Superior Mesenteric Arteriogram :

The superior mesenteric artery supplies the whole of the small intestine, except the upper part of the duodenum. It also supplies the caecum, ascending colon and most of the transverse colon. It originates about 1 cm below the coeliac artery, is crossed anteriorly by the splenic vein and body of the pancreas and then passes downwards and forwards, anterior to the head of the pancreas to reach the mesentery. Note the congenital variation of an accessory right hepatic artery coming from the superior mesenteric artery. The coeliac and superior mesenteric artery systems have numerous congenital variations, particularly concerning the vascular supply of the pancreas. If a patient is suspected of having mesenteric ischaemia, then a lateral film of the abdominal aorta should be performed so that the origins of both the coeliac and superior mesenteric arteries may be seen and checked for narrowing. Occasionally, the superior mesenteric artery is seen to cause an impression on the third part of the duodenum on a barium meal as it crosses anteriorly, and this can very rarely cause a degree of duodenal obstruction.

   Inferior Mesenteric Arteriogram :

The inferior mesenteric artery supplies blood to the distal transverse colon, descending colon, sigmoid colon and rectum. It originates about 3–4 cm above the aortic bifurcation at the level of L3 or just above the lower border of the third part of the duodenum. It crosses the left common iliac artery on the medial side of the left ureter and continues into the sigmoid mesocolon to become the superior rectal artery. Note the anastomosis of the marginal artery of Drummond. The anastomoses in the region of the splenic flexure of the colon constitute the most vulnerable part of the intestine's blood supply and are therefore most prone to schaemia. The grades of ischaemia can be diagnosed on a barium enema and divided into acute, subacute and chronic changes. The inferior mesenteric artery may considerably enlarge when there is disease of the common iliac vessels and be an important collateral route for the blood supply of the pelvis and lower limbs.

   Selective Renal Arteriogram :

For most selective catheterizations, preshaped catheters are used so that injection into the vessel of choice is possible. The renal arteries arise from the lateral walls of the aorta at the level of the L1/L2 disc. The right renal artery is longer than the left due to the position of the aorta, and it passes behind the inferior vena cava to reach the hilum of the kidney. The left renal artery is slightly higher than the right and lies behind the left renal vein. Accessory renal arteries are often found; they most commonly arise from the aorta either above or below the main artery and usually enter either the upper or lower parts of the kidneys away from the hilum. These accessory arteries may very occasionally arise from the iliac vessels. Renal arteriography is performed for two major reasons: first, to demonstrate the main renal artery to look for narrowing in cases of hypertension and, second, for the differential diagnosis of renal masses. It is important when diagnosing renal artery narrowing that the whole of the main artery, including its origin, is seen. It is often necessary to perform a non-selective lower abdominal aortogram to show these details.

   Left Suprarenal Arteriogram :

The blood supply to the suprarenal glands is from three main sources: an inferior suprarenal artery arising from the renal artery, a middle suprarenal artery arising from the aorta, and a superior suprarenal artery arising from the inferior phrenic artery. However, this supply is subject to a lot of variation and the glands may be supplied by a variety of other small vessels. A non-selective abdominal aortogram may be sufficient to show large suprarenal tumours, but selective catheterization of the three main blood vessels may be needed to show small tumours. The cortex of the suprarenal gland usually shows as a dense blush about 2 mm wide on angiography with a less opaque medulla. The three main tumours diagnosed by arteriography are: carcinomas, neuroblastomas and phaeochromocytomas.

   Pelvic arteriogram :

The internal iliac artery arises at about the level of the lumbosacral disc, in front of the sacroiliac joint. It descends to the margin of the greater sciatic foramen where it divides into anterior and posterior trunks. The anterior trunk is the direct continuation of the internal iliac artery and proceeds towards the ischial spine. The posterior trunk runs backwards towards the foramen. In approximately 25% of patients, the obturator artery is replaced by a large pubic branch of the inferior epigastric artery. Rarely, this artery runs along the free margin of the lacunar ligament and may be cut accidentally when a femoral hernia is repaired.

   Femoral arteriogram :

To see the origin of the profunda femoris artery, it is necessary to take an oblique projection so that atheromatous disease will not be missed. The femoral artery is the continuation of the external iliac artery and originates deep to the inguinal ligament. It terminates by passing through an hiatus in the adductor magnus muscle to become the popliteal artery. The first 3-4 cm of the femoral artery and vein are enclosed within the femoral sheath. The femoral artery lies lateral to the femoral vein and the femoral nerve lies lateral to the sheath.

   Popliteal Arteriogram :

The popliteal artery begins at the adductor hiatus and runs deep through the popliteal fossa to reach the lower border of the popliteus muscle, where it divides into the anterior and posterior tibial arteries. The anterior tibial artery passes forwards between the heads of the tibialis posterior muscle and through the interosseous membrane to the front of the leg, where it descends on the anterior surface of the membrane and becomes, in the foot, the dorsalis pedis artery. The posterior tibial artery descends medially on the posterior aspect of the leg and terminates as the medial and lateral plantar arteries. The peroneal artery originates from the posterior tibial artery to run in the tibiofibular syndesmosis to reach the calcaneus.

   Pulmonary Arteriogram :

Pulmonary arteriography is usually performed by cannulating the median cubital vein at the elbow and passing the catheter through the right atrium and right ventricle into the pulmonary artery. The whole of the pulmonary trunk is contained within the pericardium. The trunk arises from the base of the right ventricle to run upwards and posteriorly in front and then to the left of the ascending aorta. It divides into the right and left pulmonary arteries beneath the aortic arch. The right pulmonary artery is slightly longer and larger than the left and runs horizontally behind the ascending aorta, the superior vena cava and the upper right pulmonary vein. It runs in front of the oesophagus and the right main bronchus to the root of the right lung, where it divides into two branches. The left pulmonary artery runs horizontally in front of the descending thoracic aorta and the left main bronchus to the root of the left lung, where again it divides into two branches. On the upper surface of the left pulmonary artery there is a connection to the aortic arch by the ligamentum arteriosum, which bears a close relationship to the left recurrent laryngeal nerve. The pulmonary veins, unlike the pulmonary arteries, do not accompany the corresponding bronchi and, consequently, a bronchopulmonary segment is not a complete vascular unit as veins cross from one segment to another. The veins drain into the left atrium which lies high and posterior. Note that the pulmonary arteries and veins are not the only vascular system present in the lungs as there is a systemic bronchial circulation consisting of bronchial arteries arising from the descending thoracic aorta. The bronchial veins have two systems: a deep and superficial; the deep veins join the main pulmonary veins at the left atrium, and the superficial veins drain on the right side into the azygos vein and on the left side into the accessory hemiazygos vein or one of the superior intercostal veins.