Parietal branches: lumbar arteries, median sacral artery. Meaning of the median sacral artery in medical terms Sacral artery

Map 2. Central Asia in the 12th century. General comment. Compared to the previous map, what is striking is the reduction in the number of Turkic tribes and their replacement by several large Mongolian ones, which now constitute the main population of the steppe. Turkic tribes, behind one

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Midline

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ARTERY

ARTERY Rabbi Moshe Ephraim, grandson of the Baal Shem, was an opponent of the Polish Hasidim, because he heard that they mortify their flesh too harshly and destroy the image of God in themselves, instead of making all parts of their body perfect and uniting them with the soul into one

Aorta(aorta)- the main arterial vessel, starts from the left ventricle and ends at the level of the IV lumbar vertebra. There are 3 parts that transform into each other: ascending arc And downward(Fig. 165).

Ascending aorta(pars ascendens aortae) starts from the left ventricle, goes up and to the right to the origin of the brachiocephalic trunk. Here, at the level of the connection of the right second rib with the sternum, it passes into the aortic arch without a visible border. At its origin, the ascending aorta is expanded and forms a bulb (bulbus aortae),

Rice. 165. Aorta and its branches, front view. Internal organs, peritoneum and pleura removed:

1 - brachiocephalic trunk; 2 - left common carotid artery; 3 - left subclavian artery; 4 - aortic arch; 5 - left main bronchus; 6 - esophagus; 7 - descending aorta; 8 - posterior intercostal arteries; 9 - thoracic (lymphatic) duct; 10 - celiac trunk (cut off); 11 - superior mesenteric artery (cut off); 12 - diaphragm; 13 - testicular (ovarian) arteries; 14 - inferior mesenteric artery; 15 - lumbar arteries; 16 - right renal artery (cut off); 17 - intercostal nerves; 18 - sympathetic trunk (right); 19 - non-paired vein; 20 - posterior intercostal veins; 21 - hemizygos veins; 22 - right main bronchus; 23 - ascending aorta (from Sobotta)

in which there are 3 protrusions - aortic sinuses: right, left and rear. The coronary arteries begin from the right and left sinuses. 3 are fixed to the edges of the sinuses semilunar valves, components aortic valve. To the right of the aorta is the superior vena cava, in front is the pulmonary trunk. This part of the aorta is enclosed in the pericardium.

Aortic arch(arcus aortae) located outside the pericardium at the level of the manubrium of the sternum. The convexity of the arch is facing upward, goes from the beginning of the brachiocephalic trunk from right to left and back, passing from the anterior mediastinum to the posterior. The thymus is located in front of the aortic arch, and the trachea is located behind it. The concave surface of the aortic arch and the pulmonary trunk are connected by the ligament arteriosus (lig. arteriosum), representing an overgrown ductus arteriosus. Large arteries branch off from the convex surface of the arch, supplying blood to the head, neck and upper limbs. Consistently from right to left it is brachiocephalic trunk about 2.5 cm long, left common carotid artery And left subclavian artery. In the posterior mediastinum at the level of the IV thoracic vertebra, the aortic arch passes into the descending part.

Descending aorta(pars descendens aortae)- the longest section. It is divided into two parts: thoracic and abdominal.

Thoracic aorta (pars thoracica aortae) located in the posterior mediastinum almost vertically, first to the left and in front of the esophagus, from the level of the IV thoracic vertebra, then behind the esophagus, in front of the spinal column, at the level of the VIII-IX to XII thoracic vertebrae, and continues through the aortic opening of the diaphragm into the abdominal cavity.

Abdominal aorta (pars abdominalis aortae) located in front and to the left of the lumbar vertebral bodies. To the right of it is the inferior vena cava. Both vessels are located in the retroperitoneal space. At the level of the IV lumbar vertebra, the abdominal aorta ends, dividing into two common iliac arteries.

Arteries of the trunk

Arteries of the chest

The source of blood supply to the breast is mainly thoracic aorta. Some arteries extend to the chest from subclavian And axillary artery. They arise from the thoracic part of the aorta parietal arteries, vascularizing the wall, and visceral, supplying blood to organs located in the chest cavity (Fig. 166).

Rice. 166. The thoracic part of the aorta and the posterior intercostal arteries extending from it, anterior view. The internal organs of the chest cavity were removed:

1 - aortic arch; 2 - bronchial branches; 3 - left main bronchus; 4 - thoracic aorta; 5 - esophagus; 6 - posterior intercostal arteries; 7 - internal intercostal muscles; 8 - diaphragm; 9 - mediastinal branches; 10 - esophageal branches;

11 - right main bronchus; 12 - ascending aorta; 13 - brachiocephalic trunk; 14 - left common carotid artery; 15 - left subclavian artery

Parietal branches:

1. Posterior intercostal arteries(ah. intercostales posteriores) depart segment by segment into the third - eleventh intercostal spaces on the right and left. The last intercostal artery is called the subcostal artery (a. subcostalis), passes below the XII rib. The two upper intercostal spaces are supplied with blood from the branches of the subclavian and axillary arteries. These arteries supply blood to the ribs, intercostal muscles, and give off the dorsal branch (r. dorsalis) to the muscles and skin of the back, the spinal column and the spinal cord with its membranes. Arteries supply blood to the mammary gland; The 6 inferior posterior intercostal arteries deliver blood to the diaphragm and the anterolateral abdominal wall. All posterior intercostal arteries in front are connected to the anterior intercostal branches from the internal mammary artery (branches of the subclavian artery).

2. Superior phrenic arteries(ah. phrenicae superiores) paired, arise at the aortic opening of the diaphragm and branch in the lumbar part of the diaphragm and the pleura covering it.

Visceral branches:

1. Bronchial branches(rr. bronchiales), usually 2-3, depart at the level of the root of the left lung and branch along the left bronchus, supplying blood to the bronchi and lungs. Bronchial branches to the right lung arise from the right posterior intercostal arteries and esophageal branches.

2. Esophageal branches(rr. esophageales) paired, 4-5 in number, extend from the aorta at its junction with the esophagus. Supply blood to the esophagus.

3. Mediastinal branches(rr. mediastinales) paired, vascularize the tissue and lymph nodes of the mediastinum.

4. Pericardial branches(rr. pericardiaci) paired, go to the posterior surface of the pericardium.

Abdominal arteries

The abdominal wall and abdominal organs are supplied with blood from arteries from abdominal aorta. The arteries of the chest and branches from the internal and external iliac and femoral arteries also participate in the blood supply to the abdominal wall. Distinguish parietal And visceral branches abdominal aorta (Fig. 167).

Parietal branches:

1. Inferior phrenic arteries(ah. phrenicae inferiores), vascularizing the diaphragm and the peritoneum covering it, give off superior adrenal arteries.

Rice. 167. The abdominal part of the aorta and its branches, anterior view. The internal organs of the abdominal cavity were partially removed:

1 - lower diaphragmatic; 2 - celiac trunk; 3 - splenic; 4 - superior mesenteric; 5 - renal; 6 - testicular (ovarian); 7 - inferior mesenteric; 8 - median sacral; 9 - external iliac; 10 - internal iliac; 11 - obturator; 12 - lower gluteal; 13 - upper gluteal; 14 - iliopsoas; 15 - lumbar; 16 - abdominal aorta; 17 - lower adrenal; 18 - middle adrenal; 19 - general hepatic; 20 - left gastric; 21 - upper adrenal; 22 - inferior vena cava

2. Lumbar arteries(aa. lumbales), 4 pairs, similar to intercostal ones, are segmental vessels. They supply blood to the muscles and skin of the lower back and side wall of the abdomen. Anastomose with the superior and inferior epigastric arteries.

3. Median sacral artery(a. sacralis mediana) unpaired, starts from the bifurcation of the aorta between the common iliac arteries, descends to the sacrum, which supplies blood.

Visceral branches:

1. Celiac trunk(truncus coeliacus)(Fig. 168) unpaired, originates from the anterior semicircle of the aorta at the level of the XII thoracic vertebra, above the pancreas. The thick (up to 9 mm) and short (1-2 cm) trunk goes forward and is divided into 3 arteries: left gastric, general hepatic And splenic

Left gastric artery(a. gastric sinistra) unpaired, runs along the lesser curvature of the stomach from left to right. Gives off esophageal branches to the abdominal part of the esophagus, gastric branches. Anastomoses with the esophageal arteries and other arteries supplying blood to the stomach.

Common hepatic artery(a. hepatica communis) unpaired, goes to the right, forward and upward and divides into its own hepatic and gastroduodenal arteries. Own hepatic artery (a. hepatica propria) located between the leaves of the lesser omentum, to the left of the common bile and hepatic ducts and in front of the portal vein. Before entering the portal, the proper hepatic artery gives off the right gastric artery (a. gastric dextra) to the lesser curvature of the stomach. Gastroduodenal artery (a. gastroduodenalis) goes down and divides into the right gastroepiploic artery (a. gastroomentalis dextra)- to the right side of the greater curvature of the stomach and the superior pancreaticoduodenal arteries (aa. pancreaticoduodenales superiores), to the duodenum and pancreas.

Splenic artery unpaired, runs horizontally to the left along the upper edge of the pancreas to the hilum of the spleen, where it divides into the terminal splenic branches . They depart from it:

1) pancreatic branches (rr. pancreatici) to the pancreas;

2) left gastroepiploic artery (a. gastroomentalis sinistra) to the left half of the greater curvature of the stomach, where, together with the right gastroepiploic artery, it forms an arterial arch;

Rice. 168. Celiac trunk and its branches, front view:

1 - celiac trunk; 2 - left lobe of the liver (raised upward); 3 - left gastric artery; 4 - common hepatic artery; 5 - splenic artery; 6 - stomach; 7 - left gastroepiploic artery; 8 - omental branches; 9 - large oil seal; 10 - right gastroepiploic artery; 11 - duodenum; 12 - gastroduodenal artery; 13 - common bile duct; 14 - right gastric artery; 15 - portal vein; 16 - gallbladder; 17 - gall bladder artery; 18 - own hepatic artery

3) short gastric arteries (aa. gastricae breves), numbering 5-6, at the gate of the spleen they go to the fundus of the stomach.

An arterial ring is formed around the stomach from the branches of the celiac trunk anastomosing with each other.

2. Superior mesenteric artery(a. mesenterica superior)(Fig. 169.1) unpaired, arises from the aorta at the level of the first lumbar vertebra between

Rice. 169.1. Superior mesenteric artery and its branches, anterior view. The greater omentum and transverse colon are raised upward:

1 - appendix; 2 - cecum; 3 - artery of the appendix; 4 - ileocecal artery; 5 - ascending colon; 6 - right colon artery; 7 - duodenum; 8 - superior pancreatic-duodenal artery; 9 - head of the pancreas; 10 - middle colon artery; 11 - inferior pancreatic-duodenal artery; 12 - transverse colon; 13 - superior mesenteric artery; 14 - ascending branch of the left colon artery; 15 - descending colon; 16 - jejunal arteries; 17 - ileal arteries; 18 - loops of the small intestine

Rice. 169.2. The inferior mesenteric artery and its branches, anterior view. The transverse colon is raised upward, the loops of the small intestine are turned to the right. The parietal peritoneum in the area of ​​the left mesenteric sinus was removed: 1 - abdominal part of the aorta; 2 - inferior mesenteric artery; 3 - left colonic artery; 4 - left common iliac artery; 5 - sigmoid-intestinal artery; 6 - sigmoid colon; 7 - superior rectal artery; 8 - right common iliac artery; 9 - median sacral artery; 10 - small intestine; 11 - ascending part of the duodenum; 12 - duodenojejunal flexure; 13 - middle colon artery; 14 - mesentery of the transverse colon; 15 - transverse colon

the pancreas above and the horizontal part of the duodenum below, enters the mesentery of the small intestine. The following branches sequentially branch off from it:

1) inferior pancreaticoduodenal arteries (aa. pancreaticoduodenales inferiores) to the duodenum and pancreas. They are connected to the upper ones of the same name;

2) middle colon artery (a. colica media) to the transverse colon;

3) right colon artery (a. colica dextra) to the ascending colon;

4) ileocolic artery (a. ileocolica) to the terminal end of the ileum, the cecum with the appendix;

5) arteries of the small intestine (aa. intestinales), 14-18 vessels, spreading in the mesentery and forming rows of arches - arcades, giving off branches to the intestinal wall. Among them are the jejunal arteries (aa. jejunales) and ileointestinal (aa. ileales).

3. Middle adrenal artery(a. suprarenalis media) steam room, extends below the celiac trunk and passes to the adrenal glands. Anastomoses with the superior and inferior adrenal arteries.

4. Renal artery(a. renalis) steam room, originates from the aorta at the level of the II lumbar vertebra and goes to the kidney; the right renal artery passes behind the inferior vena cava and is longer than the left. The inferior adrenal artery arises from the renal artery (a. suprarenalis inferior).

5. Testicular (ovarian) artery(a. testicularis (ovarica)) steam room This is a thin but long vessel that extends below the renal arteries and follows the gonad (testicle, ovary).

6. Inferior mesenteric artery(a. mesenterica inferior) unpaired, starts from the left surface of the aorta at the level of the third lumbar vertebra (Fig. 169.2). The artery is divided into 3 branches:

1) left colic artery (a. colica sinistra) goes to the descending colon;

2) sigmoid arteries (aa. sigmoideae) directed to the sigmoid colon;

3) superior rectal artery (a. rectalis superior) goes to the rectum. Anastomoses are formed between all colon and sigmoid arteries.

Pelvic arteries

The pelvic arteries include arteries arising from the internal and external iliac arteries - branches of the common iliac artery (Fig. 170).

Common iliac artery(a. iliaca communis)- paired terminal branch of the abdominal aorta. It begins at the level of the IV lumbar vertebra, goes retroperitoneally along the medial edge of the psoas major muscle to the anterior surface of the sacroiliac joint, where it divides into internal And external iliac artery.

Rice. 170. Arteries of the pelvis and perineum, rear view:

1 - aorta; 2 - inferior vena cava; 3 - common iliac; 4 - external iliac; 5 - internal iliac; 6 - upper gluteal; 7 - obturator; 8 - lower gluteal; 9 - internal genitalia; 10 - middle rectal;

11 - lower rectal; 12 - upper rectum; 13 - sigmoid arteries; 14 - median sacral; 15 - inferior mesenteric

Internal iliac artery(a. iliaca interna) steam room, runs along the wall of the pelvis, under the peritoneum, is crossed in front by the ureter, lies in front of the internal iliac vein, reaches the large sciatic foramen, at the edge of which it divides into parietal And visceral branches.

Parietal branches:

1. Iliolumbar artery(a. iliolumbalis) supplies blood to the iliacus and psoas muscles.

2. Lateral sacral arteries(aa. sacrales laterales), more often, two - upper and lower, supply blood to the sacrum, coccyx, adjacent muscles and skin.

3. Superior gluteal artery(a. glutea superior) exits through the supragiriform foramen from the pelvis.

4. Inferior gluteal artery(a. glutea inferior) exits the pelvis through the infrapiriform opening.

Both gluteal arteries supply blood to the muscles and skin of the gluteal region and the hip joint.

5. Obturator artery(a. obturatoria) runs along the lateral wall of the pelvis and exits through the obturator canal onto the thigh. Supplies blood to the hip joint and adductor muscles of the thigh.

Visceral branches:

1. Umbilical artery(a. umbilicalis) runs along the lateral surface of the bladder to the anterior abdominal wall, where it lies subperitoneally and ascends to the umbilical ring. In adults, along the anterior abdominal wall the artery becomes obliterated, turning into ligament of the umbilical artery (chorda a. umbilicalis). In the fetus, the artery exits through the umbilical ring into the umbilical cord, reaching the placenta. The superior vesical arteries depart from the umbilical artery in its initial part (aa. vesicales superiores) to the bladder and ureter and artery of the vas deferens (a. ductus deferentis). The umbilical artery anastomoses with the inferior vesical artery.

2. Inferior vesical artery(a. vesicalis inferior) goes down to the bladder, gives off branches to the prostate, seminal vesicles (or vagina). Anastomoses with the superior vesical arteries and with the branches of the internal pudendal artery.

3. Uterine artery(a. uterina) descends to the cervix, lying between the leaves of its broad ligament; gives off branches to the uterus, ovary and vagina. Anastomoses with the ovarian and inferior vesical arteries.

4. Internal pudendal artery(a. Pudenda interna) exits the pelvic cavity through the infrapiriform foramen, goes around the ischial spine and enters the ischioanal fossa, where it gives off the inferior rectal artery (a. rectalis inferior) to the rectum, perineal (a.perinealis)- to the perineum, as well as arteries to the urethra, vagina (or penis), clitoris. Anastomoses with the uterine and external genital arteries.

5. Middle rectal artery(a. rectalis media) goes to the rectum, vascularizing its middle section. Anastomoses with the superior and inferior rectal arteries.

External iliac artery(a. iliaca externa) steam room, located subperitoneally, crosses the ureter and vessels of the gonads, goes to the inguinal ligament, below which it continues as femoral artery. Gives branches:

1) inferior epigastric artery (a. epigastrica inferior) ascends subperitoneally along the anterior wall of the abdomen to the navel;

2) deep artery circumflexing the ilium (a. circumflexa iliaca profunda) is located along the inner surface of the iliac crest and gives branches to the lower parts of the transverse and internal oblique abdominal muscles, the iliacus muscle and the tensor fascia lata.

Questions for self-control

1. Describe the topography of the thoracic and abdominal aorta.

2. What parietal branches of the thoracic aorta do you know?

3. What visceral branches of the thoracic aorta do you know?

4. List the parietal branches of the abdominal aorta.

5. What visceral branches of the abdominal aorta do you know?

6. List the parietal branches of the internal iliac artery.

7. What visceral branches of the internal iliac artery do you know?

1. Inferior phrenic artery, a. phrenica inferior(see Fig.) is a rather powerful paired artery. It departs from the anterior surface of the initial part of the abdominal aorta at the level of the XII thoracic vertebra and goes to the lower surface of the tendon part of the diaphragm, where it gives off anterior and posterior branches that supply blood to the latter. In the thickness of the diaphragm, the right and left arteries anastomose with each other and with branches from the thoracic part of the aorta (see Fig.). The right artery passes behind the inferior vena cava, the left - behind the esophagus.

Along its course, the artery gives off 5-7 superior adrenal arteries, aa. suprarenales superiores. These are thin branches that arise from the initial section of the inferior phrenic artery and supply blood to the adrenal gland. Along the way, several small branches extend from them to the lower parts of the esophagus and to the peritoneum.

2. Lumbar arteries, aa. lumbales(see Fig.) are 4 paired arteries. They arise from the posterior wall of the abdominal aorta at the level of the body of the I-IV lumbar vertebrae. They are directed transversely, to the lateral side, with the two upper arteries passing behind the legs of the diaphragm, the two lower ones - behind the psoas major muscle.

All lumbar arteries anastomose with each other and with the superior and inferior epigastric arteries, which supply blood to the rectus abdominis muscle. Along their course, the arteries give a number of small branches to the subcutaneous tissue and skin; in the area of ​​the white line they anastomose here and there with the arteries of the same name on the opposite side. In addition, the lumbar arteries anastomose with the intercostal arteries, aa. intercostales, iliopsoas artery, a. iliolumbalis, deep artery circumflexing the ilium, a. circumflexa ilium profunda, and the superior gluteal artery, a. glutea superior.

Having reached the transverse processes of the vertebrae, each lumbar artery gives off dorsal branch, r. dorsalis. Then the lumbar artery goes behind the quadratus lumborum muscle and supplies it with blood; then it goes to the anterior wall of the abdomen, passes between the transverse and internal oblique abdominal muscles and reaches the rectus abdominis muscle.

The dorsal branch goes to the back surface of the body to the back muscles and skin of the lumbar region. Along the way, it gives off a small branch to the spinal cord - spinal branch, r. spinalis, which enters the spinal canal through the intervertebral foramen, supplying blood to the spinal cord and its membranes.

3. Median sacral artery, a. sacralis mediana(see Fig.) is a direct continuation of the abdominal aorta. It starts from its posterior surface, slightly above the bifurcation of the aorta, i.e. at the level of the V lumbar vertebra. It is a thin vessel passing from top to bottom in the middle of the pelvic surface of the sacrum and ending at the coccyx in the coccygeal body, glomus coccygeum (see “Endocrine glands”).

Branching from the median sacral artery along its course are:

• inferior lumbar artery, a. lumbalis imae, steam room, extends into the area of ​​the V lumbar vertebra and supplies blood to the iliopsoas muscle. On its way, the artery gives off a dorsal branch, which is involved in the blood supply to the deep muscles of the back and spinal cord;
• lateral sacral branches, rr. sacrales laterales, depart from the main trunk at the level of each vertebra and, branching on the anterior surface of the sacrum, anastomose with similar branches from the lateral sacral arteries (branches of the internal iliac arteries).

Several branches depart from the lower part of the median sacral artery, which supply blood to the lower parts of the rectum and the loose tissue around it.

Lumbar arteries (aa. lumbales) are four paired arteries arising from the posterior surface of the abdominal aorta. The level of their origin varies within the origin of the first pair of arteries from the level of the XII thoracic vertebra to the lower edge of the II lumbar vertebra. The origin of the last pair of arteries can vary from the lower edge of the second lumbar to the lower edge of the fourth lumbar vertebrae. The lumbar arteries run posteriorly and laterally. The two upper arteries pass behind the crura of the diaphragm, the two lower ones pass behind the psoas major muscle. At the level of the transverse processes of the vertebrae, each lumbar artery is divided into an anterior branch, which participates in the blood supply to the lower part of the anterolateral abdominal wall, and a posterior branch, which supplies the soft tissues of the lumbar region and gives branches to the spinal cord.

3. Median sacral artery (a. sacralis mediana) is a thin vessel that is a direct continuation of the abdominal aorta and takes part in the blood supply mainly to the walls and partially to the pelvic organs. It starts from the posterior surface of the aorta at the site of its division into the common iliac arteries. The vessel descends to the sacrum and runs along the middle of its pelvic surface to the coccyx, giving off branches supplying the iliopsoas muscle, the sacrum and the coccyx. The lower section of the middle sacral artery participates in the blood supply to the anal end of the rectum and pararectal tissue, anastomosing with the rectal branches of the internal iliac artery.

Visceral branches: celiac trunk

Celiac trunk (truncus coeliacus) is a short vessel 1-2 cm long, extending from the anterior surface of the aorta at the level of the lower edge of the XII thoracic or upper edge of the I lumbar vertebra. Most often, the trunk departs at the level of the upper edge of the pancreas, much less often - at the level of its lower edge. Departing from the aorta, the trunk is located between the legs of the diaphragm. The trunk lies retroperitoneally and retroperitoneally is usually divided into three branches: a) the left gastric artery (a. gastrica sinistra), heading up and to the left to the place where the esophagus passes into the cardiac part of the stomach; b) the common hepatic artery (a. hepatica communis), a more powerful branch heading to the right and forward to the hepatoduodenal ligament; c) the splenic artery (a. lienalis), the longest and largest of the three branches of the celiac trunk, heading along the postero-superior edge of the pancreas to the left, to the gate of the spleen (Fig. 25).

Rice. 25. Branches of the celiac trunk. 1 - common hepatic artery; 2 - posterior gastric artery; 3 - short gastric arteries; 4 - splenic branches; 5 - pancreatic branches; 6 - left gastroepiploic artery; 7, 9 - omental branches; 8 - gastric branches; 10 - duodenal branches; 11 - pancreatic branches; 12 - anterior superior pancreaticoduodenal artery; 13 - right gastroepiploic artery; 14 - right gastric artery; 15 - gastroduodenal artery; 16 - gallbladder artery; 17 - right hepatic artery; 18, 20 - own hepatic artery; 19 - left hepatic artery.

The division of the celiac trunk into its branches is highly variable. V.V. Kovanov and T.I. Anikina (1974) divide the occurring variants of the celiac trunk into six groups: I - absence of the celiac trunk (independent branching of branches from the abdominal aorta); II - bifurcation division of the celiac trunk and the departure of the third branch from another source; III - trifurcation division of the celiac trunk with its departure from the main arteries and other sources; IV - origin of the celiac trunk along with the superior mesenteric artery; V - origin of the gastrosplenic and mesenteric-hepatic trunks from the abdominal aorta; VI - departure from the celiac trunk of supernumerary branches.

Most rationally, all variants of the branches of the celiac trunk are described in Tandler’s diagram. According to this scheme, during the process of embryogenesis the following sequence of 4 abdominal arteries departing from the aorta is formed (from top to bottom): left gastric artery; splenic artery; common hepatic artery; superior mesenteric artery. Any nearby arteries can form common trunks. The first three are the celiac trunk; the first two are the gastrosplenic trunk; the last two are the hepatomesenteric trunk, etc.