arteria sacralis lateralis arise from the posterior division of the hypogastric they are usually two a superior and an inferior the superior of large size passes medial ward and after anastomosing this branches from the middle sacral enters the first a second interior sacral foramen supplies branches to the contents of the sacral canal and escaping the corresponding posterior sacral foramen is distributed to skin and muscle of the dorsum of the sacrum anastomosing is the superior gluteal the inferior runs obliqually across the front of the piriformis and the sacral nerves of the medial side of the interior sacral foramina descends on the front of the sacrum and anastomosis over the coccyx with the middle sacral and opposite lateral sacral artery in its cores it gives off branches which enter the interior sacral foramina these after supplying the contents of the sacral canal escapes by the posterior sacral foramina and are distributed to the muscles and skin of the dorsal surface of the sacrum anastomosing is the gluteal arteries the superior gluteal artery a tereocluteal superior gluteal artery is the largest branch of the hypogastric and appears to be the continuation of the posterior division of that vessel it is a short artery which runs backward between the lambo sacral trunk and the first sacral nerve and passing out of the pelvis above the upper border of the piriformis immediately divides into a superficial and the deep branch is in the pelvis it gives off a few branches to the iliacus piriformis and obturator internus and just previous to quitting that cavity a nutrient artery which enters the ilium the superficial branch enters the deep surface of the gluteus maximus and divides into numerous branches some of which supply the muscle and anastomosis with the inferior gluteal while others perforate the tendinous origin and supply the enticament covering the posterior surface of the sacrum anastomosing is the posterior branches of the lateral sacral arteries deep branch lies under the gluteus medias and almost immediately subdivides into two of these the superior division continuing the original course of the vessel passes along the upper border of the gluteus minimus to the interior superior spine of the ilium anastomosing is the deep iliac circumflex artery and the ascending branch of the lateral femoral circumflex artery the inferior division crosses the gluteus minimus obliqually to the greater trochanter distributing branches to the glutee and anastomosis with the lateral femoral circumflex artery some branches pierce the gluteus minimus and supply the hip joint end of section 23 recording by ellie section 28 of gray's anatomy part 3 this is a libravox recording all libravox recordings are in the public domain for more information or to volunteer please visit libravox.org anatomy of the human body part 3 by henry gray the external iliac artery a iliac external the external iliac artery is larger than the hypogastric and passes obliquely downward and lateral word along the medial border of the psoces major from the bifurcation of the common iliac to a point beneath the inguinal ligament midway between the interior superior spine of the ilium and the symphysis pubis where it enters the thigh and becomes ephemeral artery relations in front and medially the artery is in relation with the peritoneum subperitoneal areilla tissue the termination of the ilium and frequently the veriform process on the right side and the sigmoid colon on the left and a thin layer of fascia derived from the iliac fascia which surrounds the artery and vein at its origin it is crossed by the ovarian vessels in the female and occasionally by the orator the internal spermatic vessels lie for some distance upon it near its termination and it is crossed in this situation by the external spermatic branch of the genital ephemeral nerve and the deep iliac circumflex vein the ductus deference in the male and the round ligament of the uterus in the female curved down across its medial side behind it is in relation with the medial border of the psoas major from which it is separated by the iliac fascia at the upper part of its course the external iliac vein lies partly behind it but lower down lies entirely to its medial side laterally it rests against the psoas major from which it is separated by the iliac fascia numerous lymphatic vessels and lymph glands lie on the front and on the medial side of the vessel collateral circulation the principal anastomosis in carrying on the collateral circulation after the application of ligature to the external iliac r the ilio lumbar with the iliac circumflex the superior gluteal with the lateral femoral circumflex the obturator with the medial femoral circumflex the inferior gluteal with the first perforating and circumflex branches of the profunda artery and the internal pudental with the external pudental when the obturator arises from the inferior epigastric it is supplied with blood by branches from either the hypogastric the lateral sacral or the internal pudental the inferior epigastric receives its supply from the internal mammary and the lower intercostal arteries and from the hypogastric by the anatomosis of its branches with the obturator branches beside several small branches to the psoas major and the neighboring lymph glands the external iliac gives off two branches of considerable size inferior epigastric deep iliac circumflex the inferior epigastric artery a epigastrica inferior deep epigastric artery arises from the external iliac immediately above the inguinal ligament it curves forward in the subperitoneal tissue and then ascends obliquely along the medial margin of the abdominal inguinal ring continuing its course upward it pierces a transversalis fascia and passing in front of the linea semicircularis ascends between the rectus abdominis and the posterior lamella of its sheath it finally divides into numerous branches which anastomose above the umbilicus with the superior epigastric branch of the internal mammary and with the lower intercostal arteries as the inferior epigastric artery passes obliquely upward from its origin it lies along the lower and medial margins of the abdominal inguinal ring and behind the commencement of the spermatic cord the ductus deferens as it leaves the spermatic cord in the male and the round ligament of the uterus in the female winds around the lateral and posterior aspects of the artery branches the branches of the vessel are the external spermatic artery cremasteric artery which accompanies the spermatic cord and supplies the cremaster and other coverings of the cord anastomizing with the external spermatic artery in the female it is very small and accompanies the round ligament a pubic branch which runs along the inguinal ligament and then descends along the medial margin of the femoral ring to the back of the pubis and there anastomosis with the pubic branch of the obturator artery muscular branches some of which are distributed to the abdominal muscles and the peritoneum astomosing with the iliac circumflex and lumbar arteries branches which perforate the tendon of the obliques externus and supply the integument astomosing with branches of the superficial epigastric peculiarities the origin of the inferior epigastric may take place from any part of the external iliac between the inguinal ligament and a point six centimeters above it or it may arise below this ligament from the femoral it frequently springs from the external iliac by a common trunk with the obturator sometimes it arises from the obturator the latter vessel being furnished by the hypogastric or it may be formed of two branches one derived from the external iliac the other from the hypogastric the deep iliac circumflex artery a circumflexa ilium profunda arises from the lateral aspect of the external iliac nearly opposite the inferior epigastric artery it ascends obliquely lateralward behind the inguinal ligament contained in a fibrous sheath formed by the junction of the transversalis fascia and iliac fascia to the anterior superior iliac spine where it entomoses with the ascending branch of the lateral femoral circumflex artery it then pierces the transversalis fascia and passes along the inner lip of the crest of the ilium to about its middle where it perforates the transversus and runs backward between that muscle and the obliquus internus to anastomose with the ilio lumbar and superior gluteal arteries opposite the anterior superior spine of the ilium it gives off a large branch which ascends between the obliquus internus and transversus muscles supplying them anastomosing with the lumbar and inferior epigastric arteries note sir astley cooper describes and guides hospital reports volume one the dissection of a limb 18 years after successful ligature of the external iliac artery end note end of section 28 recording by david laurence july 1st 2009 in brampton ontario section 29 of graze anatomy part three this is a libravox recording all libravox recordings are in the public domain for more information or to volunteer please visit libravox.org anatomy of the human body part three by henry gray the arteries of the lower extremity the artery which supplies the greater part of the lower extremity is the direct continuation of the external iliac it runs a single trunk from the inguinal ligament to the lower border of the popliteas where it divides into two branches the anterior and posterior tibial the upper part of the main trunk is named the femoral the lower part the popliteal the femoral artery a femoralis the femoral artery begins immediately behind the inguinal ligament midway between the anterior superior spine of the ilium and the synthesis pubis and passes down the front and medial side of the thigh it ends at the junction of the middle with the lower third of the thigh where it passes through an opening in the adapter magnus to become the popliteal artery the vessel at the upper part of the thigh lies in front of the hip joint in the lower part of its course it lies to the medial side of the body of the femur and between these two parts where it crosses the angle between the head and body the vessel is some distance from the bone the first four centimeters of the vessel is enclosed together with the femoral vein in a fibrous sheath the femoral sheath in the upper third of the thigh the femoral artery is contained in the femoral triangle scarpa's triangle and in the middle third of the thigh in the adapter canal hunter's canal the femoral sheath crural sheath is formed by a prolongation downward behind the inguinal ligament of the fasciae which line the abdomen the transversalis fasciae being continued down in front of the femoral vessels and the iliac fasciae behind them the sheath assumes the form of a short funnel the wide end of which is directed upward while the lower narrow end fuses with the fascial investment of the vessels about four centimeters below the inguinal ligament it is strengthened in front by a band termed the deep crural arch the lateral wall of the sheath is vertical and is perforated by the lumbolinguinal nerve the medial wall is directed obliquely downward and lateral word and is pierced by the great syphilis vein and by some lymphatic vessels the sheath is divided by two vertical partitions which stretch between its anterior and posterior walls the lateral compartment contains the femoral artery and the intermediate the femoral while the medial and smallest compartment is named the femoral canal and contains some lymphatic vessels and a lymph gland embedded in a small amount of a realer tissue the femoral canal is conical and measures about 1.25 centimeters in length its base directed upward and named the femoral ring is oval in form its long diameter being directed transversally and measuring about 1.25 centimeters the femoral ring is bounded in front by the inguinal ligament behind by the pectinus covered by the pectinial fascia medially by the crescentic base of the lacuna ligament and laterally by the fibrous septum on the medial side of the femoral vein the spermatic cord in the male and the round ligament of the uterus in the female lie immediately above the anterior margin of the ring while the inferior epigastric vessels are close to its upper and lateral angle the femoral ring is closed by a somewhat condensed portion of the extra peritoneal fatty tissue named the septum femoralae crural septum the abdominal surface of which supports a small lymph gland and is covered by the parietal layer of the peritoneum the septum femoralae is pierced by numerous lymphatic vessels passing from the deep inguinal to the external iliac lymph glands and the parietal peritoneum immediately above it presents a slight depression named the femoral fascia the femoral triangle trigonum femoralae scarpus triangle corresponds to the depression seen immediately below the fold of the groin its apex is directed downward and the sides are formed laterally by the medial margin of the sartorius medially by the medial margin of the adductor longus and above by the inguinal ligament the floor of the space is formed from its lateral to its medial side by the iliacus psoas major pectinus in some cases a small part of the adductor brevis and the adductor longus and it is divided into two nearly equal parts by the femoral vessels which extend from near the middle of its base to its apex the artery giving off in this situation its superficial and profunda branches the vein receiving the deep femoral and great syphilis tributaries on the lateral side of the femoral artery is the femoral nerve dividing into its branches besides the vessels and nerves this space contains some fat and lymphatics the adductor canal canalis adductorius hunter's canal is an aponeurotic tunnel in the middle third of the thigh extending from the apex of the femoral triangle to the opening in the adductor Magnus it is bounded in front and laterally by the vastus medialis behind by the adductoris longus and Magnus and is covered in by a strong aponeurosis which extends from the vastus medialis across the femoral vessels to the adductoris longus and Magnus lying on the aponeurosis is the sartorius muscle the canal contains the femoral artery in vein the syphilis nerve and the nerve to the vastus medialis relations of the femoral artery in the femoral triangle the artery is superficial in front of it are the skin and superficial fascia the superficial sub-inguinal lymph glands the superficial iliac circumflex vein the superficial layer of the fascia lata and the anterior part of the femoral sheath the lumboinguinal nerve courses for a short distance within the lateral compartment of the femoral sheath and lies it first in front and then lateral to the artery near the apex of the femoral triangle the medial branch of the anterior femoral cutaneous nerve crosses the artery from its lateral to its medial side behind the artery are the posterior part of the femoral sheath the pectinial fascia the medial part of the tendon of the psoas major the pectinus and the adductor longus the artery is separated from the capsule of the hip joint by the tendon of the psoas major from the pectinus by the femoral vein and profunda vessels and from the adductor longest by the femoral vein the nerve to the pectinus passes medial word behind the artery on the lateral side of the artery but separated from it by some fibers of the psoas major is the femoral nerve the femoral vein is on the medial side of the upper part of the artery but is behind the vessel in the lower part of the femoral triangle in the adductor canal the femoral artery is more deeply situated being covered by the entanglement the superficial and deep fasci the sartorius and the fibrous roof of the canal the syphenis nerve crosses from its lateral to its medial side behind the artery are the adductoris longus and magnus in front and lateral to it is the vastus medialis the femoral vein lies posterior to the upper part and lateral to the lower part of the artery peculiarities several cases are recorded in which the femoral artery divided into two trunks below the origin of the profunda and became reunited near the opening in the adductor magnus so as to form a single papillodial artery one occurred in a patient who was operated upon for papillodial aneurysm a few cases have been recorded in which the femoral artery was absent its place being supplied by the inferior gluteal artery which accompanied the sciatic nerve to the papillodial fossa the external iliac in these cases was small and terminated in the profunda the femoral vein is occasionally placed along the medial side of the artery throughout the entire extent of the femoral triangle or it may be split so that a large vein is placed on either side of the artery for a greater or lesser distance collateral circulation after ligature of the femoral artery the main channels for carrying on the circulation are the anastomosis between one the superior and inferior gluteal branches of the hypogastric with the medial and lateral femoral circumflex and first perforating branches of the profunda femoris to the obturator branch of the hypogastric with the medial femoral circumflex of the profunda three the internal pudendal of the hypogastric with the superficial and deep external pudendal of the femoral four the deep iliac circumflex of the external iliac with the lateral femoral circumflex of the profunda and the superficial iliac circumflex of the femoral, and five, the inferior gluteal of the hypogastric with the perforating branches of the profunda. Branches. The branches of the femoral artery are superficial epigastric, superficial iliac circumflex, superficial external pudental, deep external pudental, profunda femoris, highest genicular. The superficial epigastric artery, a epigastrica superficialis, arises from the front of the femoral artery about one centimeter below the inguinal ligament, and passing through the femoral sheath and the fascia cribrosa turns upward in front of the inguinal ligament, and ascends between the two layers of the superficial fascia of the abdominal wall nearly as far as the umbilicus. It distributes branches to the superficial sub-inguinal lymph glands, the superficial fascia, and the entanglement. It anastomoses with branches of the inferior epigastric and with its fellow of the opposite side. The superficial iliac circumflex artery, a circumflexa ilium superficialis, the smallest of the cutaneous branches arises close to the proceeding, and piercing the fascialata runs lateralward parallel with the inguinal ligament as far as the crest of the ilium. It divides into branches which supply the entanglement of the groin, the superficial fascia, and the superficial sub-inguinal lymph glands, anastomosing with the deep iliac circumflex, the superior gluteal and lateral femoral circumflex arteries. The superficial external pudendal artery, a pudenda external superficialis, superficial external putic artery arises from the medial side of the femoral artery close to the proceeding vessels, and after piercing the femoral sheath and fascia fibrosa courses medial ward across the spermatic cord, or round ligament in the female, to be distributed to the entanglement on the lower part of the abdomen, the penis and scrotum in the male, and the labium majus in the female, anastomosing with branches of the internal pudendal. The deep external pudendal artery, a pudenda external profunda, deep external putic artery, more deeply seated than the proceeding, passes medial ward across the pectinus and the adductorlongus muscles. It is covered by the fascia latae, which it pierces at the medial side of the thigh, and is distributed in the male to the entanglement of the scrotum and perineum in the female to the labium majus, its branches anastomose with the scrotal or labial branches of the perineal artery. Muscular branches, rame muscularies, are supplied by the femoral artery to the sartorius, vastus medialis and adductoris. The profunda femoris artery, a profunda femoris, deep femoral artery, is a large vessel arising from the lateral and back part of the femoral artery from two to five centimeters below the inguinal ligament. At first it lies lateral to the femoral artery, it then runs behind it and the femoral vein to the medial side of the femur, and passing downward behind the adductor longus ends at the lower third of the thigh in a small branch, which pierces the adductor magnus and is distributed on the back of the thigh to the hamstring muscles. The terminal part of the profunda is sometimes named the fourth perforating artery. Relations, behind it from above downward are the iliacus, pectinius, adductor brevis, and adductor magnus. In front it is separated from the femoral artery by the femoral and profunda veins above and by the adductor longus below. Laterally the origin of the vastus medialis intervenes between it and the femur. Peculiarities. This vessel sometimes arises from the medial side and more rarely from the back of the femoral artery, but a more important peculiarity from a surgical point of view is that relating to the height at which the vessel arises. In three-fourths of a large number of cases it arose from 2.25 to 5 centimeters below the inguinal ligament. In a few cases the length was less than 2.25 centimeters, more rarely opposite the ligament, and in one case above the inguinal ligament from the external iliac. Occasionally the distance between the origin of the vessel and the inguinal ligament exceeds 5 centimeters. Branches. The profunda gives off the following branches, lateral femoral circumflex, medial femoral circumflex, perforating, muscular. The lateral femoral circumflex artery, a circumflexa femoris lateralis, external circumflex artery, arises from the lateral side of the profunda, passes horizontally between the divisions of the femoral nerve and behind the sartorius and rectus femoris, and divides into ascending, transverse, and descending branches. The ascending branch passes upward beneath the tensor fascii latte to the lateral aspect of the hip and anastomosis with the terminal branches of the superior gluteal and deep iliac circumflex arteries. The descending branch runs downward behind the rectus femoris upon the vastus lateralis to which it gives offsets. One long branch descends in the muscle as far as the knee and anastomosis with the superior lateral genicular branch of the popliteal artery. It is accompanied by the branch of the femoral nerve to the vastus lateralis. The transverse branch, the smallest, passes lateral word over the vastus intermedius, pierces the vastus lateralis and winds around the femur just below the greater trochanter, anastomosing on the back of the thigh with the medial femoral circumflex, inferior gluteal and first perforating arteries. The medial femoral circumflex artery, a circumflexa femoris medialis, internal circumflex artery, arises from the medial and posterior aspect of the profunda, and winds around the medial side of the femur passing first between the tritinius and psoas major, and then between the obturator externus and the adductor brevis. At the upper border of the adductor brevis it gives off two branches. One is distributed to the adductoris, the gracilis and obturator externus, and anastomoses with the obturator artery. The other descends beneath the adductor brevis to supply it in the adductor magnus. The continuation of the vessel passes backward and divides into superficial, deep, and acetabular branches. The superficial branch appears between the quadratus femoris and upper border of the adductor magnus, and anastomoses with the inferior gluteal, lateral femoral circumflex and first perforating arteries, crucial anastomoses. The deep branch runs obliquely upward upon the tendon of the obturator externus and in front of the quadratus femoris toward the trochanteric fossa, where anastomoses with twigs from the gluteal arteries. The acetabular branch arises opposite the acetabular notch, and enters the hip joint beneath the transverse ligament, in company with an articular branch from the obturator artery. It supplies the fat in the bottom of the acetabulum, and is continued along the round ligament to the head of the femur. The perforating arteries, usually three in number, are so named because they perforate the tendon of the adductor magnus to reach the back of the thigh. They pass backward close to the linear asper of the femur under cover of small tendinous arches in the muscle. The first is given off above the adductor brevis, the second in front of that muscle, and the third immediately below it. The first perforating artery, A perforans prima, passes backward between the pictinius and adductor brevis. Sometimes it perforates the latter. It then pierces the adductor magnus close to the linear aspera. It gives branches to the adductories brevis and magnus, biceps femoris, and gluteus maximus, and anastomoses with the inferior gluteal, medial and lateral femoral circumflex, and second perforating arteries. The second perforating artery, A perforans secunda, larger than the first, pierces the tendons of the adductories brevis and magnus, and divides into ascending and descending branches which supply the posterior femoral muscles, anastomosing with the first and third perforating. The second artery frequently arises in common with the first. The nutrient artery of the femur is usually given off from the second perforating artery. When two nutrient arteries exist, they usually spring from the first and third perforating vessels. The third perforating artery, A perforans tertia, is given off below the adductor brevis. It pierces the adductor magnus and divides into branches which supply the posterior femoral muscles, anastomosing above with the higher perforating arteries, and below with the terminal branches of the profunda and the muscular branches of the popliteal. The nutrient artery of the femur may arise from this branch. The termination of the profunda artery, already described, is sometimes termed the fourth perforating artery. Numerous muscular branches arise from the profunda. Some of these end in the adductories. Others pierce the adductor magnus, give branches to the hamstrings, and anastomose with the medial femoral circumflex artery and with the superior muscular branches of the popliteal. The highest genicular artery, A genus suprema, anastomotica magna artery, arises from the femoral just before it passes through the opening in the tendon of the adductor magnus and immediately divides into a syphenis and a musculoarticular branch. The syphenis branch pierces the aponeurotic covering of the adductor canal and accompanies the syphenis nerve to the medial side of the knee. It passes between the sartorius and gracilus and piercing the fasciolata is distributed to the entanglement of the upper and medial part of the leg, anastomosing with the medial inferior genicular artery. The musculoarticular branch descends in the substance of the vastus medialis and in front of the tendon of the adductor magnus to the medial side of the knee where it anastomoses with the medial superior genicular artery and anterior recurrent tibial artery. A branch from this vessel crosses above the paddler surface of the femur, forming an anastomotic arch with the lateral superior genicular artery and supplying branches to the knee joint. End of section 29