Blood Vessels of the Pelvis

Gross Anatomy - Blood Vessels of the Pelvis

A. Internal iliac artery

• Arises from the bifurcation of the common iliac artery, in front of the sacroiliac joint, and is crossed in front by the ureter at the pelvic brim.
• Is commonly divided into a posterior division , which gives rise to the iliolumbar, lateral sacral, and superior gluteal arteries, and an anterior division , which gives rise to the inferior gluteal, internal pudendal, umbilical, obturator, inferior vesical, middle rectal, and uterine arteries.

1. Iliolumbar artery

• Runs superolaterally to the iliac fossa, deep to the psoas major.
• Divides into an iliac branch supplying the iliacus muscle and the ilium and a lumbar branch supplying the psoas major and quadratus lumborum muscles.

2. Lateral sacral artery

• Passes medially in front of the sacral plexus, giving rise to spinal branches , which enter the anterior sacral foramina to supply the spinal meninges and the roots of the sacral nerves and then emerge through the posterior sacral foramina to supply the muscles and skin overlying the sacrum.

3. Superior gluteal artery

• Usually runs between the lumbosacral trunk and the first sacral nerve.
• Leaves the pelvis through the greater sciatic foramen above the piriformis muscle to supply muscles in the buttocks.

4. Inferior gluteal artery

• Runs between the first and second or between the second and third sacral nerves.
• Leaves the pelvis through the greater sciatic foramen , inferior to the piriformis.

5. Internal pudendal artery

• Leaves the pelvis through the greater sciatic foramen, passing between the piriformis and coccygeus muscles, and enters the perineum through the lesser sciatic foramen.

6. Umbilical artery

• Runs forward along the lateral pelvic wall and along the side of the bladder.
• Has a proximal part that gives rise to the superior vesical artery to the superior part of the bladder and, in the male, to the artery of the ductus deferens , which supplies the ductus deferens, the seminal vesicles, the lower part of the ureter, and the bladder.
• Has a distal part that is obliterated and continues forward as the medial umbilical ligament.

7. Obturator artery

• Usually arises from the internal iliac artery, but in about 20% to 30% of the population, it arises from the inferior epigastric artery. It then passes close to or across the femoral canal to reach the obturator foramen and hence is susceptible to damage during hernia operations.
• Runs through the upper part of the obturator foramen, divides into anterior and posterior branches , and supplies the muscles of the thigh.
• Forms a posterior branch that gives rise to an acetabular branch, which enters the joint through the acetabular notch and reaches the head of the femur by way of the ligamentum capitis femoris.

8. Inferior vesical artery

• Occurs in the male and corresponds to the vaginal artery in the female.
• Supplies the fundus of the bladder, prostate gland, seminal vesicles, ductus deferens, and lower part of the ureter.

9. Vaginal artery

• Arises from the uterine or internal iliac artery.
• Gives rise to numerous branches to the anterior and posterior wall of the vagina and makes longitudinal anastomoses in the median plane to form the anterior and posterior azygos arteries of the vagina.

10. Middle rectal artery

• Runs medially to supply mainly the muscular layer of the lower part of the rectum and the upper part of the anal canal.
• Also supplies the prostate gland and seminal vesicles (or vagina) and the ureter.

11. Uterine artery

• Is homologous to the artery of the ductus deferens in the male.
• Arises from the internal iliac artery or in common with the vaginal or middle rectal artery.
• Runs medially in the base of the broad ligament to reach the junction of the cervix and the body of the uterus, runs in front of and above the ureter near the lateral fornix of the vagina, then ascends along the margin of the uterus, and ends by anastomosing with the ovarian artery.
• Divides into a large superior branch , supplying the body and fundus of the uterus, and a smaller vaginal branch , supplying the cervix and vagina.
• Takes a tortuous course along the lateral margin of the uterus and ends by anastomosing with the ovarian artery.

B. Median sacral artery

• Is an unpaired artery arising from the posterior aspect of the abdominal aorta just before its bifurcation.
• Descends in front of the sacrum, supplying the posterior portion of the rectum, and ends in the coccygeal body , which is a small cellular and vascular mass located in front of the tip of the coccyx.

C. Superior rectal artery

• Is the direct continuation of the inferior mesenteric artery.

D. Ovarian artery

• Arises from the abdominal aorta, crosses the proximal end of the external iliac artery to enter the pelvic minor, and reaches the ovary through the suspensory ligament of the ovary.

E. Veins of the pelvis

• Generally correspond to arteries.

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