Branches of the aorta
32 named structures.
Draft — not yet clinically reviewed. The structure of this map is checked automatically, but its wording has not been fact-checked against a textbook. Do not rely on it for an exam answer yet.
Hover or tab a structure to trace what it connects to. Some structures reveal further branches.
Clinical detail
- Ascending aortaIntrapericardial Aortic sinusesStanford type A dissection (intimal tear in the ascending aorta in a hypertensive or Marfan patient with tearing chest pain radiating to the back)
- Arch of the aortaT4/T5 Superior mediastinum 3 branchesAortic arch aneurysm3 questions
- Descending thoracic aortaT4/T5 to T12 Posterior mediastinum Aortic hiatus T12Coarctation of the aorta (narrowing at the isthmus just distal to the left subclavian, at the ligamentum arteriosum)3 questions
- Abdominal aortaT12 to L4 Retroperitoneal IVC on rightAbdominal aortic aneurysm (diameter over 3 cm; about 90% infrarenal; older male smokers)
- Right and left coronary arteriesAortic sinuses Diastolic fillingOcclusion of the right coronary artery1 question
- Brachiocephalic trunk1st arch branch Right SCJLow tracheostomy, or erosion by a long-term tracheostomy tube cuff1 question
- Left common carotid artery2nd arch branch Bifurcates C3/C4Atheroma at the carotid bifurcation1 question
- Left subclavian artery3rd arch branch VIT C&DSubclavian stenosis proximal to the vertebral origin1 question
- Posterior intercostal arteries (3rd–11th)Spaces 3–11 Costal groove VANChest drain or intercostal block placed at the lower border of a rib3 questions
- Bronchial arteriesT5–T6 2 left, 1 rightChronic inflammatory lung disease (bronchiectasis, tuberculosis, aspergilloma) hypertrophies the bronchial arteries3 questions
- Coeliac trunkT12 Foregut 3 branchesMedian arcuate ligament syndrome (the ligament compresses the trunk, worse on expiration)1 question
- Superior mesenteric arteryL1 Midgut 5 branchesEmbolus from atrial fibrillation or a mural thrombus lodging in the SMA, usually just beyond the middle colic origin1 question
- Renal arteriesL1–L2 Below SMA Right longerRenal artery stenosis (atheroma in older smokers; fibromuscular dysplasia in young women)1 question
- Gonadal (testicular / ovarian) arteriesL2 Para-aortic nodesTesticular tumour1 question
- Inferior mesenteric arteryL3 Hindgut 3 branchesIMA ligated or covered during abdominal aortic aneurysm repair or left-sided colectomy1 question
- Common iliac arteriesL4 Iliac crest plane Divide L5–S1Aortoiliac atherosclerotic occlusion1 question
- Right subclavian arteryFrom brachiocephalic R recurrent laryngealAberrant right subclavian artery arising as the last arch branch and passing behind the oesophagus1 question
- Vertebral arteryC6–C1 Foramen magnum BasilarVertebral artery dissection after neck manipulation or trauma2 questions
- Artery of Adamkiewicz (great anterior radiculomedullary artery)T8–L1 (peak T9–T11) Left ~75%Open or endovascular repair of a thoracoabdominal aneurysm, aortic cross-clamping, or a type B dissection occluding the intercostal ostia1 question
- Left gastric arteryLesser curvature Oesophageal branchesLesser-curve gastric ulcer eroding posteriorly1 question
- Splenic arteryUpper border pancreas Short gastricsSplenic artery aneurysm (the commonest visceral artery aneurysm, more frequent in multiparous women)1 question
- Common hepatic arteryGastroduodenal a. Proper hepatic a.Posterior duodenal ulcer (first part) eroding through the wall1 question
- Ileocolic arteryAppendicular a. CaecumLuminal obstruction of the appendix (faecolith, lymphoid hyperplasia) raising intraluminal pressure1 question
- Middle colic arteryTransverse colon Griffiths' pointHypotension or SMA embolus when the anastomosis at Griffiths' point is poor or absent (about 40% of people)1 question
- Jejunal and ileal arteries12–15 branches Arcades, vasa rectaMesentery twisted or torn around a fixed point (volvulus, internal hernia, adhesion band)1 question
- Left colic arteryDescending colon Splenic flexureIMA occlusion (atheroma, ligation at aortic surgery)1 question
- Superior rectal arteryContinues IMA Above pectinate lineWeak marginal anastomosis at the rectosigmoid (Sudeck's point, between the last sigmoid artery and the superior rectal)1 question
- Thoracolumbar spinal cord (anterior two-thirds)Anterior 2/3 of cord Lower two-thirdsInterruption of the anterior spinal artery supply during aortic surgery1 question
- ForegutOesophagus → D2 papilla Epigastric painPeptic ulcer, early cholecystitis, pancreatitis2 questions
- MidgutD2 papilla → 2/3 transverse Periumbilical painEarly appendicitis2 questions
- HindgutDistal 1/3 transverse → pectinate Suprapubic painDiverticulitis or sigmoid volvulus1 question
Common questions
What are the vertebral levels of the abdominal aortic branches?
Coeliac trunk T12, superior mesenteric L1, renal L1–L2 (usually quoted as L2), gonadal L2, inferior mesenteric L3, bifurcation into common iliacs L4. The aorta enters the abdomen through the aortic hiatus at T12 and the common iliacs divide at L5–S1 on the pelvic brim.
What is the order of the arch branches and how does the right side differ from the left?
Right to left: brachiocephalic trunk, left common carotid, left subclavian. The right common carotid and right subclavian arise from the brachiocephalic trunk, so the left common carotid has a longer thoracic course. In about 1 in 5 people the left common carotid shares an origin with the brachiocephalic trunk (the so-called bovine arch).
Why can repair of a thoracoabdominal aneurysm cause paraplegia?
The anterior spinal artery below the cervical cord depends on segmental feeders from the aorta, chiefly the artery of Adamkiewicz, which usually arises from a left posterior intercostal or lumbar artery between T9 and T12. Cross-clamping, covering or dividing these ostia infarcts the anterior two-thirds of the cord: paraplegia with loss of pain and temperature but preserved proprioception and vibration.
Why are the splenic flexure and rectosigmoid the sites of ischaemic colitis?
They are watersheds between arterial territories. At the splenic flexure (Griffiths' point) the ascending left colic must meet the middle colic through the marginal artery, and that link is poor or absent in about 40% of people. At the rectosigmoid (Sudeck's point) the last sigmoid artery meets the superior rectal. In low-flow states these zones lose perfusion first.
What is the difference between Stanford type A and type B dissection?
Type A involves the ascending aorta, whatever the site of the tear, and needs emergency surgery because it can occlude a coronary ostium, cause aortic regurgitation or rupture into the pericardium. Type B spares the ascending aorta, typically beginning just beyond the left subclavian origin, and is managed with blood-pressure control unless a branch (intercostal, renal, mesenteric, iliac) is compromised.
Where is the aortic bifurcation on the surface, and why does it matter?
At L4, in the plane joining the highest points of the iliac crests and roughly at the level of the umbilicus. A pulsatile mass above the umbilicus is the classic surface sign of an abdominal aortic aneurysm, and the level marks where a lumbar puncture needle (L3/4 or L4/5) is placed well below the conus.