[2][3] The superior epigastric artery pierces the diaphragm[1] to enter the rectus sheath and descend upon the deep surface of the rectus abdominis.

[citation needed] It anastomoses with the inferior epigastric artery[4][2] within the rectus abdominis muscle[4][1] at the umbilicus.

[2] Where it anastomoses, the superior epigastric artery supplies the anterior part of the abdominal wall,[5][6] upper rectus abdominis muscle,[5] and some of the diaphragm.

If the abdominal aorta develops a significant stenosis and/or blockage (as may be caused by atherosclerosis), this collateral pathway may develop sufficiently, over time, to supply blood to the lower limbs.

[7] A congenitally narrowed aorta, due to coarctation, is often associated with a significant enlargement of the internal thoracic and epigastric arteries.