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The umbilical artery is a branch. Terminal branches of the abdominal aorta

Doctors of obstetrics-gynecology, urology and general surgical specialties cannot imagine their work without knowledge of the topographic anatomy of the common iliac artery system. After all, most pathological conditions and cases of surgical treatment on the pelvic organs and perineal area are accompanied by blood loss, so it is necessary to have information about which vessel the bleeding is coming from in order to successfully stop it.

General information

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

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

External iliac artery

The vessel is directed downward and forward along the medial edge of the psoas muscle of the doguinal ligament. When it exits the thigh, it becomes the femoral artery. In addition, a.iliaca externa gives off two large vessels that arise near the inguinal ligament itself. These vessels are the following.

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

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

The deep artery circumflexing the ilium (a.circumflexa ilium profunda) goes to the iliac crest posteriorly and parallel to the inguinal ligament. This vessel supplies the iliacus 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 greater sciatic foramen. At this level, a division occurs into 2 trunks - the posterior one, which gives rise to the parietal arteries (except for the a.sacralis lateralis), and the anterior one, which gives rise to the remaining branches of the 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 designed to supply blood primarily to muscles, as well as other anatomical formations involved in the structure of the walls of the pelvic cavity:

1. The iliopsoas artery (a.iliolumbalis) enters the iliac fossa, where the a.circumflexa ilium profunda connects. The vessel supplies arterial blood to the muscle of the same name.
2. The lateral sacral artery (a.sacralis lateralis) supplies blood to the piriformis muscle (m.piriformis), the levator ani muscle (m.levator ani), and the nerves of the sacral plexus.
3. The superior gluteal artery (a.glutea superior) leaves the pelvic cavity through the supragiriform foramen and goes to the gluteal muscles, accompanying the nerve and vein of the same name.
4. The inferior gluteal artery (a.glutea inferior) leaves the pelvic cavity through the infrapiriform foramen together with the a.pudenda interna and the sciatic nerve, to which it 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. The obturator artery (a.obturatoria) goes to the obturator foramen. Upon exiting the obturator canal, it supplies the obturator externus muscle and the adductor muscles of the thigh. A.obturatoria gives off a branch to the acetabulum (ramus acetabulis). Through the notch of the latter (incisura acetabuli), this branch penetrates the hip joint, supplying blood to the head of the hip bone and the ligament of the same name (lig.capitis femoris).

Visceral branches

Visceral vessels are designed to supply blood to the pelvic organs and perineal area:

1. The umbilical artery (a.umbilicalis) retains lumen in an adult only for a short distance - from the beginning to the place where the superior vesical artery departs from it; the rest of its trunk is obliterated and turns into the middle umbilical fold (plica umbilicale mediale).
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), to which it also gives branches, supplying blood to the latter.
3. The superior vesical artery (a.vesicalis superior) arises from the remaining part of the umbilical artery, supplying blood to the upper part of the bladder. The inferior cystic artery (a.vesicalis inferior), starting directly from the a.iliaca interna, supplies the bottom of the bladder and the ureter with arterial blood, and also gives off branches to the vagina, seminal vesicles and prostate gland.
4. The middle rectal artery (a.rectalis media) arises from a.iliaca interna or from a.vesicalis inferior. The vessel also connects with a.rectalis superior and a.rectalis inferior, supplying blood to the middle third of the rectum, and gives off branches to the bladder, ureter, vagina, seminal vesicles and prostate gland.
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 leaves of the broad ligament of the uterus, gives off the vaginal artery (a.vaginalis). The a.uterina itself turns upward and is directed along the line of attachment of the broad ligament to the uterus. Branches extend from the vessel to the ovary and fallopian tube.
6. The ureteral branches (rami ureterici) deliver arterial blood to the ureters.
7. The internal pudendal artery (a.pudenda interna) in the pelvis gives off small branches to nearby muscles and the sacral nerve plexus. Mainly supplies blood to the organs located below the pelvic diaphragm and the perineal area. The vessel leaves the pelvic cavity through the infrapiriform foramen and then, rounding the ischial spine (spina ischiadicus), reenters the pelvic cavity through the lesser 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 of a conditional nature and is the most common in humans. It is necessary to remember about the possible individual characteristics of the origin of certain vessels.

Internal iliac artery, a. iliaca interna, departs from the common iliac artery and goes down into the pelvic cavity, located along the line of the sacroiliac joint. At the level of the upper edge of the greater sciatic foramen, it is divided into anterior and posterior trunks. The branches extending from these trunks are directed to the walls and organs of the small pelvis and are therefore divided into visceral and parietal.

Internal branches

1. Umbilical artery, a. umbilicalis, in the embryonic period - one of the largest branches of the internal iliac artery. It departs from the anterior trunk of the latter and, moving forward along the side wall of the pelvis, exits onto the side wall of the bladder, and then under the peritoneum it goes along the posterior surface of the anterior wall of the abdominal cavity up to the navel area. Here, together with the vessel of the same name on the opposite side, the umbilical artery is part of the umbilical cord. After birth, the lumen of the vessel closes over a significant extent (obliterated part, pars occlusa), and the artery turns into the medial umbilical ligament. The initial section of the vessel remains passable - this is the open part, pars patens, and functions throughout life. The following arteries depart from it:

a) superior vesical arteries, aa. vesicales superiores, 2 - 4 in total, arise from the initial section of the umbilical artery. They go to the upper parts of the bladder and supply blood to the top of it;

b) artery of the vas deferens, a. ductus deferentis, goes forward and, having reached the vas deferens, divides into two branches that follow along the duct. One of them, together with the duct, becomes part of the spermatic cord, anastomosing with a. testicularis. Together with the spermatic cord, it passes through the inguinal canal and reaches the epididymis. The other branch goes along with the vas deferens to the seminal vesicles. The ureteral branches depart from it in this area, rr. ureterici, to the pelvic part of the ureter.

2. Inferior vesical artery, a. vesicalis inferior, departs from the internal iliac artery and, approaching the bottom of the bladder, anastomoses with the branches of the superior vesical artery. Gives off prostatic branches, rr. prostatici, and in women - non-permanent branches to the vagina.

3. Uterine artery, a. uterina (corresponds to the artery of the vas deferens in men), departs from the anterior trunk of the internal iliac artery and, located under the peritoneum, goes forward and medially at the base of the broad ligament, reaching the lateral wall of the uterus at the level of its cervix; along the way it crosses the deeper ureter. Approaching the wall of the uterus, it gives off descending vaginal branches, rr. vaginales, which run along the anterolateral wall of the vagina, giving it branches that anastomose with the same branches of the opposite side. The uterine artery ascends along the lateral wall of the uterus to the corresponding uterine horn, where it sends helical branches, rr. helicini. The artery anastomoses with the ovarian artery (a branch of the abdominal aorta) and gives off tubal branches, rr. tubarii, to the fallopian tube and ovarian branches, rr. ovarici, to the ovary.

4. Middle rectal artery, a. rectalis media, - a small vessel, sometimes absent. It starts from the anterior trunk of the internal iliac artery, usually independently, but sometimes from the inferior vesical artery or internal pudendal artery, a. pudenda interna; supplies blood to the middle part of the rectum. A series of small branches branch off from the artery to the prostate gland and seminal vesicles. In the wall of the rectum, the artery anastomoses with the superior (branch of the inferior mesenteric artery) and inferior rectal arteries, a. rectalis superior et a. rectalis inferior.

5. Internal pudendal artery. a. pudenda interna, arises from the anterior trunk of the internal iliac artery, goes down and outward and leaves the pelvis through the infrapiriform foramen. Then it goes around the ischial spine and, heading medially and forward, again enters the pelvic cavity through the small sciatic foramen, already below the pelvic diaphragm, ending up in the ischial-anal fossa. Following the lateral wall of this fossa, the internal pudendal artery reaches the posterior edge of the urogenital diaphragm. Heading anteriorly along the lower branch of the pubic bone, at the edge of the superficial transverse perineal muscle, the artery pierces the urogenital diaphragm from the depths to the surface and divides into a number of terminal branches:

a) dorsal artery of the penis (clitoris), a. dorsalis penis (clitoridis), is essentially a continuation of a. Pudenda interna. Together with the artery of the same name on the opposite side, it passes along the sling-shaped ligament of the penis, on the sides of the deep dorsal vein of the penis, v. dorsalis penis profunda, up to its head, giving branches to the scrotum and cavernous bodies;

b) artery of the bulb of the penis, a. bulbi penis, [in women - the artery of the bulb of the vestibule (vagina), a. bulbi vestibuli (vaginae)], supplies blood to the bulb of the penis, bulbospongiosus muscle, mucous membrane of the posterior urethra and bulbourethral glands;

c) urethral artery, a. urethralis, enters the spongy body of the urethra and follows it to the head of the penis, where it anastomoses with a. profunda penis. In women it ends with two branches: to the urethra and to the bulb of the vestibule;

d) deep artery of the penis (clitoris), a. profunda penis (clitoridis), pierces the tunica albuginea at the base of the cavernous body of the penis and goes to the head. The branches of this artery anastomose with the arteries of the same name on the opposite side;

e) inferior rectal artery, a. rectalis inferior, originates in the ischial-anal fossa at the level of the ischial tuberosity and goes medially to the lower rectum and anus; supplies the skin and fatty tissue of this area, as well as the levator ani muscle and the anal sphincter. In the thickness of the intestinal wall, its branches anastomose with the branches of the middle rectal artery;

f) perineal artery, a. perinealis, arises from the internal pudendal artery, somewhat distal to the previous one, and is most often located behind the superficial transverse perineal muscle, giving off small posterior scrotal branches, rr. scrotales posteriores, to the posterior sections of the scrotum, the muscles of the perineum and the posterior portion of the scrotal septum (in women - the posterior labial branches, rr. labiales posteriores, to the posterior portions of the labia majora).

Parietal branches.

1. Iliopsoas artery, a. iliolumbalis, originates from the posterior trunk of a. Iliaca interna, directed upward and posteriorly, passes under the psoas major muscle and at its inner edge is divided into the lumbar and iliac branches:

a) lumbar branch, r. lumbalis, corresponds to the dorsal branch of the lumbar arteries. It goes posteriorly, gives off a spinal branch to the spinal cord, r. spinalis; supplies blood to the psoas major and minor muscles, the quadratus lumborum muscle, and the posterior sections of the transverse abdominis muscle;

b) iliac branch, r. iliacus, is divided into two branches - superficial and deep.

The superficial branch runs along the iliac crest and anastomoses with a. circumflexa ilium profunda, forms an arch from which branches extend, supplying the iliacus muscle and the lower sections of the muscles of the anterior abdominal wall.

The deep branch gives off branches to the ilium, anastomosing with a. obturatoria.

2. Lateral sacral artery, a. sacralis lateralis, heading to the medial side, descends along the anterior surface of the sacrum medially from the pelvic openings, while it gives off medial and lateral branches.

The medial branches, 5-6 in total, anastomose with the branches of the median sacral artery, forming a network.

The lateral branches penetrate through the pelvic sacral foramina into the sacral canal, giving off spinal branches here, rr. spinales, and, emerging through the dorsal sacral foramina, supply blood to the sacrum, the skin of the sacral region and the lower parts of the deep muscles of the back, as well as the sacroiliac joint, the piriformis, coccygeus muscles and the levator ani muscle.

3. Superior gluteal artery, a. glutea superior, is the most powerful branch of the internal iliac artery. Being a continuation of the posterior trunk, it leaves the pelvic cavity through the supragiriform foramen back to the gluteal region, giving branches along the way to the piriformis, internal obturator muscles and the levator ani muscle. Coming out of the pelvic cavity, the artery divides into two branches - superficial and deep:

a) superficial branch, r. superficialis, located between the gluteus maximus and gluteus medius muscles and supplies them with blood;

b) deep branch, r. profundus, divided into upper and lower branches, rr. superior et inferior. Lying between the gluteus medius and minimus muscles, it supplies them with blood and the tensor fascia lata muscle, giving off a number of branches to the hip joint, anastomoses with a. glutea inferior and a. circumflexa femoris lateralis.

4. Inferior gluteal artery, a. glutea inferior, in the form of a rather large branch, departs from the anterior trunk of the internal iliac artery, descends along the anterior surface of the piriformis muscle and the sacral plexus and exits the pelvic cavity through the infrapiriform foramen along with the internal pudendal artery.

The inferior gluteal artery supplies blood to the gluteus maximus muscle, sends the artery accompanying the sciatic nerve, a. comitans n. ischiadici, and gives off a number of branches to the hip joint and skin of the gluteal region, anastomosing with a. circumflexa femoris medialis, posterior branch of the obturator artery, a. abturatoria, and with a. glutea superior.

5. Obturator artery, a. obturatoria, departs from the anterior trunk of the internal iliac artery, runs along the lateral surface of the small pelvis, parallel to the arcuate line, forward to the obturator foramen and leaves the pelvic cavity through the obturator canal.

Options are described when a. obturatoria departs from a. epigastrica inferior or from a. iliaca externa.

Before entering the obturator canal, the obturator artery gives off a pubic branch, and in the canal itself it is divided into its terminal branches - anterior and posterior:

a) pubic branch, r. pubicus, rises along the posterior surface of the superior branch of the pubic bone and, having reached the pubic fusion, anastomoses with the pubic branch of the inferior epigastric artery;

b) anterior branch, r. anterior, goes down the external obturator muscle, supplies it and the upper sections of the adductor muscles of the thigh;

c) posterior branch, r. posterior, directed posteriorly and downward along the outer surface of the obturator membrane and supplies blood to the external and internal obturator muscles, the ischium and sends the acetabular branch, r, to the hip joint. acetabularis. The latter enters the cavity of the hip joint through the notch of the acetabulum and reaches the head of the femur along the ligament of the femoral head.

The abdominal aorta at the level of the IV lumbar vertebra is divided into two common iliac arteries (aa. iliacae communes) with a diameter of 11 - 12 mm and a length of 7 cm, each following along the medial edge of m. psoas major. At the level of the upper edge of the sacroiliac joint, these arteries are divided into internal (a. iliaca interna) and external (a. iliaca externa) iliac arteries (Fig. 408).

Internal iliac artery

The internal iliac artery (a. iliaca interna) is a pair, 2 - 5 cm long, located on the lateral wall of the pelvic cavity. At the upper edge of the greater sciatic foramen, it divides into parietal and visceral branches (Fig. 408).

408. Pelvic arteries.
1 - aorta abdominalis; 2 - a. iliaca communis sinistra; 3 - a. iliaca communis dextra; 4 - a. iliaca interna; 5 - a. iliolumbalis; 6 - a. sacralis lateralis; 7 - a. glutea superior; 8 - a. glutea inferior; 9 - a. prostatica; 10 - a. rectalis media; 11 - a. vesicae urinariae; 12 - a. dorsalis penis; 13 - ductus deferens; 14 - a. deferentialis; 15 - a. obturatoria; 16 - a. umbilicalis; 17 - a. epigastrica inferior; 18 - a. circumflexa ilium profunda.

Parietal branches of the internal iliac artery: 1. Iliopsoas artery (a. iliolumbalis) branches from the initial part of the internal iliac artery or from the superior gluteal, passes behind n. obturatorius, a. iliaca communis, at the medial edge of m. psoas major is divided into lumbar and iliac branches. The first vascularizes the psoas muscles, spine and spinal cord, the second - the ilium and iliacus muscle.

2. The lateral sacral artery (a. sacralis lateralis) (sometimes 2 - 3 arteries) branches from the posterior surface of the internal iliac artery near the third anterior sacral foramen, then, descending along the pelvic surface of the sacrum, gives branches to the membranes of the spinal cord and pelvic muscles.

3. The superior gluteal artery (a. glutea superior) is the largest branch of the internal iliac artery, penetrates from the pelvic cavity into the gluteal region through the for. suprapiriforme.

On the posterior surface of the pelvis it is divided into a superficial branch for blood supply to the gluteus maximus and medius muscles and a deep branch for the gluteus minimus and medius muscles, the capsule of the hip joint. Anastomoses with the inferior gluteal, obturator and branches of the deep femoral artery.

4. The inferior gluteal artery (a. glutea inferior) exits to the posterior surface of the pelvis through the for. infrapiriforme together with the internal pudendal artery and the sciatic nerve. Supplies blood to the gluteus maximus and quadratus femoris muscles, the sciatic nerve and the skin of the gluteal region. All parietal branches of the internal iliac artery anastomose with each other.

5. The obturator artery (a. obturatoria) is separated from the initial part of the internal iliac artery or from the superior gluteal and through the obturator canal enters the medial part of the thigh between m. pectineus and m. obturatorius internus. Before the obturator artery enters the canal, it is located on the medial side of the femoral fossa. On the thigh, the artery is divided into three branches: internal - for blood supply to the obturator internus muscle, anterior - for blood supply to the obturator externus muscle and the skin of the genital organs, posterior - for blood supply to the ischium and head of the femur. Before entering the obturator canal, the pubic branch (r. pubicus) is separated from the obturator artery, which at the symphysis connects with the branch a. epigastrica inferior. The obturator artery anastomoses with the inferior gluteal and inferior epigastric arteries.

Visceral branches of the internal iliac artery: 1. The umbilical artery (a. umbilicalis) is located under the parietal peritoneum on the sides of the bladder. In fetuses, it then penetrates the umbilical cord through the umbilical opening and reaches the placenta. After birth, part of the artery from the navel is obliterated. From its initial section, the superior cystic artery (a. vesicalis superior) departs to the apex of the bladder, which supplies blood not only to the bladder, but also to the ureter.

2. The inferior vesical artery (a. vesicalis inferior) goes down and forward, enters the wall of the bottom of the bladder. It also vascularizes the prostate gland, seminal vesicles, and in women, the vagina.

3. The artery of the vas deferens (a. ductus defferentis) sometimes arises from the umbilical or superior or inferior cystic arteries. Along the course of the vas deferens it reaches the testicle. Anastomoses with the internal spermatic artery.

4. The uterine artery (a. uterina) is located under the parietal peritoneum on the inner surface of the small pelvis and penetrates the base of the broad uterine ligament. At the cervix, it gives off a branch to the upper part of the vagina, rises up and on the lateral surface of the cervix and body of the uterus gives off corkscrew-shaped branches into the thickness of the uterus. At the angle of the uterus, the terminal branch accompanies the fallopian tube and ends at the hilum of the ovary, where it anastomoses with the ovarian artery. The uterine artery crosses the ureter twice: once on the side wall of the pelvis near the iliosacral joint, and again in the broad ligament of the uterus near the uterine cervix.

5. The middle rectal artery (a. rectalis media) goes forward along the pelvic floor and reaches the middle part of the rectum. Supplies blood to the rectum, m. levator ani and external sphincter of the rectum, seminal vesicles and prostate gland, in women - the vagina and urethra. Anastomoses with the superior and inferior rectal arteries.

6. The internal pudendal artery (a. pudenda interna) is the terminal branch of the visceral trunk of the internal iliac artery. Via for. infrapiriforme exits onto the posterior surface of the pelvis, through for. ischiadicum minus penetrates the fossa ischiorectalis, where it gives off branches to the muscles of the perineum, rectum and external genitalia. It is divided into branches:
a) perineal artery (a. perinealis), which supplies blood to the muscles of the perineum, scrotum or labia majora;
b) artery of the penis (a. penis) at the junction of the right and left mm. transversi perinei superficiales penetrates under the symphysis and divides into the dorsal and deep arteries. The deep artery supplies blood to the cavernous bodies. In women, the deep artery is called a. clitoridis. The dorsal artery is located under the skin of the penis and supplies blood to the scrotum, skin and head of the penis;
c) the arteries of the urethra supply blood to the urethra;
d) the vestibular bulbous artery supplies blood to the vagina and spongy tissue of the bulb of the vestibule of the vagina.

The iliac arteries are one of the largest vessels in the body. They are paired vessels up to 7 cm long and up to 13 mm in diameter. The beginning of the arteries is located in the area of the 4th lumbar vertebra and is a continuation of the abdominal aorta (its bifurcation).

Where the articulation of the sacrum and iliac bones is located, these vessels are divided into the external and internal iliac arteries.

Common iliac artery

It should be lateral and down to the pelvis.

In the area of the iliosacral joint, the common iliac artery is divided into internal and external arteries of the same name, which travel to the thigh and small pelvis.

A. iliaca interna

The internal iliac artery (2) supplies the organs and walls of the pelvis. It descends along the inside of the psoas (major) muscle.

In the area of the upper part of the sciatic foramen, the parietal and visceral arteries branch off from the vessel.

Parietal branches

Lusoiliac branch (3). It follows laterally and posteriorly the psoas major muscle, giving branches to the iliacus muscle and the bone of the same name, as well as to the quadratus and psoas major muscles. In addition, they supply blood to the membranes and nerves of the spinal cord.
Sacral lateral arteries (4). They nourish the deep muscles of the back, the sacrum, the spinal cord (nerve roots and membranes), the ligaments of the coccyx and sacrum, the piriformis muscle, the muscle that lifts the anus.
Obturator artery (6). It should be in front on the sides of the small pelvis. The branches of this vessel are: the pubic, anterior, posterior arteries that supply the skin of the genital organs, the obturator and adductor muscles of the thigh, the hip joint, the femur (its head), the pubic symphysis, the iliac bone, gracilis, pectineus, lumboiliac, quadratus muscles, obturator (external, internal) muscles and the muscle that raises the anus.
Gluteal inferior artery (7). It exits the small pelvis through the infrapiriform opening. Nourishes the skin in the gluteal region, hip joint, quadratus, semimembranosus, gluteus maximus, piriformis, semitendinosus, adductor (major) muscles, gemellus (inferior, superior), obturator (internal, external) muscles and biceps femoris (its long head).
Gluteal superior artery (5). It follows laterally and through the supragiriform foramen passes to the muscles and skin of the gluteal region in the form of deep and superficial branches. These vessels nourish the small and medium gluteal muscles, the hip joint, and the skin of the buttocks.

Visceral branches

Umbilical artery (13, 14). It runs along the back surface of the abdominal wall, rising to the navel. In the antenatal period, this vessel functions fully. After birth, the main part of it is abandoned and becomes the umbilical ligament. However, a small part of the vessel still functions and gives off the superior vesical arteries and the artery of the vas deferens, feeding the walls of the latter, as well as the bladder and the walls of the ureter.
Uterine artery. It follows between the leaves of the broad uterine ligament to the uterus, crossing the ureter along the way and giving off tubal, ovarian and vaginal branches. R. tubarius feeds the fallopian tubes, r. ovaricus through the thickness of the mesentery approaches the ovary and forms an anastomosis with the branches of the ovarian artery. Rr. vaginales follow down to the vaginal walls (lateral).
Rectal (middle) artery (9). It follows the rectum (the lateral wall of its ampulla), feeding the muscle that elevates the anus, ureter, lower and middle rectal sections, in women - the vagina, and in men - the prostate and seminal vesicles.
The pudendal (internal) artery (10) is the terminal branch of the internal iliac artery. The vessel emerges, accompanied by the gluteal inferior artery, through the infrapiriform foramen, bending around the sciatic spine, and again penetrates into the small pelvis (in the area of the rectal-sciatic fossa) through the sciatic (small) foramen. In this fossa, the artery gives off the rectal inferior artery (11), and then branches into: the dorsal artery of the penis (clitoris), the perineal artery, the urethral artery, the deep artery of the clitoris (penis), a vessel that feeds the bulb of the penis and an artery that feeds the bulb of the vestibule of the vagina. All of the above arteries supply the corresponding organs (obturator internal muscle, lower part of the rectum, external genital organs, urethra, bulbourethral glands, vagina, muscles and skin of the perineum).

A.Iliaca externa

The external iliac artery begins in the area of the iliosacral joint and is a continuation of the common iliac artery.

The iliac artery (marked with an arrow) follows downwards and anteriorly along the inner surface of the psoas major muscle to the inguinal ligament, passing under which through the vascular lacuna, it turns into the femoral artery. The branches that give off the external iliac artery nourish the labia and pubis, the scrotum, the iliacus muscle and the abdominal muscles.

Branches of the external iliac artery

Occlusion of the iliac arteries

The reasons for the development of occlusion/stenosis of these arteries are the presence of aortoarteritis, thromboangiitis obliterans, muscular fibrous dysplasia and atherosclerosis.

The occurrence of this pathology leads to tissue hypoxia and disorders of tissue metabolism, and, as a consequence, to the development of metabolic acidosis and the accumulation of metabolic under-oxidized products. The properties of platelets change, as a result of which blood viscosity increases and multiple blood clots form.

There are several types of occlusion (according to etiology):

Post-traumatic.
Post-embolic.
Iatrogenic.
Aortitis is nonspecific.
Mixed forms of atherosclerosis, aortitis and arteritis.

In accordance with the nature of damage to the iliac arteries, the following are distinguished:

Chronic process.
Stenosis.
Acute thrombosis.

This pathology is characterized by several syndromes:

Occlusion therapy is carried out using both conservative and surgical methods.

Conservative treatment is aimed at optimizing blood clotting, eliminating pain and vasospasm. For this, ganglion blockers, antispasmodics, and so on are prescribed.

In case of severe lameness, pain at rest, tissue necrosis, embolism, surgical operations are used. In this case, the damaged part of the iliac artery is removed, surgery to remove plaques, sympathectomy, or a combination of various techniques.

Aneurysms of the iliac arteries

At first it is asymptomatic, and only after a significant increase does it begin to manifest itself clinically.

An aneurysm is a sac-like protrusion of the vascular wall, as a result of which the elasticity of the tissue is significantly reduced and replaced by connective tissue growths.

May become: atherosclerosis of the iliac arteries, trauma, hypertension.

This pathology is dangerous due to the development of a serious complication - aneurysm rupture, which is accompanied by massive bleeding, decreased blood pressure, heart rate and collapse.

If the blood supply is disrupted in the area of the aneurysm, thrombosis of the vessels of the thigh, leg and pelvis may develop, which is accompanied by dysuria and intense pain.

This pathology is diagnosed using ultrasound, CT or MRI, angiography and duplex scanning.

psoas major. At the level of the upper edge of the sacroiliac joint, these arteries are divided into internal (a. iliaca interna) and external (a. iliaca externa) iliac arteries (Fig. 408).

Internal iliac artery

408. Pelvic arteries.

1 - aorta abdominalis; 2 - a. iliaca communis sinistra; 3 - a. iliaca communis dextra; 4 - a. iliaca interna; 5 - a. iliolumbalis; 6 - a. sacralis lateralis; 7 - a. glutea superior; 8 - a. glutea inferior; 9 - a. prostatica; 10 - a. rectalis media; 11 - a. vesicae urinariae; 12 - a. dorsalis penis; 13 - ductus deferens; 14 - a. deferentialis; 15 - a. obturatoria; 16 - a. umbilicalis; 17 - a. epigastrica inferior; 18 - a. circumflexa ilium profunda.

3. The superior gluteal artery (a. glutea superior) is the largest branch of the internal iliac artery, penetrates from the pelvic cavity into the gluteal region through the for. suprapiriforme.

a) perineal artery (a. perinealis), which supplies blood to the muscles of the perineum, scrotum or labia majora;

b) artery of the penis (a. penis) at the junction of the right and left mm. transversi perinei superficiales penetrates under the symphysis and divides into the dorsal and deep arteries. The deep artery supplies blood to the cavernous bodies. In women, the deep artery is called a. clitoridis. The dorsal artery is located under the skin of the penis and supplies blood to the scrotum, skin and head of the penis;

c) the arteries of the urethra supply blood to the urethra;

d) the vestibular bulbous artery supplies blood to the vagina and spongy tissue of the bulb of the vestibule of the vagina.

Umbilical artery

Umbilical artery, a. umbilicalis (see Fig. 781), in the embryonic period - one of the largest branches of the internal iliac artery. It departs from the anterior trunk of the latter and, moving forward along the side wall of the pelvis, exits onto the side wall of the bladder, and then under the peritoneum it goes along the posterior surface of the anterior wall of the abdominal cavity up to the navel area. Here, together with the vessel of the same name on the opposite side, the umbilical artery is part of the umbilical cord. After birth, the lumen of the vessel closes over a significant extent (obliterated part, pars occlusa), and the artery turns into the medial umbilical ligament. The initial part of the vessel remains passable - this is the open part, pars patens, and functions throughout life. The following arteries depart from it:

superior vesical arteries, aa. vesicales superiores, 2-4 in total, arise from the initial section of the umbilical artery. They go to the upper parts of the bladder and supply blood to the top of it;
artery of the vas deferens, a. ductus deferentis, goes forward and, having reached the vas deferens, divides into two branches that follow along the duct. One of them, together with the duct, becomes part of the spermatic cord, anastomosing with a. testicularis. Together with the spermatic cord, it passes through the inguinal canal and reaches the epididymis. The other branch goes along with the vas deferens to the seminal vesicles. The ureteral branches depart from it in this area, rr. ureterici, to the pelvic part of the ureter.

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umbilical artery

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6. Main artery

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7. Vertebral artery

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Umbilical hernia

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Financial artery

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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

Topographic anatomy of the common iliac artery system

From the aortic bifurcation, the large vessels diverge at an acute angle (the divergence angle is different in men and women and is approximately 60 degrees, respectively) and are directed laterally (that is, to the side of the midline) and down to the sacroiliac joint. At the level of the latter, each OA is divided into two terminal branches: the internal iliac artery (a.iliaca interna), which supplies blood to the walls and pelvic organs, and the external iliac artery (a.iliaca externa), which supplies arterial blood mainly to the lower limb.

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

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

Parietal vessels are designed to supply blood primarily to muscles, as well as other anatomical formations involved in the structure of the walls of the pelvic cavity:

1. The iliopsoas artery (a.iliolumbalis) enters the iliac fossa, where the a.circumflexa ilium profunda connects. The vessel supplies arterial blood to the muscle of the same name.
2. The lateral sacral artery (a.sacralis lateralis) supplies blood to the piriformis muscle (m.piriformis), the levator ani muscle (m.levator ani), and the nerves of the sacral plexus.
3. The superior gluteal artery (a.glutea superior) leaves the pelvic cavity through the supragiriform foramen and goes to the gluteal muscles, accompanying the nerve and vein of the same name.
4. The inferior gluteal artery (a.glutea inferior) leaves the pelvic cavity through the infrapiriform foramen together with the a.pudenda interna and the sciatic nerve, to which it 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. The obturator artery (a.obturatoria) goes to the obturator foramen. Upon exiting the obturator canal, it supplies the obturator externus muscle and the adductor muscles of the thigh. A.obturatoria gives off a branch to the acetabulum (ramus acetabulis). Through the notch of the latter (incisura acetabuli), this branch penetrates the hip joint, supplying blood to the head of the hip bone and the ligament of the same name (lig.capitis femoris).

Visceral vessels are designed to supply blood to the pelvic organs and perineal area:

1. The umbilical artery (a.umbilicalis) retains lumen in an adult only for a short distance - from the beginning to the place where the superior vesical artery departs from it; the rest of its trunk is obliterated and turns into the middle umbilical fold (plica umbilicale mediale).
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), to which it also gives branches, supplying blood to the latter.
3. The superior vesical artery (a.vesicalis superior) arises from the remaining part of the umbilical artery, supplying blood to the upper part of the bladder. The inferior cystic artery (a.vesicalis inferior), starting directly from the a.iliaca interna, supplies the bottom of the bladder and the ureter with arterial blood, and also gives off branches to the vagina, seminal vesicles and prostate gland.
4. The middle rectal artery (a.rectalis media) arises from a.iliaca interna or from a.vesicalis inferior. The vessel also connects with a.rectalis superior and a.rectalis inferior, supplying blood to the middle third of the rectum, and gives off branches to the bladder, ureter, vagina, seminal vesicles and prostate gland.
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 leaves of the broad ligament of the uterus, gives off the vaginal artery (a.vaginalis). The a.uterina itself turns upward and is directed along the line of attachment of the broad ligament to the uterus. Branches extend from the vessel to the ovary and fallopian tube.
6. The ureteral branches (rami ureterici) deliver arterial blood to the ureters.
7. The internal pudendal artery (a.pudenda interna) in the pelvis gives off small branches to nearby muscles and the sacral nerve plexus. Mainly supplies blood to the organs located below the pelvic diaphragm and the perineal area. The vessel leaves the pelvic cavity through the infrapiriform foramen and then, rounding the ischial spine (spina ischiadicus), reenters the pelvic cavity through the lesser 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 of a conditional nature and is the most common in humans. It is necessary to remember about the possible individual characteristics of the origin of certain vessels.

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Umbilical artery anatomy

1. A. umbilicalis, the umbilical artery, retains lumen in an adult only for a short distance - from the beginning to the place where the superior vesical artery departs from it; the rest of its trunk to the umbilicus is obliterated and turns into lig. umbilicale mediale.

2. Rami uretericii - to the ureter (can extend from a. umbilicalis).

3. Ah. vesieales superior et inferior: the superior cystic artery starts from the non-obliterated part of a. umbilicalis and branches in the upper part of the bladder; The inferior cystic artery starts from a. iliaca interna and supplies the ureter and the bottom of the bladder, and also gives branches to the vagina (in women), the prostate gland and seminal vesicles (in men).

4. A. ductus deferentis, the artery of the vas deferens (in men), goes to the ductus deferens and, accompanied by it, extends to the testis, to which it also gives off branches.

5. A. uterina, uterine artery (in women), arises from either the trunk of a. iliaca interna, or from the initial part of a. umbilicalis, goes to the medial side, crosses the ureter and, reaching between the two leaves of the lig. latum uteri of the lateral side of the cervix, gives a branch downwards - a. vaginalis (can extend from a. iliaca interna directly) to the walls of the vagina, itself turning upward, along the line of attachment of the broad ligament to the uterus. Gives branches to the fallopian tube - ramus tubdrius and to the ovary - ramus ovaricus; a. The uterina after childbirth becomes sharply tortuous.

6. A. rectalis media, middle rectal artery, arises from either a. iliaca interna, or from a. vesicalis inferior, branches in the walls of the rectum, anastomosing with aa. rectales superior et inferior, also gives branches to the ureter and bladder, prostate gland, seminal vesicles, and in women - to the vagina.

7. A. pudenda interna, the internal genital artery, in the pelvis gives only small branches to the nearest muscles and roots of the plexus sacralis, mainly supplies blood to the organs located below the diaphragma pelvis and the perineal area. It leaves the pelvis through the foramen infrapiriforme and then, going around the back side of the spina ischiadica, re-enters the pelvis through the lesser sciatic foramen and thus enters the fossa ischiorectalis. Here it breaks up into branches supplying the lower section of the rectum in the anus (a. rectalis inferior), the urethra, the muscles of the perineum and the vagina (in women), the bulbourethral glands (in men), the external genitalia (a. dorsdlis penis s. clitoridis, a. profunda penis s. clitdridis).

Educational video of the anatomy of the iliac arteries and their branches

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Umbilical artery - Arteria umbilicalis

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Internal iliac artery.

Internal iliac artery, a. iliaca interna, departs from the common iliac artery and goes down into the pelvic cavity, located along the line of the sacroiliac joint. At the level of the upper edge of the greater sciatic foramen, it is divided into anterior and posterior trunks. The branches extending from these trunks are directed to the walls and organs of the small pelvis and are therefore divided into visceral and parietal.

b) iliac branch, r. iliacus, is divided into two branches - superficial and deep.

The deep branch gives off branches to the ilium, anastomosing with a. obturatoria.

The medial branches, 5-6 in total, anastomose with the branches of the median sacral artery, forming a network.

a) superficial branch, r. superficialis, located between the gluteus maximus and gluteus medius muscles and supplies them with blood;

Options are described when a. obturatoria departs from a. epigastrica inferior or from a. iliaca externa.

Before entering the obturator canal, the obturator artery gives off a pubic branch, and in the canal itself it is divided into its terminal branches - anterior and posterior:

b) anterior branch, r. anterior, goes down the external obturator muscle, supplies it and the upper sections of the adductor muscles of the thigh;

Testicular artery

Testicular artery, atesricularis. It starts from the aorta at the level of L 2, crosses the ureter in front and, with the vas deferens, passes through the inguinal canal to the testicle. Rice. IN.
Ureteral branches, rami ureterici. They are directed to the ureter. Rice. B. 2a Branches of the epididymis, rami epididymides.
Ovarian artery, a. ovarica. It starts from the aorta at the level of L 2 and reaches the ovary as part of lig. suspensorium ovarii. Anastomoses with the uterine artery. Rice. IN.
Ureteral branches, rami ureterici. They are directed to the ureter. Rice. B. 4a Trumpet branches, rami tubarii (tubaks). They are directed to the funnel of the fallopian tube and anastomose with the branches of the uterine artery.
Bifurcation of the aorta, bifurcatio aortae. Located in front of L 4, approximately at the level of the navel. Rice. IN.
Common iliac artery, a. Shasa communis. From the aortic bifurcation at level L4 it continues to the sacroiliac joint, where it divides into the external and internal iliac arteries. Rice. IN.
Internal iliac artery, and Shasa interna. From the bifurcation of the common iliac artery it goes into the small pelvis to the upper edge of the greater sciatic foramen. Rice. IN.
Iliopsoas artery, a. iliolumbalis. It passes under the psoas major muscle posteriorly and laterally to the iliac fossa. Rice. IN.
Lumbar branch, ramus lumbalis. Supplies blood to the psoas major and quadratus lumborum muscles. Rice. IN.
Spinal branch, ramus spinalis. Enters the spinal canal through the opening between the sacrum and L 5. Fig. IN.
Iliac branch, ramus iliacus. It branches in the muscle of the same name and anastomoses with the deep circumflex artery of the ilium. Rice. IN.
Lateral sacral arteries, aa sacrales laterales. They descend from the side of a.sacralis mediana. May begin from the superior gluteal artery. Rice. IN.
Spinal branches, rami spinales. Through the pelvic openings the sacrum enters the canalis sacralis. Rice. IN.
Obturator artery, a. obturatoria. It runs along the lateral wall of the pelvis and passes through the obturator foramen to the adductor muscles of the thigh. Rice. B, V.
Pubic branch, ramus pubieus. Connects with the obturator branch of the inferior epigastric artery []. Fig. B.
Acetabular branch, ramus acetabulis. Passes through the notch of the same name to the ligament of the head of the femur. Rice. B.
Anterior branch, ramus anterior. It is located on the adductor brevis muscle and anastomoses with the medial circumflex femoral artery. Rice. B.
Posterior branch, ramus posterior. Located under the adductor brevis muscle. Rice. B.
Superior gluteal artery, a. glutealis superior. It exits the pelvis through the greater sciatic foramen above the piriformis muscle. Rice. A, V.
Superficial branch, ramus superficialis. Located between the gluteus maximus and gluteus medius muscles. Anastomoses with the inferior gluteal artery. Rice. A.
Deep branch, ramus profundus. Located between the gluteus medius and minimus muscles. Rice. A.
Upper branch, ramus superior. It runs along the upper edge of the gluteus minimus muscle to the m.tensor fasciae latae. Rice. A.
Lower branch, ramus inferior. In the gluteus medius muscle it reaches the greater trochanter of the femur. Rice. A.
Inferior gluteal artery, o. glutealis inferior. It passes through the greater sciatic foramen under the piriformis muscle and branches under the m.gluteus maximus. Anastomoses with the superior gluteal and obturator arteries, as well as with the lateral and medial circumflex femoral arteries. Rice. A, V.
The artery accompanying the sciatic nerve, a. comitans n. ischiadici (sciatici). In phylogeny, the main artery of the lower limb. Accompanies and supplies blood to nischiadicus. Anastomoses with the medial circumflex femoral artery and perforating arteries. Rice. A, V.
Umbilical artery, a. umbilicalis. Branch of the internal iliac artery. After birth, its lumen above the origin of the superior abdominal arteries is obliterated. Rice. B. 26a Open part, pars patens. Unobliterated part of the umbilical artery.
Artery of the vas deferens, a. ductus deferentis. It descends into the pelvic cavity to the bottom of the bladder, from where, accompanied by the vas deferens, it goes to the testicle, where it anastomoses with a. testicularis. Rice. IN.
Ureteral branches, rami ureterici. Three branches to the ureter. Rice. IN.
Superior vesical arteries, aa vesicates superiores. They supply blood to the upper and middle sections of the bladder. Rice. B. 29a Obliterated part, pars occlusa. The part of the umbilical artery that becomes the medial umbilical ligament after birth.
Medial umbilical ligament, lig. umbilicale mediale []. Replaces the umbilical artery and passes in the fold of the peritoneum of the same name. Rice. IN.

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