Anatomy - PTA of the right common and external iliac artery in PAOD stage IIb

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Arterial Supply of the Pelvis

Abdominal aorta divides at the aortic bifurcation (approx. level L4) into the two common iliac arteries
each common iliac artery divides in turn into an internal and external iliac artery
Internal iliac artery supplies mainly the pelvic viscera with its visceral branches, and with its parietal branches it is involved in supplying the lower extremities
External iliac artery contributes to the supply of the pelvis and becomes the femoral artery after passing through the lacuna vasorum

1. Internal Iliac Artery

Origin	arises directly caudal to the aortic bifurcation from the common iliac artery
Course	passes caudally over the upper margin of the sciatic foramen
Positional Relationships	dorsal: internal iliac vein, piriformis muscle, lumbosacral plexus ventral: ureter lateral: external iliac vein, psoas major muscle caudal: obturator nerve
Branches	visceral branches: Umbilical artery 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
Supply Area	Pelvic organs, gluteal musculature

1.1 Visceral Branches of the Internal Iliac Artery

Main Branches	Course and Branches	Supply Area
Umbilical Artery	postnatal obliteration to the medial umbilical ligament remaining branches: superior vesical arteries, in men: artery of the ductus deferens	Urinary bladder body in men: ductus deferens
Inferior Vesical Artery	branching in the fundus of the urinary bladder into small branches	Urinary bladder in men: prostate, seminal vesicles
Middle Rectal Artery	branching in the middle rectal segment anastomoses with the superior and inferior rectal arteries	Rectal ampulla in women: vagina in men: prostate
Uterine Artery (Women)	passes over the ureter tortuous course in the broad ligament of the uterus gives off numerous small branches	Ovary Uterine tube proximal vagina Uterus

1.2 Parietal Branches of the Internal Iliac Artery

Main Branches	Course and Branches	Supply Area
Iliolumbar Artery	runs obliquely upward to the iliopsoas muscle	Psoas major muscle Iliacus muscle
Lateral Sacral Arteries	Superior branch: runs medially through the 1st or 2nd anterior sacral foramen and exits again through the posterior sacral foramen Inferior branch: passes over the piriformis muscle and, medial to the sacral foramina, caudally along the sacrum	Sacral canal Piriformis muscle Muscles/skin dorsal to the sacrum
Superior Gluteal Artery	passes with the superior gluteal nerve through the suprapiriform foramen, with branches to the gluteus maximus muscle (superficial branch) and gluteus medius muscle (deep branch)	Gluteus maximus, medius, and minimus muscles Piriformis muscle Tensor fasciae latae muscle Skin over the sacrum
Inferior Gluteal Artery	passes on the piriformis muscle caudally through the infrapiriform foramen then runs together with the posterior femoral cutaneous nerve and sciatic nerve through the gluteus maximus muscle	Gluteus maximus, medius, and minimus muscles Piriformis muscle Quadriceps femoris muscle Skin of the lower buttocks and proximal thigh
Obturator artery	passes along the lateral pelvic wall forward and downward branches to the ilium and iliacus muscle after passing through the obturator canal, gives off further branches, including the pubic branch (anastomoses with the inferior epigastric artery to form the corona mortis) and the posterior branch (branch: acetabular artery -> artery of the head of the femur)	Ilium Iliacus muscle Thigh adductors Pubis External hip muscles Femoral head
Internal pudendal artery	runs ventral to the sacral plexus to the infrapiriform foramen re-enters the lesser pelvis via the lesser sciatic foramen, through the pudendal canal, and branches in the ischiorectal fossa	distal third of the rectum Anal canal Urethra Scrotal skin/labia Bulb of the penis/vestibule Dorsum of the penis/clitoral prepuce

2. External iliac artery

Origin	arises caudal to the internal iliac artery from the common iliac artery
Course	runs along the psoas major muscle to the inguinal ligament, through the vascular lacuna, and becomes the femoral artery here
Positional relationships	The right external iliac artery runs beneath the ureter
Branches	Deep circumflex iliac artery runs to the anterior superior iliac spine and anastomoses with the iliolumbar artery and superior gluteal artery Inferior epigastric artery runs medial to the deep inguinal ring cranially and between the transversus abdominis muscle and the rectus abdominis muscle, with further branches including the cremasteric artery or the artery of the round ligament of the uterus
Supply area	Ilium, lower portion of the abdominal wall

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