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Arteries in true pelvis
- 1. Arteries of pelvis • Mainly by • Branches of Internal iliac artery • Other contributions • Ovarian artery • Superior rectal artery • Median sacral artery
- 2. Iliac arteries • Common iliac artery divides • In front of the sacroiliac joint • Into External and internal iliac arteries
- 3. Internal iliac artery (Also known as hypogastric artery) • Origin • Arises from • Common iliac artery • At sacroiliac joint • 5th lumbar vertebra & sacrum • Course • Passes down & back into pelvis • Reaches • Upper margin of greater sciatic foramen • Divides into • Anterior and posterior divisions
- 4. Internal iliac artery - Relations • In front • Ureter • Uterine tube (fimbriated end) • Ovary (in female) • Posterior • Sacroiliac joint • Lumbosacral trunk • Internal iliac vein
- 5. Internal iliac artery - relations • Medially • On right • Terminal part of ileum • On left • Sigmoid mesocolon • Laterally • Psoas major • External iliac vein • Obturator nerve
- 6. Internal iliac artery - divisions • Posterior division supplies • Posterior abdominal wall • Posterior pelvic wall • Gluteal region • Anterior division supplies • Pelvic viscera (Except Ovary) • Perineum • Gluteal region • Adductor (medial) region of the thigh
- 7. Branches of Posterior division • Iliolumbar artery • Lateral sacral artery • Superior gluteal artery
- 8. Iliolumbar artery • Ascends behind • External iliac vessels, psoas and iliacus • Divides into • Lumbar • Supplies the muscles of posterior abdominal wall • Psoas and quadratus lumborum • Spinal branch • cauda equine • Iliac branch • Passes through • Intervertebral foramen in between LV and SV • Supplies • Iliacus muscle & bone
- 9. Lateral sacral arteries • Descend in front of sacral plexus • Give branches • Pass into the anterior sacral foramina • Supply • Structures in vertebral canal • Sacral meninges • Piriformis muscle, Erector spinae muscle • Cutaneous area over sacrum
- 10. Superior gluteal • Leaves the pelvis • Through • Greater sciatic foramen • Above • Piriformis • Supplies • Gluteal region
- 11. Branches of Anterior division • Umbilical artery • Obturator artery • Inferior vesical artery (Male) • Vaginal artery • Middle rectal artery • Internal pudendal artery • Inferior gluteal artery • Uterine artery (Female)
- 12. Umbilical artery • Passes on • Lateral wall of pelvis • On levator ani muscle • Proximal part • Is patent & gives • Superior vesical artery • One or many branches • To supply • Upper part of the urinary bladder • Lower end of ureter • Distal part is obliterated • Medial umbilical ligament • Distal fibrous part of the artery
- 13. Obturator artery • Traversing forward on lateral pelvic wall • 2-3 cm below pelvic brim • Passes through • Obturator canal
- 14. Obturator artery – on medial side of thigh • After passes through • Obturator canal • Exits on • Medial side of thigh • Divides into • Anterior & posterior branches • Supplies • Medial compartment of thigh muscles • Obturator extenus
- 15. Obturator artery - branches • Pubic branch • Passes to • Pubic region • Anastomoses with • Pubic branch of inferior epigastric (External iliac) • Acetabular branch • Passes through • Acetabular notch and enters the hip-joint beneath the transverse ligament • In company with an articular branch from the obturator artery • Within joint cavity • Passes along the round ligament to the head of the femur
- 16. Uterine artery • Runs on the pelvic floor • Passes along • Between the layers of the broad ligament • Crosses • Ureter superiorly • Towards lateral fornix of vagina • Then ascends superiorly along • Lateral margin of the uterus • Anastomoses with • Ovarian artery • Supplies • Uterus • Part of vagina • Part of ovary
- 17. Inferior vesical artery • Present in male • Supplies • Base of the bladder • Prostate • Seminal vesicles
- 18. Vaginal artery • Corresponds to inferior vesicle in male • Supplies • Base of the bladder, vagina & rectum • Course • Passes inferomedially • After reaches the vagina • Divides into many anterior & posterior branches • In midline they form anastomoses • Known as anterior and posterior azygos arteries of vagina
- 19. Internal Pudendal Artery • Branch of Internal iliac artery • Leaves pelvic cavity through • Greater sciatic foramen • Enters perineum through • Lesser sciatic foramen • Passes forward in • Pudendal canal with pudendal nerve
- 20. • Inferior rectal artery • Accompanying structures • Inferior rectal nerve • Perineal branch divides into • Posterior scrotal artery • Transverse perineal • Artery to bulb • Deep artery of penis • Supplies erectile tissue • Dorsal artery of penis Internal pudendal artery - Branches
- 21. Inferior gluteal • Largest branch • Of anterior division • Enters gluteal region • Through greater sciatic foramen • Below piriformis
- 22. Parietal Branches • From posterior division • Iliolumbar artery • Lateral sacral arteries (2 branches) • Superior gluteal artery • From anterior division • Obturator artery • Inferior gluteal artery
- 24. Median sacral • Dorsal branch of abdominal aorta • Just above the aortic bifurcation • Represents primitive dorsal aorta • Lies on • Lower 2 lumbar vertebrae • Sacrum • Coccyx • Supplies • Rectum (superopostrior part) • Last 2 lumbar vertebrae • Sacrum • Coccyx
- 25. Ovarian / Testicular • Paired arteries • Origin • Just below the origin of renal arteries • Course • Descends downwards on • Psoas, Ureter & genitofemoral nerve • Right side • Lies behind • 3rd part of duodenum • Root of mesentery • Terminal part of ileum • Left side • Lies behind • Left colic vessels • Inferior mesenteric vein • Descending colon Right gonadal vein drains into IVC Left gonadal vein drains into left renal vein Inferior mesenteric vein drains into
- 26. Ovarian artery • Crosses • External iliac vessels • At pelvic brim • Enters • Infundibulopelvic (suspensory) ligament • So lies in broad ligament • Finally reaches ovary • Supplies • Ovary • Uterine tube • Uterus
- 27. Superior rectal • Continuation of • Inferior mesenteric artery • Crosses • Left common iliac artery • Descends in • Medial limb of sigmoid mesocolon • Supplies • Mucous membrane of rectum & upper half of anal canal
- 28. Internal Iliac Vein • Majority of pelvic venous drainage in pelvic region • Lies lateral to internal iliac artery • Formed near the greater sciatic foramen • Ascends anterior to sacroiliac joint • Joins with external iliac vein to form the common iliac vein • Tributaries • Correspond with the branches of the internal iliac artery • Except iliolumbar vein • Which drains into common iliac
- 29. Other veins • Median sacral vein • Left common iliac vein • Superior rectal vein • Becomes inferior mesenteric vein • After crossing common iliac artery • Drains into splenic vein • Ovarian vein • Formed by • Collection of pampiniform plexus around ovarian artery • Drains into • Right side into IVC • Left side into left renal vein