Anatomy - Retrograde iliofemoral TEA (ring stripper desobliteration) right with profunda patch plasty

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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 primarily the pelvic viscera with visceral branches, and with its parietal branches it is involved in the supply of the lower extremities
External iliac artery contributes to the supply of the pelvis and becomes the femoral artery after passing through the vascular lacuna

1. Internal Iliac Artery

Origin	arises directly caudal to the aortic bifurcation from the common iliac artery
Course	passes over the upper margin of the greater sciatic foramen caudally
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 section anastomoses with 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 on the sacrum caudally	Sacral canal Piriformis muscle Muscles/skin dorsal to the sacrum
Superior gluteal artery	passes with the superior gluteal nerve through the suprapiriform foramen and 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 buttock 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 pubic branch (anastomoses with the inferior epigastric artery to form the corona mortis) and posterior branch (branch: acetabular artery -> artery of the femoral head)	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 here becomes the femoral artery
Positional Relationships	Right external iliac artery runs under 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 rectus abdominis muscle, further branches including cremasteric artery or artery of the round ligament of the uterus
Supply Area	Ilium, lower portion of the abdominal wall

Arterial Supply of the Lower Extremity

1. A. femoralis

1.1. Overview

Origin	A. iliaca externa, which becomes the A. femoralis after passing under the inguinal ligament
Course	runs between M. iliopsoas and M. pectineus (= iliopectineal fossa) covered by fascia lata is accompanied by M. sartorius up to the middle of the thigh passes together with V. femoralis and N. saphenus through the adductor canal transitions into the A. poplitea after passing through the adductor hiatus
Branches	A. epigastrica superficialis A. circumflexa ilium superficialis A. profunda femoris (main artery for supplying the thigh!) Aa. pudendae externae A. descendens genus
Supply Area	Thigh Skin of the abdominal wall External genitalia Knee joint and proximal/medial lower leg

1.2. Important Branches of the A. femoralis

	Branches	Supply Area
A. epigastrica superficialis	Ø	Skin of the abdominal wall up to the umbilical region
A. circumflexa ilium superficialis	Ø	Anterior superior iliac spine
A. profunda femoris	A. circumflexa femoris medialis runs between M. iliopsoas and M. pectineus dorsally → trochanteric fossa; anastomosis with A. circumflexa femoris lateralis A. circumflexa femoris lateralis runs between M. rectus femoris and Mm. vasti laterally; anastomosis with A. circumflexa femoris medialis Aa. perforantes pass through the adductors to the back of the thigh	Thigh
Aa. pudendae externae	Ø	External genitalia Scrotum or Labia majora pudendi
A. descendens genus	Rr. articulares → Rete articulare genus R. saphenus → runs medially together with V. saphena magna and N. saphenus to the calf	Knee Medial calf proximal

2. A. poplitea

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2.1. Overview

Origin	Continuation of the A. femoralis after its passage through the adductor hiatus
Course	runs through the popliteal fossa runs between the heads of the M. gastrocnemius transitions into the tibiofibular trunk after giving off the A. tibialis anterior
Branches	A. tibialis anterior
Supply Area	Popliteal fossa Knee joint

2.2. Important Branches of the A. poplitea

	Course	Branches	Supply Area
A. tibialis anterior	Branch of the A. poplitea is accompanied by 2 veins and in the lower part by the N. peronaeus profundus passes through the interosseous membrane of the leg and runs on its anterior side runs behind the tendon of the M. extensor hallucis longus transitions into the A. dorsalis pedis	A. recurrens tibialis posterior + anterior A. malleolaris anterior lateralis + medialis A. dorsalis pedis (terminal branch of the A. tibialis anterior)	Anterior lower leg Dorsum of the foot

3. A. tibialis posterior

3.1. Overview

Origin	Continuation of the A. poplitea after the departure of the A. tibialis anterior
Course	runs together with the N. tibialis under the tendinous arch of the M. soleus → medial malleolar groove → medial malleolus Division into A. plantaris medialis + lateralis
Branches	A. fibularis A. plantaris medialis + lateralis
Supply Area	Dorsal part of the lower leg Sole of the foot

3.2. Important Branches of the A. tibialis posterior

	Course	Branches	Supply Area
A. fibularis	runs on the back of the fibula runs between M. tibialis posterior and M. flexor hallucis longus	R. communicans: Transverse connection to the A. tibialis posterior Rr. malleolares laterales	Lateral-dorsal lower leg
A. plantaris medialis	runs in the medial neurovascular bundle of the sole of the foot (A., V. and N. plantaris medialis) between M. abductor hallucis and M. flexor digitorum brevis	Ø	Medial sole of the foot
A. plantaris lateralis	runs in the lateral neurovascular bundle of the sole of the foot (A., V. and N. plantaris lateralis) between M. flexor digitorum brevis and M. quadratus plantae	Arcus plantaris profundus: Anastomosis between A. plantaris lateralis and the R. plantaris profundus of the A. dorsalis pedis in the area of the metatarsal bones	Lateral sole of the foot Toes