1.(Ascending aorta) The first large blood vessel through which arterial blood flows after leaving the heart is the ascending aorta. It is named “ascending” because its direction is upward. The ascending aorta is the closest blood vessel to the heart, and therefore bears the greatest blood pressure and has the thickest lumen. Its root emits two smaller vessels, which are directly responsible for the blood supply of the heart itself, the famous “coronary arteries”. As we already know, the heart is the “starting point” of blood circulation, the “pump”, the “engine”! The contraction of the heart is the driving force for the blood to move forward. The heart, like other tissues and organs in the body, also needs energy to replenish, consume oxygen, nutrients, and eliminate metabolic waste, and it is the two coronary arteries from the ascending aorta that ensure it gets enough material and energy support. Most of the angina pectoris, myocardial infarction, coronary artery disease, and insufficient blood supply to the heart muscle that we often encounter in the clinic are due to abnormal lesions such as narrowing and blockage of the coronary arteries. The heart itself has a metabolic problem, which inevitably affects its normal contractile function, with predictable consequences – often fatal! 2, (aortic arch and descending aorta) The ascending aorta continues to travel, but the direction begins to adjust, gradually to the left, backward, and began to slowly downward, just like the Yangtze River through the Jinsha River section, the Yellow River through Shaanxi Province, and finally completed a “magnificent turn” in the thoracic opening, the direction of travel to a 180-degree turn, transitioning to the descending aorta section. This “turn” stage is also called the “aortic arch” because the shape of the vessel resembles an “arch”. The segment of the aortic arch branches upward from the right to the left into the three branch arteries of the aorta, the left common carotid artery and the left subclavian artery, commonly known as the “three hairs”. The former, together with the left subclavian artery, is responsible for the blood supply to the upper limbs bilaterally, while the latter, together with the left common carotid artery, is responsible for the blood supply to the head and neck and the brain. Thus, the three branch arteries of the aortic arch control the blood supply to the upper extremities and the head and neck, as well as the brain, which is particularly important, and their status should not be underestimated. Patients with multiple aortitis (mostly seen in oriental people and young women, hence the term “oriental ligamentosis”) often suffer from upper limb weakness, coldness, pulselessness, dizziness, and blackness (blackness in front of the eyes). The ancient saying of “cutting the pulse” is the palpation of the radial artery. The radial artery is located at the wrist joint and belongs to the distal direct migrating branch of the subclavian artery. Narrowing or occlusion of the opening of the subclavian artery can lead to reduced blood supply to the upper extremities, resulting in symptoms such as weakness of the upper extremities and reduced pulsation of the radial artery, resulting in “no pulse” on palpation. Dizziness and darkness are manifestations of the central (brain) blood supply, mostly due to direct blood supply carotid artery lesions, which is often referred to as “carotid stenosis”. The carotid artery specifically includes the common carotid artery and the internal and external carotid arteries (of which the internal carotid artery enters the skull directly and supplies blood to the brain). Atherosclerosis and trauma can cause narrowing or occlusion of the common or internal carotid artery, which can cause a reduction in the blood supply to the brain. More importantly, the intimal plaque or small emboli localized in the carotid artery lesion can easily be dislodged and enter the brain with the blood flow, blocking it somewhere in the brain – this is “cerebral infarction”, also known as “stroke”. The biggest risk of “carotid stenosis” is “stroke”! Therefore, carotid artery stenosis found by ultrasound, CT, etc. should not be taken lightly. The aortic arch continues down to the descending aorta, which has no large branch vessels except for some small intercostal arteries and bronchial arteries. We have already mentioned the possible lesions of many branch arteries, but in fact it is the lesions of these main vessels that pose a greater threat to humans. Take the ascending aorta, aortic arch and descending aorta as examples, aortic coarctation is a common fatal disease in these areas. What is aortic coarctation? The wall of a human blood vessel is composed of an inner, middle and outer membrane, similar to a sandwich or triple sandwich structure, forming a strong “dam” that safely restrains the flow of blood all the time. The inner membrane of the blood vessel is directly exposed to the flow of blood at all times. In some special cases where the vessel wall becomes diseased (mostly due to atherosclerosis and trauma), a small opening is made in the intima and the rapid blood flow gushes “out”; the outer layer of the intima is the relatively weak middle membrane layer, and further out is the outer membrane layer; if the blood flow gushes directly out of the outer membrane, the aorta ruptures! If the outer membrane temporarily resists the attack of the blood flow, the “dam” does not immediately break, the blood flow is still raging inside the “dam”, it will form a sandwich between the inner and outer membranes. This is aortic coarctation! Because the ascending aorta, aortic arch and descending aorta are closer to the heart, the highest blood pressure, blood flow is also the most turbulent, plus the blood vessels here happen to have a large turn, so the endothe is more likely to be damaged, but also more likely to occur aortic coarctation. Because this area is so close to the heart and the blood flow is so rapid, once the clot is ruptured, all the blood in the body can flow out quickly in just a few minutes. The danger can be imagined! 3. (Abdominal aorta and visceral arteries) Fortunately, not all trunk vessels are susceptible to aortic coarctation. As it gets further away from the heart, the blood flow slowly slows down and the pressure on the vessel wall decreases. The blood flow continues down through the descending aorta and crosses the diaphragm before entering the abdominal aortic segment. The chances of abdominal aortic coarctation then drop significantly! The abdominal aorta is the equivalent of the area through the abdomen in terms of human appearance, and is in fact primarily responsible for the blood supply to this area. The first major branch artery is the “abdominal trunk (artery)”. The name alone tells us that it is “dominant” – the “main member” responsible for the entire “abdominal cavity”! The celiac trunk then sends out the left gastric artery, the splenic artery, the common hepatic artery and other next-level branches, directly providing oxygen and nutrients to the stomach, spleen, liver, pancreas and almost all of the parenchymal organs in the abdominal cavity. Next, the abdominal aorta gives rise to the main branch arteries, including the superior mesenteric artery, bilateral renal arteries, and inferior mesenteric artery in turn. The superior and inferior mesenteric arteries are responsible for the blood supply of all intestinal tracts (including small and large intestine) and are important for the maintenance of normal digestive tract functions. Some patients often complain of “unexplained” abdominal pain, nausea, anorexia (or even “fear of food” – abdominal pain when eating), weight loss, etc., and a lot of abdominal tests have been done. In the end, most of them were hastily or crudely crowned with vague diagnoses such as “indigestion”. Most of these symptoms actually belong to the manifestation of acute or chronic intestinal ischemia. Ischemia can occur in the brain, such as cerebral thrombosis, cerebral infarction, stroke, etc.; ischemia can also occur in the heart, such as coronary heart disease, angina pectoris, heart attack, etc.; now, the intestines are no exception! In this case, pay particular attention to the existence of lesions in these branch arteries of the abdominal aorta that are closely related to the function of the digestive system. Although the renal artery also emanates from the abdominal aorta, its condition is still somewhat different from the previous mentioned branch arteries. The previous branch arteries are deep in the “hinterland” of the abdominal cavity and carry the burden of digestive function. The two “brothers” (left and right renal arteries) do not enter the abdominal cavity at all and are completely outside the peritoneal cavity (anatomically accurate description is “located in the retroperitoneal space”), so of course there is little digestive There is no digestive “burden”. The kidneys play an absolutely vital role in the normal metabolic process of the body! It is where the majority of the body’s metabolic waste is excreted, which is where its not-so-elegant nickname of “sewer” comes from. It is through the renal artery that about 2,000 liters of circulating blood flow enters the kidneys every day, expelling the body’s metabolic products, such as water, electrolytes, creatinine, urea and other “toxins” and “wastes” from the body. Lesions of the renal arteries, whether stenosis or occlusion, whether atherosclerosis or external compression, whether entrapment or “tumor”, all have the potential to eventually lead to kidney failure. In addition to assisting in the “drainage of filth”, the renal artery also has the function of blood pressure regulation. A significant portion of hypertensive patients belong to the “renal vascular hypertension”. Back in the day, renal artery surgery was once a “popular” option for treating patients with this type of hypertension. People were surprised to find out that some hypertension can be treated by surgery! It is not a fantasy that “no medication is needed to lower blood pressure”! 4. (Iliac artery) After saying goodbye to the celiac trunk, the superior and inferior mesenteric arteries and the renal artery, the abdominal aorta has also come to its end. At the entrance to the pelvis, it splits in two and “transforms” into the right and left common iliac arteries to continue its descent. The common iliac artery first divides into the internal iliac artery to supply blood to the pelvic organs, and the trunk transitions into the external iliac artery, which then crosses the inguinal ligament at the root of the thigh and becomes the femoral artery, officially announcing that the trunk of the vessel has left the trunk portion (thoracic, abdominal, and pelvic cavities) and entered the trunk portion of the lower extremities. At this point, the diameter of the vessel has been reduced from 2-3 cm (ascending aorta) to less than 1 cm (femoral artery) when it first exits the heart. Despite this significant “thinning”, the femoral artery still faithfully performs its role of delivering “supplies” to the lower extremities. After all, the entire body weight is placed on the lower extremities, and the entire body movement depends on the lower extremities. 5, (lower limb arteries) from the root of the thigh to the most distal end of the circulation – the foot, the main trunk of the blood vessels and through the femoral artery, superficial femoral artery, N artery, anterior tibial artery, dorsalis pedis artery several sections. Perhaps because the previous journey was too “aggressive”, the vessels in the lower extremity appeared to be “difficult”. The lumen gradually decreases, the blood flow also decreases, and walking in the “embrace” of many muscle groups in the lower extremity, the muscle contraction causes “bump” is inevitable, all the reasons are foreshadowing the lower extremity blood vessels may not be flat The “fate” of the lower extremity blood vessels may be less than flat. Atherosclerosis, hypertension, hyperlipidemia, diabetes, smoking, trauma, etc. invariably increase the chances of damage to the blood vessels of the lower extremities. Lower extremity arteries can be said to be the “high incidence area” of ischemic diseases. The “ischemic trilogy” is the typical three stages of this kind of disease. Chapter 1, “Interstitial claudication”; Chapter 2, “Resting pain”; and Chapter 3, “Gangrene”. Before the three chapters, there may be a “prelude”, when the patient already has coldness or some abnormal sensation in the lower extremities. Once the “interstitial claudication” occurs, it is the symptomatic stage. What is “intermittent claudication”? The full name is “intermittent claudication”, which refers to pain in the lower limbs after walking a certain distance, and after a short rest, the pain can disappear, but the symptoms reappear after walking a certain distance again, which often indicates that the arteries supplying blood to the lower limbs have become significantly narrowed. This often indicates that the arteries supplying blood to the lower extremities have become significantly narrowed. When the “resting pain” stage is reached, the pain in the lower extremities will be unbearable even if you do not do anything – in a resting state – which indicates that the narrowing of the blood vessels has reached the edge of “disaster”. What is “disaster” is the “gangrene” stage, when the blood vessels of the lower limbs have basically lost their blood supply function, the limbs have no blood supply, no oxygen, no nutrients, they begin to necrosis, first the tip of the toe, then the foot, then the calf, the plane of necrosis gradually rise, until The whole lower limb, and finally the fate of amputation.