Anatomy

Question 1

Branches of the subclavian artery

Answer 1

1) Vertebral artery
2) Internal thoracic (mammary) - musculophrenic and superior epigastric branches (anterior intercostals)
3) Thyrocervical trunk - thyroid and superficial cervical arteries
4) Costocervical trunk - superior intercostal and deep cervical arteries
5) Dorsal scapular artery

Question 2

Where does the Artery of Adamkiewicz (aka dominant anterior spinal artery) arise? And what is the significance of this artery?

Answer 2

At T9-T12, usu from left intercostal or lumbar artery
Characteristic hairpin turn at anastomosis with ASA.
When embolizing intercostal or bronchial arteries, care must be taken to not treat this branch as it can result in transverse myelitis and paraplegia (also an issue during aortic stenting or primary AAA repair)

Question 3

Branches of the internal iliac artery

Answer 3

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I: iliolumbar artery (POSTERIOR)
L: lateral sacral artery (POSTERIOR)
G: gluteal (superior and inferior) arteries (POSTERIOR)
P: (internal) pudendal artery
I: inferior vesical (vaginal in females) artery
M: middle rectal artery
V: vaginal artery (females only)
O: obturator artery
U: umbilical artery and uterine artery (females only)

Question 4

Branches of the external iliac artery

Answer 4

Inferior epigastric artery

Deep circumflex iliac artery

Question 5

List the portosyetmic shunts

Answer 5

• Left gastric/ coronary vein to esophageal veins (located along the lesser curvature)
• Esophageal (dilated submucosal venous plexus)
• Paraesophageal (coronary vein to azygous/hemiazygous)
• Perisplenic/splenorenal (splenic vein to left renal vein)
• Retrogastric (left gastric or gastroepiploic veins to the esophageal veins - posterior gastric fundus)
• Retroperitoneal/Paravertebral (SMV branches to retroperitoneal/lumbar veins)
• Paraumbilical (left portal to paraumbilical)
• Anterior abdominal wall (paraumbilical to periumbilical veins - causing caput medusa)
• Mesenteric (dilated branches of SMV)
• Anal canal (superior rectal vein from IMV to upper anal canal veins)