Anatomy - Right transfemoral amputation in Fontaine stage IV peripheral arterial disease – Vascular Surgery

  1. Arterial pelvic blood supply

    Arterial pelvic blood supply
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    • The abdominal aorta divides at the aortic bifurcation (around level L4) into both common iliac arteries
    • In turn, each common iliac artery divides into an internal and external iliac artery
    • With its visceral branches, the internal iliac artery supplies mainly the pelvic organs, while its parietal branches ensure the blood supply to the lower extremities
    • The external iliac artery contributes to the pelvic blood supply and, after passing through the vascular compartment (lacuna vasorum retroinguinalis), becomes the femoral artery
    1. Internal iliac artery


    • Arises from the common iliac artery immediately inferior to the aortic bifurcation


    • Courses caudad over the superior border of the greater sciatic foramen.


    • Posterior: internal iliac vein, pirirformis muscle, lumbosacral plexus
    • Anterior: ureter
    • Lateral: external iliac vein, psoas major
    • Inferior: obturator nerve


    Visceral branches:

    • Umbilical arteries
    • Inferior vesical artery
    • Middle rectal artery
    • In women: Uterine artery

    Parietal branches:

    • Iliolumbar artery
    • Lateral sacral arteries
    • Superior gluteal artery
    • Inferior gluteal artery
    • Obturator artery
    • Internal pudendal artery

    Arterial blood supply for

    • Pelvic organs, gluteal muscles
    2. External iliac artery


    • Arises from the common iliac artery immediately distal to the origin of the internal iliac artery


    • Courses along the major psoas muscle to the inguinal ligament, and after passing through the vascular compartment becomes the femoral artery


    • The right external iliac artery courses posterior to the ureter
    • The left ureter crosses somewhat lower anterior to the bifurcation of the external iliac artery


    • The deep iliac circumflex artery courses to the superior iliac spine and joins the Iliolumbar artery and superior gluteal artery
    • The inferior epigastric artery runs craniad medial to the deep inguinal ring and between the transverse abdominis and rectus abdominis muscles; other branches include the cremasteric artery and artery of round ligament of uterus 

    Arterial blood supply for

    • Iliac bone, inferior aspect of abdominal wall
Arterial blood supply to the lower extremity

1. Femoral artery1,1. OverviewOriginExternal iliac artery which becomes the femoral artery after pa

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