Common, external and internal iliac arteries, their branches, areas of blood supply. Common iliac artery Parietal branch of the internal iliac artery

Doctors of obstetric-gynecological, urological and general surgical specialties cannot imagine their work without knowledge of the topographic anatomy of the common iliac artery system. Indeed, most pathological conditions and cases of surgical treatment on the pelvic organs and the perineum are accompanied by blood loss, so it is necessary to have information from which vessel the bleeding occurs in order to successfully stop it.

general information

The abdominal aorta at the level of the fourth lumbar vertebra (L4) divides into two large vessels - the common iliac arteries (CIA). The place of this separation is usually called a bifurcation (bifurcation) of the aorta, it is located somewhat to the left of the midline, therefore the right a.iliaca communis is 0.6-0.7 cm longer than the left.

From the bifurcation of the aorta, large vessels diverge at an acute angle (for men and women, the angle of divergence is different and is approximately 60 and 68-70 degrees, respectively) and go laterally (that is, sideways from the midline) and down to the sacroiliac joint. At the level of the latter, each OPA is divided into two terminal branches: the internal iliac artery (a.iliaca interna), which supplies the walls and pelvic organs, and the external iliac artery (a.iliaca externa), which supplies mainly the lower limb with arterial blood.

External iliac artery

The vessel is directed down and forward along the medial edge of the psoas muscle of the dogroin ligament. When exiting the thigh, it passes into the femoral artery. In addition, a.iliaca externa gives off two large vessels that depart near the inguinal ligament itself. These vessels are as follows.

The lower epigastric artery (a.epigastrica inferior) goes medially (that is, to the midline) and then up, between the transverse fascia in front and the parietal peritoneum in the back, and enters the rectus abdominis sheath. On the back surface of the latter, it goes up and anastomoses (connects) with the superior epigastric artery (a branch from the internal mammary artery). Also from a.epigastrica inferior gives 2 branches:

• the artery of the muscle that lifts the testicle (a.cremasterica), which feeds the muscle of the same name;
• pubic branch to the pubic symphysis, also connected to the obturator artery.

The deep artery that envelops the ilium (a.circumflexa ilium profunda) goes to the iliac crest posteriorly and parallel to the inguinal ligament. This vessel supplies the iliac muscle (m.iliacus) and the transverse abdominal muscle (m.transversus abdominis).

internal iliac artery

Descending into the small pelvis, the vessel reaches the upper edge of the large sciatic foramen. At this level, there is a division into 2 trunks - the posterior, giving rise to the parietal arteries (except a.sacralis lateralis), and the anterior, giving rise to the rest of the branches of a.iliaca interna.

All branches can be divided into parietal and visceral. Like any anatomical division, it is subject to anatomical variations.

parietal branches

Parietal vessels are intended for blood supply mainly to muscles, as well as other anatomical structures involved in the structure of the walls of the pelvic cavity:

1. 1. The iliac-lumbar artery (a.iliolumbalis) enters the iliac fossa, where it connects a.circumflexa ilium profunda. The vessel supplies arterial blood to the muscle of the same name.
2. 2. The lateral sacral artery (a.sacralis lateralis) supplies blood to the piriformis muscle (m.piriformis), the muscle that lifts the anus (m.levator ani), and the nerves of the sacral plexus.
3. 3. The superior gluteal artery (a.glutea superior) leaves the pelvic cavity through the supra-piriform opening and goes to the gluteal muscles, accompanying the same-named nerve and vein.
4. 4. The lower gluteal artery (a.glutea inferior) leaves the pelvic cavity through the piriform opening together with a.pudenda interna and the sciatic nerve, which gives off a long branch - a.comitans n.ischiadicus. Coming out of the pelvic cavity, a.glutea inferior nourishes the gluteal muscles and other nearby muscles.
5. 5. Obturator artery (a.obturatoria) goes to the obturator foramen. Upon exiting the obturator canal, it feeds the obturator externus muscle, the adductor muscles of the thigh. A.obturatoria gives a branch to the acetabulum (ramus acetabularis). Through the notch of the latter (incisura acetabuli), this branch penetrates the hip joint, supplying the head of the hip bone and the ligament of the same name (lig. capitis femoris).

Visceral branches

Visceral vessels are intended for blood supply to the pelvic organs and the perineum:

1. 1. The umbilical artery (a.umbilicalis) retains a lumen in an adult only for a short distance - from the beginning to the place where the superior cystic artery departs from it, the rest of its trunk is obliterated and turns into the middle umbilical fold (plica umbilicale mediale).
2. 2. The artery of the vas deferens (a.ductus deferens) in men goes to the vas deferens (ductus deferens) and, accompanied by it, reaches the testicles themselves (testis), which also gives off branches, supplying the latter with blood.
3. 3. The superior vesical artery (a.vesicalis superior) departs from the remaining part of the umbilical artery, supplying the upper part of the bladder with blood. The inferior vesical artery (a.vesicalis inferior), starting directly from a.iliaca interna, supplies the bottom of the bladder and ureter with arterial blood, and also gives branches to the vagina, seminal vesicles and the prostate gland.
4. 4. The middle rectal artery (a.rectalis media) departs from a.iliaca interna or from a.vesicalis inferior. Also, the vessel connects with a.rectalis superior and a.rectalis inferior, supplying the middle third of the rectum, and gives branches to the bladder, ureter, vagina, seminal vesicles and prostate gland.
5. 5. The uterine artery (a.uterina) in women goes to the medial side, crossing the ureter in front, and, reaching the lateral surface of the cervix between the sheets of the broad ligament of the uterus, gives off the vaginal artery (a.vaginalis). The very same a.uterina turns up and goes along the line of attachment of the broad ligament to the uterus. Branches depart from the vessel to the ovary and fallopian tube.
6. 6. Ureteral branches (rami ureterici) deliver arterial blood to the ureters.
7. 7. The internal pudendal artery (a.pudenda interna) in the pelvis gives off small branches to the nearest muscles and the sacral nerve plexus. It mainly nourishes the organs below the pelvic diaphragm and the perineal region with blood. The vessel leaves the pelvic cavity through the piriform opening and then, rounding the sciatic spine (spina ischiadicus), re-enters the pelvic cavity through the small sciatic foramen. Here a.pudenda interna breaks up into branches that supply arterial blood to the lower third of the rectum (a.rectalis inferior), perineal muscles, urethra, bulbourethral glands, vagina and external genitalia (a.profunda penis or a.profunda clitoridis; a. dorsalis penis or a.dorsalis clitoridis).

In conclusion, I would like to note that the above information on topographic anatomy is conditional and is the most common in humans. It is necessary to remember about the possible individual features of the discharge of certain vessels.

1. The iliac-lumbar artery (a. iliolumbalis) goes behind the psoas major back and laterally and gives off two branches:
   • lumbar branch(r. lumbalis) goes to the large lumbar muscle and the square muscle of the lower back. A thin spinal branch (r. spinalis) departs from it, heading into the sacral canal;
   • iliac branch(r. illiacus) supplies blood to the ilium and the muscle of the same name, anastomoses with the deep circumflex iliac artery (from the external iliac artery).
2. Lateral sacral arteries (aa. sacrales laterales), upper and lower, are sent to the bones and muscles of the sacral region. Their spinal branches (rr. spinales) go through the anterior sacral openings to the membranes of the spinal cord.
3. The superior gluteal artery (a. glutealis superior) exits the pelvis through the suprapiriform opening, where it is divided into two branches:
   • superficial branch(r. superficialis) goes to the gluteal muscles and to the skin of the gluteal region;
   • deep branch(r. profundus) splits into upper and lower branches (rr. superior et inferior), which supply blood to the gluteal muscles, mainly the middle and small, and adjacent pelvic muscles. The lower branch, in addition, is involved in the blood supply to the hip joint.

The superior gluteal artery anastomoses with branches of the lateral circumflex femoral artery (from the deep femoral artery).

1. The lower gluteal artery (a. glutealis inferior) is sent along with the internal pudendal artery and the sciatic nerve through the piriformis opening to the gluteus maximus muscle, gives a thin long artery accompanying the sciatic nerve(a. comitans nervi ischiadici).
2. Obturator artery (a. obturatoria), together with the nerve of the same name along the side wall of the small pelvis, is directed through the obturator canal to the thigh, where it is divided into anterior and posterior branches. The anterior branch (r. anterior) supplies blood to the external obturator and adductor muscles of the thigh, as well as the skin of the external genital organs. The posterior branch (r. posterior) also supplies the external obturator muscle and gives the acetabular branch (r. acetabularis) to the hip joint. The acetabular branch not only nourishes the walls of the acetabulum, but as part of the ligament of the femoral head reaches the femoral head. In the pelvic cavity, the obturator artery gives off a pubic branch (r. pubicus), which, in the medial semicircle of the deep ring of the femoral canal, anastomoses with the obturator branch from the inferior epigastric artery. With a developed anastomosis (in 30% of cases), it can be damaged during hernia repair (the so-called corona mortis).

Visceral (splanchnic) branches of the internal iliac artery

1. The umbilical artery (a. umbilicalis) functions throughout only the embryo; goes forward and up, rises along the back side of the anterior wall of the abdomen (under the peritoneum) to the navel. In an adult, it is stored as a medial umbilical ligament. From the initial part of the umbilical artery depart:
   • superior vesical arteries(aa. vesicales superiores) give ureteral branches (rr. ureterici) to the lower ureter;
   • vas deferens artery(a. ductus deferentis).
2. The lower vesical artery (a. vesicalis inferior) in men gives off branches to the seminal vesicles and the prostate gland, and in women to the vagina.
3. The uterine artery (a. uterina) descends into the pelvic cavity, crosses the ureter and between the sheets of the broad uterine ligament reaches the cervix. Gives away vaginal branches(rr. vaginales), pipe branch(r. tubarius) and ovarian branch(r. ovaricus), which in the mesentery of the ovary anastomoses with the branches of the ovarian artery (from the abdominal part of the aorta).
4. The middle rectal artery (a. rectalis media) goes to the lateral wall of the ampulla of the rectum, to the muscle that lifts the anus; gives off branches to the seminal vesicles and prostate in men and to the vagina in women. Anatomizes with branches of the superior and inferior rectal arteries.
5. The internal pudendal artery (a. pudenda interna) exits the pelvic cavity through the piriform opening, and then through the small sciatic foramen follows into the ischiorectal fossa, where it is adjacent to the inner surface of the obturator internus muscle. In the ischiorectal fossa gives inferior rectal artery(a. rectalis inferior), and then divided into perineal artery(a. perinealis) and glad of other vessels. For men it is urethral artery(a. urethralis), artery of the bulb of the penis(a. bulbi penis), deep and dorsal arteries of the penis(aa. profunda et dorsalis penis). Among women - urethral artery(a. urethralis), bulb artery of vestibule[vagina] (bulbi vestibuli), deep and dorsal clitoral artery(aa. profunda et dorsalis clitoridis).

The external iliac artery (a. iliaca externa) serves as a continuation of the common iliac artery. Through the vascular lacuna, it goes to the thigh, where it receives the name of the femoral artery. The following branches depart from the external iliac artery.

1. The lower epigastric artery (a. epigastrica inferior) rises along the back side of the anterior abdominal wall retroperitoneally to the rectus abdominis muscle. From the initial section of this artery departs pubic branch(r. pubicus) to the pubic bone and its periosteum. A thin obturator branch (r. obturatorius) is separated from the pubic branch, anastomosing with the pubic branch from the obturator artery, and the cremaster artery (a. cremasterica - in men). The cremasteric artery departs from the inferior epigastric artery at the deep inguinal ring, supplies blood to the membranes of the spermatic cord and testicle, as well as the muscle that lifts the testicle. In women, this artery is similar to the artery of the round ligament of the uterus (a. lig. teretis uteri), which, as part of this ligament, reaches the skin of the external genital organs.
2. The deep artery that surrounds the ilium (a. circumflexa iliaca profunda) goes along the iliac crest posteriorly, gives branches to the abdominal muscles and nearby pelvic muscles; anastomoses with branches of the iliac-lumbar artery.

The iliac artery is a rather large paired blood channel, which is formed as a result of the bifurcation of the abdominal aorta..

After division, the main artery of the human body passes into the iliac. The length of the latter is from 5 to 7 cm, and the diameter varies between 11-12.5 mm.

The common artery, reaching the level of the sacroiliac joint, gives two large branches - internal and external. They diverge and go down, settling outwards and at an angle.

internal iliac artery

It descends to the large psoas muscle, namely to its medial edge, and then lies down, penetrating into the small pelvis. In the area of ​​the sciatic foramen, the artery divides into the posterior and anterior trunk. The latter are responsible for the blood supply to the tissues of the walls and organs of the small pelvis.

The internal iliac artery has the following branches:

• ilio-lumbar;
• umbilical;
• upper, lower gluteal;
• middle rectal;
• lower bladder;
• internal genital;
• obturator;
• uterine.

In addition to the listed branches, this artery also gives parietal and visceral branches.

This vessel, like the internal one, provides blood supply to the pelvic cavity, and also nourishes the penis, testicular membranes, thigh, and bladder. Reaching the region of the lower extremities, the artery passes into the femoral. Throughout its length, it gives the following branches:

Vascular pathologies

The iliac artery is the second largest after the aorta itself. For this reason, the vessel is quite vulnerable to various pathologies. When it is damaged, there is a serious danger to human life and health.

The most common vascular disease of the iliac artery is atherosclerosis and aneurysm. In the case of the development of the first, cholesterol plaques accumulate on the walls, which cause a narrowing of the lumen and a deterioration in blood flow in the vessel. Atherosclerosis needs mandatory and timely treatment, as it can lead to occlusion - a complete blockage of the artery. This complication occurs due to an increase in the size of body fat, adherence of blood cells and epithelium, as well as other substances, to them.

The formation of plaques in the iliac artery provokes the development of stenosis - narrowing, against which tissue hypoxia occurs and metabolism is disturbed.

Due to oxygen starvation, acidosis occurs, associated with the accumulation of under-oxidized metabolic products. The blood becomes more viscous and blood clots begin to form.

Occlusion of the iliac artery occurs not only against the background of stenosis, but also due to other diseases. Pathologies such as thromboangiitis obliterans, fibromuscular dysplasia, aortoarteritis, embolism predispose to blockage of the vessel lumen. Injury to the walls of the artery during surgery or injury can also lead to occlusion.

Aneurysm is considered a rarer disease than atherosclerosis, but in most cases is its consequence.

Pathological protrusion is formed mainly on the walls of large vessels, which are already weakened by cholesterol plaques or other factors. Predisposes to aneurysm and hypertension.

Pathology may not manifest itself for a long time, but as it grows, the protrusion begins to put pressure on the surrounding organs and impair blood flow. In addition, there is a risk of rupture of the aneurysmal sac with subsequent bleeding.

If the patient is diagnosed with iliac artery occlusion, then to restore blood flow in it, medical or surgical correction is required. Conservative therapy for blockage of the vessel involves the use of painkillers, drugs to reduce blood clotting and antispasmodics. Measures are also taken to expand the collaterals.

If conservative methods do not give the expected result, then patients are prescribed a surgical correction aimed at removing the formed plaques and excising the affected area of ​​the artery, as well as replacing it with a graft.

With an aneurysm, surgery is also performed, which is necessary to prevent the development of thrombosis and rupture of the protrusion or to eliminate its consequences.

The abdominal aorta under the 5th lumbar vertebra gives off the right and left external iliac arteries, which are the main highways for the free sections of the pelvic limbs, then under the 6th lumbar vertebra - the right and left internal iliac arteries for the walls and organs of the pelvic cavity and the last pair of lumbar arteries . Further, the abdominal aorta passes into the middle sacral artery, and the latter - into the caudal artery.

internal iliac artery- a.iliaca interna - goes caudally in the pelvic cavity and ends at the exit from the latter in the region of the lesser sciatic notch caudal gluteal artery branching in the muscles of the posterior femoral group. On its way, it gives off parietal branches to the walls of the pelvis and visceral branches to the organs of the pelvic cavity. Parietal branches include:

iliac-lumbar artery

crnial gluteal artery;

obturator artery or obturator branches

caudal gluteal artery.

The visceral branches include:

internal pudendal artery;

umbilical artery;

caudal cystic artery and caudal uterine artery;

rectal arteries.

All visceral branches depart from the internal pudendal artery. Internal pudendal artery- a.pudenda interna - very large, so there are two highways in the pelvic cavity: the lateral for the walls of the pelvis - the internal iliac artery and for the internal organs - the internal pudendal artery.

Parietal branches of the internal iliac artery:

iliopsoas artery- a.iliolumbalis - is the first branch, runs along the medial (pelvic) surface of the ilium to its lateral edge near the maklok and nourishes the lumbar and gluteal muscles and the tensor fascia of the thigh.

Cranial gluteal artery- a.glutaea cranialis - is the second branch, branches off at the level of the dorsal edge of the iliac wing and through the large sciatic notch, along with the nerve of the same name, goes to the gluteal muscles.

Obturator branches- rami obturatorii - obturators go to the muscles.

Caudal gluteal artery- a.glutaea caudalis - in the region of the lesser sciatic notch, it goes along with the nerve of the same name to the biceps femoris muscle. It is the terminal branch of the internal iliac artery.

Visceral branches of the internal iliac artery:

Internal pudendal artery- a.pudenda interna - is a common trunk for all visceral arteries, goes to the sciatic arch, where it goes along with the pudendal nerve and is divided into the artery of the perineum and the artery of the clitoris.

umbilical artery- a.umbilicalis - very powerful only in the fetus, as it carries blood to the placenta. After the birth of the animal, it becomes empty and for the most part turns into a lateral cystic ligament and a round uterine ligament. Only in its proximal segment does it retain a slight lumen. The umbilical artery gives off thin arteries: a) the artery of the ureter - a.ureterica; b) cranial cystic artery - a.vesicalis cranialis - for the bladder c) caudal cystic artery - a.vesicalis caudalis - for the bladder d) caudal uterine artery - a.uterina caudalis; (caudal cystic and caudal uterine arteries depart as a common trunk) e) middle uterine artery a.uterina media.

Caudal rectal artery- a.rectalis caudalis - branches in the rectum.

perineal artery- a.perinealis - for the anus, vulva and perineum.

The artery of the clitoris - a.clitoridis - is a continuation of the internal pudendal artery.

A. Iliaca communis

(steam room, formed during the bifurcation of the abdominal part of the aorta).

1) Internal iliac artery.

At the level of the sacroiliac joint is divided: 2) External iliac artery.

I. Parietal branches

1) Internal iliac artery. 1) The iliac-lumbar artery.

(a. Iliaca Interna) 2) Lateral sacral artery.

· On the medial edge of the large 3) Obturator artery.

lumbar muscle down into the cavity 4) Inferior annual artery.

small pelvis. 5) Superior gluteal artery.

At the top edge of the large

The sciatic foramen is divided into II. Visceral branches

posterior + anterior trunks supplying blood 1) Umbilical artery.

walls and organs of the small pelvis. 2) Artery of the vas deferens.

3) Uterine artery.

4) Middle rectal artery.

5) Internal genital artery.

2) External iliac artery. 1) Inferior epigastric artery.

(a. Iliaca Externa) 2) Deep artery, envelope

Goes to the thigh = femoral artery. iliac bone.

1) Internal iliac artery:

I. Parietal branches of the internal iliac artery:

1) A. Iliolumbalis:

Lumbar branch (r. Lumbalis) - to the large lumbar muscle and the square muscle of the lower back. The spinal branch (r. spinalis) departs from it in the sacral region.

Iliac branch (r. Iliacus) - supplies blood to the bone and the muscle of the same name (!).

2) AA. Sacrales laterales (upper and lower) - to the bones and muscles of the sacral region. Them Spinal branches (rr. Spinales) go to the membranes of the spinal cord.

3) A. Glutealis superior exits the pelvis through the suprapiriform opening, divides:

Superficial branch (r. superficialis) - to the gluteal muscles, skin.

Deep branch (r. profundus) - on the Upper and Lower branches (rr. superior et inferior), which supply blood to the gluteal (mainly middle and small) and neighboring muscles. The lower one is the hip joint. Upper (!)

4) A. Glutealisinferior - together with the internal pudendal artery, the sciatic nerve through the subpiriform opening to the gluteus maximus muscle. Gives away Artery accompanying the sciatic nerve (a. Comitans nervi ichiadici).

5) A. Obturatoria - on the thigh is divided:

Anterior branch (r. anterior) - external obturator, adductor muscles of the thigh, skin of the external genital organs.

Posterior branch (r. posterior) - external obturator muscle, gives Acetabular branch (r. acetabulares) - to the hip joint (acetabulum + femoral head).

Pubic branch (r. pubis) (!)

II. Visceral (visceral) branches of the internal iliac artery:

1) A. Lumbalicalis - functions only in the embryo. In an adult:

Superior vesical arteries (aa. vesicales superiores) - give Ureteric branches (rr. Ureterici) - to the lower part of the ureter.

Artery of the vas deferens (a. vesicalis inferior)

2) A. Vesicalis inferior - in men, branches to the seminal vesicles, prostate gland, in women to the vagina.

3) A. Uterina - descends into the pelvic cavity:

Vaginal branches (rr. vaginales)

Pipe branch (r. tubarius)

Ovarian branch (r. ovaricus) (!)

4) A. Rectalis media - to the lateral wall of the ampulla of the rectum, the muscle that makes the anus related. In men, branches to the seminal vesicles, the prostate gland, in women to the vagina.

5) A. Pudenda interna - adjacent to the internal obturator muscle. In the ischiorectal fossa gives:

Lower rectal artery (a. rectalis inferior)

Perineal artery (a. perinealis)

For men:

The artery of the bulb of the penis (a. Bulbi penis).

Deep and dorsal arteries

penis (aa. Profunda et dorsalis penis).

Among women:

Urethral artery (a. Urethralis).

The artery of the bulb of the vagina (a. Bulbi vaginae).

Deep and dorsal arteries of the clitoris (aa. Profunda et dorsalis

2) External iliac artery:

1) A. Epigastrica inferior - to the rectus abdominis muscle:

Pubic branch (r. pubicus) - to the pubic bone and periosteum. Gives the obturator branch (r. Obturatorius) (!) And also

For men:

Cremaster artery (a. Cremaster) -

blood supply to the membranes of the spermatic cord and testis,

muscle that lifts the testicle.

Among women:

The artery of the round ligament of the uterus (a. Lig. Teretis uteri) - as part of this ligament to the skin of the external genitalia.

2) A. Circumflexa Iliaca profunda - along the iliac crest posteriorly, branches to the abdominal muscles and nearby pelvic muscles. (!)