Abdominal Aorta: Anatomy, Topography, and Branches

Q: At what level does the abdominal aorta divide into the iliac arteries?

Aortic bifurcation (bifurcatio aortae) occurs at the level of the fourth lumbar vertebra (L4), where it divides into the right and left common iliac arteries.

Q: What is "abdominal angina"?

This is a pain syndrome (angina abdominalis) caused by chronic ischemia of the abdominal organs due to narrowing of the visceral branches of the abdominal aorta, such as the mesenteric vessels. The pain is associated with increased peristalsis after eating.

Topography and syntopy

The abdominal aorta begins at the aortic hiatus of the diaphragm (hiatus aorticus) at the level of the twelfth thoracic vertebra (Th12) and descends to the fourth–fifth lumbar vertebrae. The vessel lies retroperitoneally on the anterior surface of the lumbar spine, slightly to the left of the midline.

Relations to adjacent structures (syntopy):

Superiorly and anteriorly: the aorta is related to the pancreas, the ascending part of the duodenum, and the root of the mesentery of the small intestine. The left renal vein (v. renalis sinistra) also runs anterior to the aorta.
To the right: the inferior vena cava (v. cava inferior) is located.
To the left: the left sympathetic trunk and intermesenteric plexus are located.

The aorta is surrounded by branches of the abdominal aortic plexus and ganglia. The surrounding adipose tissue contains the left lumbar lymph nodes: preaortic, postaortic, lateral aortic, and intermediate.

Free video lessonAngiology: aorta and its branches — an overview of the arterial system

Branches of the abdominal aorta

The branches of the abdominal aorta are classified into visceral and parietal. At the L4 level, the aortic bifurcation (bifurcatio aortae) occurs — it divides into the right and left common iliac arteries (aa. iliacae communes).

Unpaired visceral branches:

Celiac trunk (truncus coeliacus) — gives off the left gastric, splenic, and common hepatic arteries.
Superior mesenteric artery (a. mesenterica superior).
Inferior mesenteric artery (a. mesenterica inferior).

Paired visceral branches:

Inferior phrenic arteries.
Middle suprarenal arteries.
Renal arteries (a. renalis dextra et sinistra).
Gonadal arteries — testicular arteries (a. testicularis) in males or ovarian arteries (a. ovarica) in females. They have a high origin and a long course.

Parietal branches:

Lumbar arteries (aa. lumbales I–IV) — paired segmental vessels running laterally posterior to the psoas major muscle. There are anastomoses between the lumbar arteries and the deep circumflex iliac artery.
Median sacral artery (a. sacralis mediana) — a slender unpaired vessel that is the continuation of the aorta, running downward along the anterior surface of the sacrum into the lesser pelvis.

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Clinical significance and diagnostics

To assess the condition of the abdominal aorta, comprehensive ultrasound and duplex scanning are used; CT angiography is used as the reference method. Aortic stiffness is assessed by measuring pulse wave velocity (PWV).

Topical clinical syndromes:

Abdominal aortic aneurysm: dilation of the wall. During its formation and dissection, sharp, intense abdominal pain occurs.
Visceral branch ischemia: stenosis of the celiac trunk or mesenteric vessels leads to abdominal angina (angina abdominalis) — chronic ischemic abdominal pain associated with increased peristalsis after eating. A systolic murmur is heard on abdominal auscultation. Critical stenosis can lead to intestinal necrosis.
Renal artery lesion: renal ischemia causes renovascular hypertension.
Lesion at the bifurcation area: leads to impaired blood supply to the lower extremities. Intermittent claudication (claudicatio intermittens) — pain during walking, leg weakness, and decreased pulsation in peripheral arteries are possible.

Fun Fact: Phylogeny

In a closed single-circuit circulatory system, the heart is absent. Its hemodynamic function is performed by the pulsating abdominal aorta (aorta ventralis) and the bases of the afferent branchial arteries.

Class and exam questions

At what level does the abdominal aorta divide into the iliac arteries?

The aortic bifurcation (bifurcatio aortae) occurs at the level of the fourth lumbar vertebra (L4), where it divides into the right and left common iliac arteries.

What is "abdominal angina"?

This is a pain syndrome (angina abdominalis) caused by chronic ischemia of the abdominal organs due to narrowing of the visceral branches of the abdominal aorta, such as the mesenteric vessels. The pain is associated with increased peristalsis after eating.

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What else to study on this topic

Celiac trunk and its branches
Inferior vena cava
Common iliac artery
Abdominal aortic aneurysm

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Abdominal aorta