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Arteries and veins of the esophagus.
Hello, everyone! This is Joao from Kenhub, and welcome to another anatomy tutorial where, this time, we're going to be talking about the blood vessels of the esophagus. And in order to do so, we’re going to be looking at this image here that you see which is an anterior view of the open thorax where we removed a lot of the structures especially muscles and you can then be left with all these blood vessels that we’re going to be talking about. And just for a bit of location, you can see here the esophagus. You notice here just in front of the esophagus – this structure which is a very important structure of the respiratory system – the trachea, and a bit of the stomach here. Separating the thorax and the abdomen, you find this structure or this muscle which is known as the diaphragm.
And the first structures we’re going to be covering here on this tutorial are the arteries of the esophagus. And there are a few structures here that are also directly what we know as the arterial blood supply of the esophagus – so the structures that will actually be supplying the esophagus. But there are a lot of arteries that you can see here. So, we’re also going to talk about these structures because they are found nearby the esophagus.
So as you can see this is a network of blood vessels specifically arteries that we’re going to be covering. Starting off with the main one which is then the aorta and the esophageal branches which will then be supplying the esophagus. But we’re going to also talk about the right and left common carotid, the posterior intercostal which you see here also on this image, the inferior phrenic, the left gastric, and also some esophageal branches that we’re going to be seeing, and also the common hepatic artery. We’re also going to talk about the splenic artery, the right and left subclavian arteries, the brachiocephalic trunk that you see here on this image as well, and the thyrocervical trunk. So, all of these structures are listed as arteries that we find here on this image and they are connected to one another somehow.
We’re going to start off with the very first one – the very first structure that you see here highlighted in green – this one is known as the ascending aorta. Now, this is a part of the largest blood vessel in your body, the aorta, that will be exiting the left ventricle and if you show here, if I show you here this image of the anterior view of the heart, you can see now the ascending aorta highlighted in green. You can also see here another structure that follows the ascending aorta which is then the aortic arch. And as the aorta turns here on the aortic arch, it goes down and becomes then what we know as the descending aorta.
The descending aorta which is the next structure that we’re going to be talking about at least one part of the descending aorta, this is known as then more specifically as the thoracic aorta. As I said, this is one of the 2 parts of the descending aorta. The other part being the portion of the aorta that will be crossing the diaphragm and then entering the abdomen then we will be calling it abdominal aorta. And as I mentioned before, this part of the aorta starts at the aortic arch which is this arch here that you see on the image and then runs down through the chest and then the abdomen.
Now, the descending aorta is divided into 2 parts – the thoracic and abdominal as I mentioned before, related to then the 2 great cavities of the trunk, the thorax and the abdomen. And within the abdomen, the descending aorta will then be branching into 2 very important structures, two very important arteries known as the common iliac arteries, the right and left one and these will then be supplying your pelvis and eventually your legs with arterial blood.
Now, we find on the next image here highlighted in green, these branches coming out of the aorta, the descending aorta, these are known as the esophageal branches of the thoracic aorta. Now, these are 4 or 5 in number and they arise from the thoracic aorta and pass obliquely downward to then the esophagus forming a chain of anastomosis along the esophagus. It will be anastomosing– here, write this down on your notes – these will be anastomosing with the esophageal branches of the inferior thyroid artery. By anastomose, I mean, arteries that will be then connecting.
Another anastomose that you’re going to be finding is that the esophageal branches will be anastomosing below with now the ascending branches from the left inferior phrenic and left gastric arteries. And as I mentioned before, these arteries are going to be supplying the middle third of the esophagus.
Moving on, we’re going to be seeing these highlighted structures now in green. These are the esophageal branches of the inferior thyroid artery. And as the name indicates, these branches are coming out of the inferior thyroid artery supplying then the esophagus and they anastomose or form a connection with the esophageal branches of the aorta as I mentioned on the previous slides. On this image, you can also see here highlighted in green, if you see, notice here below, you can find this portion of the aorta that is highlighted in green, this is the part of the aorta that is crossing the diaphragm – here this muscle that I talked about before – and that from here, the aorta is then called the abdominal aorta.
This structure starts with then the celiac trunk which you can also see here and continues with the superior mesenteric artery, the left and right renal arteries, and the inferior mesenteric arteries. So, as you would expect, the abdominal aorta will be supplying all the major organs of the abdomen.
Next on our list on this image, you find these 2 arteries that you see here highlighted in green. On the image on the left side, we’re looking at the right common carotid artery while on the image on the right side, we see then the left common carotid artery. And if you notice here that the left common carotid artery is arising – notice here on this image – that it is arising from this structure, the aortic arch. So, the left common carotid artery arises from the aortic arch while the right common carotid artery – as you notice here – is now coming from or branching off of the brachiocephalic trunk which is the structure that you see here. Now, these arteries will be traveling up and then supplying the major part or the majority of the head and neck with arterial blood. It run below the sternocleidomastoid muscle and then split up into the internal and external carotid arteries.
Next on our list, we’re going to be covering these structures – these highlights that you see now on the screen – these are known as the posterior intercostal arteries. Now, the posterior intercostal arteries are branches of the thoracic aorta which is the structure here and also they are branches of the highest intercostal artery which then run through the intercostal spaces as you can see here. So, these arteries are running in the spaces between the ribs which are known as the intercostal spaces.
There are 11 posterior intercostal arteries on each side. A posterior intercostal artery runs along the bottom of the rib as you can see here. So this is the rib, the structure here, notice how it runs below the inferior portion of the rib. And it does so with its corresponding posterior intercostal vein as well as the intercostal nerves which you don’t see here on this image. Now, the vein is superior to the artery – keep that in mind – and the intercostal nerve is inferior to it. So, a good mnemonic to have whenever you’re thinking about the positioning of the intercostal veins, nerves, and arteries is VAN. So, this is a good way to recall the order of the intercostal veins, arteries and nerves from the superior position to an inferior one.
The next arteries that we’re going to be highlighting here, a bit further down, we’re seeing now highlighted coming from the abdominal aorta, we now see the inferior phrenic arteries. And they are a pair of small branches of the abdominal aorta or the celiac trunk originating directly beneath the diaphragm. And as you can see, they run craniolaterally towards the diaphragm and supply this structure – the diaphragm – with arterial blood. And as you can see here on this image, notice a bit here of the left phrenic artery which will be passing dorsally or crossing the esophagus dorsally and runs forward on the left side of the esophageal hiatus which is this structure here of the diaphragm where the esophagus will be passing through. And, as you notice here, this is the right phrenic artery which passes behind this structure that is cut here, the inferior vena cava.
Next, we’re going to be seeing this structure here highlighted in green – this artery – which is known as the left gastric artery. Now, the left gastric artery originates from the celiac trunk – this structure here that you see coming out of the abdominal aorta. And it does so at the height of the 12th thoracic vertebra. Then, runs towards the lesser curvature of the stomach giving branches to the esophagus and also the stomach and, in most cases, it will be anastomosing or connecting with the right gastric artery.
On the next slide, we’re going to be seeing then one of the branches of the left gastric artery, this one that will be running to then the esophagus and, for that reason, we will call it the esophageal branches of the left gastric artery. Also, we’re going to be seeing here this structure that is now highlighted in green which is known as the common hepatic artery. Now, this artery is a short branch of the celiac trunk which will be supplying a few structures including the liver, the pylorus of the stomach, the duodenum, and also parts of the pancreas with blood, then runs towards the superior part of the duodenum and forms the lower border of the omental foramen. Then, it crosses the portal vein running towards the liver and it will be giving off 3 branches – the proper hepatic artery, the gastroduodenal artery, and the right gastric artery.
Next in line, we’re going to be talking about another artery here, this is known as the splenic artery. And just like the left gastric and the common hepatic artery, this one will be originating from the celiac trunk. It is the strongest branch of the trunk and then will be transporting blood to the spleen, stomach and pancreas. And if I show you here this image, you can clearly see how the splenic artery travels all the way to then the spleen as you can see here. We’re also adding a bit more of the stomach and notice here, superiorly, the liver which is retracted here by this tool. Now, you can see how then the highlight is showing the splenic artery. So, you can also see here that this artery is running on the upper border of this organ here which is the pancreas towards the left side of the trunk. Notice here at the end that it will be dividing into several branches that will be supplying then this organ here, the spleen.
We’re going to continue on talking about the splenic artery as you can see here on this image to now list the different branches of this artery. There is one known as the left gastroepiploic artery which supplies the greater curvature of the stomach, the posterior gastric artery which supplies the posterior side of the stomach, and then there are 5-7 short gastric arteries which supply the greater curvature of the stomach.
Now, we’re going to go a bit further up to show you these 2 arteries that are now highlighted in green. These are known as the – as you can see here on the left image – the right subclavian artery and, on the right image, the left subclavian artery. You can also notice here on this image that the left subclavian artery is a branch of this structure here that we’ve seen before, the aortic arch. You can also see here on this image on the left side that the right subclavian artery is then branching off of the brachiocephalic trunk, sometimes referred to as the brachiocephalic artery or innominate artery. Now, these arteries will be running through the posterior scalene gap just between the anterior and medial scalene muscles and enters the axilla between the first rib and the clavicle and, from there, it is then called the axillary artery.
On the next slide, we’re going to still highlight the subclavian arteries to then show you the different branches that will be coming out of these arteries. So, the list includes the vertebral artery which ascends towards the head and is very important for the blood supply of your brain as the basilar artery. The next one on the list is the internal thoracic artery that runs caudally next to the sternum supplying mostly the epigastric region. The thyrocervical trunk that gives off branches supplying structures of the neck region, the costocervical trunk supplying the deep neck region, and, finally, the dorsal scapular artery.
The next structure we’re going to be highlighting now is known as the brachiocephalic trunk. This one will be supplying blood to the brain and head in general and, if you notice here, it is the first branch of the aortic arch. Now, it rises up to a point near the junction of the sternum and the right clavicle and, at that point, it will be dividing and giving rise to different branches – 2 main branches – the common carotid artery which you can see here on this image and this one will be carrying blood to the right side of the neck and head, the other branch is the right subclavian artery which you see here as well and we talked about before and this one will then take blood to the right arm.
Next on our list, we’re going to be highlighting these 2 structures which are the thyrocervical trunks and they are branches of the subclavian arteries. This is a short and thick vessel and divides soon after its origin into 4 branches – the inferior thyroid artery, the suprascapular artery, the ascending cervical artery, and the transverse cervical artery.
Now, that we’re done covering the different arteries, we’re going to move on and talk about the different veins that we see here. Now, the veins include then the inferior and superior vena cava, the brachiocephalic veins, the azygos and hemiazygos veins, the posterior intercostal veins, the esophageal veins, the left gastric veins, and the inferior thyroid veins. So, this is the network that we’re going to be talking about that is connected somehow to the esophagus.
First structure that we’re going to be highlighting here is then the inferior vena cava that you see here split in two. This large vein will be carrying blood or venous blood from the lower half of your body towards the heart. Now, the inferior vena cava is formed by the joining of two veins – the left and right common iliac veins – and anastomosis with the azygos vein system which we will talk about later. And if I show you this image going a bit further down in the abdomen, you can see then the highlighted inferior vena cava all the way to then split into the 2 common iliac veins which will then continue on to the pelvis and your legs.
Next we’re going to be highlighting the superior vena cava which is then the – this is the sister of the inferior vena cava that is found superiorly and it collects venous blood from the upper half of the body in order to transport it towards your heart. The superior vena cava is formed by the left and right brachiocephalic veins – as you can also see here on this image – and is joined by the azygos vein shortly before it reaches the right atrium of the heart. You can also see here the azygos vein on this image. You can also see here an image of the anterior view of the heart in the thorax and notice here then the superior vena cava highlighted in green entering the right atrium of the heart.
Next structures we’re going to be highlighting now – these are the structures that I mentioned before, the veins I mentioned before – the right brachiocephalic vein and the left brachiocephalic vein. Now, these veins, both of them, are formed when the internal jugular veins – these veins that you see here – will be then joining with these veins here which are the subclavian veins. So, they meet here and then form the brachiocephalic veins which then become the superior vena cava. Their main function is to transport deoxygenated blood of the upper extremity and head region towards the superior vena cava and then to your heart.
The next vein we’re going to be highlighting here, one that I mentioned before, this is the azygos vein. The azygos vein is the continuation of the ascending lumbar vein on the right side of your body. Now, the azygos vein will be draining venous blood towards the superior vena cava and you can see here on this image that this vein is running on the right side of the thoracic vertebrae and runs cranially where then several veins of the thorax will be draining into the azygos vein which include then the posterior intercostal veins, the esophageal veins, the hemiazygos veins and also the bronchial veins. And we have here also another image of the azygos vein where I just removed the esophagus to then just show you how the azygos vein is running on the right side of the thoracic vertebrae – as you can see here – and different veins are then draining into the azygos vein.
Next, we’re going to be highlighting here another vein known as the hemiazygos vein and this one is the continuation of the ascending lumbar vein on the left side of the body which drains venous blood towards the azygos vein as you can also see here on the image. It runs on, this time, on the left side of the thoracic vertebrae then runs cranially where other veins like we saw with the azygos vein like the lower posterior intercostal veins, the lower esophageal veins and the lower bronchial veins will be draining into the hemiazygos vein. But you can also see here then the hemiazygos vein will be crossing to the right side where it drains into the azygos vein.
Next on the structures we’re going to be highlighting – this one that you now see on the screen – the accessory hemiazygos vein, and like the hemiazygos vein, the accessory hemiazygos vein runs on the left side of the vertebral column, will be transporting blood cranially and drains into the brachiocephalic vein. It generally drains the 5th to 8th intercostal spaces on the left side of your body, however, it varies in size and can also be absent in some people.
Next veins we’re going to be highlighting the equivalent of the arteries, the posterior intercostal veins – as you can see here now highlighted in green – and you can also see here the posterior intercostal arteries – these red structures. Now, these veins drain the intercostal spaces and are in close relation with the posterior intercostal arteries like I mentioned before. They run below the corresponding ribs as you can also see here on this image and give off a dorsal branch to collect blood from the muscles of your back. Now, the first posterior intercostal vein drains either into the brachiocephalic vein or the vertebral vein whereas the 2nd, 3rd, and often 4th drain into the superior intercostal vein. The remaining lower posterior intercostal veins will be draining into the azygos vein or the hemiazygos vein on the left.
Next structures we’re going to be highlighting here – important structures that are then draining the esophagus – these are the esophageal veins. Now these small veins will be draining blood from the esophagus to the azygos vein and the inferior thyroid vein in order to transport deoxygenated blood of the esophagus back towards the heart.
Next on our list, we’re going to be seeing this vein here which is known as the left gastric vein as we’ve seen also with the artery and the left gastric vein lies at the lesser curvature of the stomach and collects deoxygenated blood from the different parts of this organ draining then into the portal vein. And you don’t see here the portal vein on this image but you see here the cut of the left gastric artery where it connects to then the portal vein.
Finally, this is the last structure, last vein that we’re going to be talking on this tutorial, this is known as the inferior thyroid vein. These small veins make sure that blood from the thyroid is then drained into the brachiocephalic veins. The inferior thyroid veins are a group of 2-4 veins that during their course towards the brachiocephalic trunk, it will be also collecting blood from the trachea and the esophagus.
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Now, good luck everyone, and I will see you next time.