Anatomy - Right retrograde iliofemoral TEA (ring stripper desobliteration) with profunda patch plasty

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Arterial Supply of the Pelvis

The abdominal aorta divides at the aortic bifurcation (approximately at the level of L4) into the two common iliac arteries
each common iliac artery in turn divides into an internal and external iliac artery
The internal iliac artery supplies mainly the pelvic viscera with visceral branches, and with its parietal branches it is involved in the supply of the lower extremities
The 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 immediately 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 muscles

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 bladder fundus 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	runs 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	the 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. Femoral artery

1.1. Overview

Origin	External iliac artery, which becomes the femoral artery after passing under the inguinal ligament
Course	runs between iliopsoas muscle and pectineus muscle (= iliopectineal fossa) covered by fascia lata is accompanied by the sartorius muscle up to the middle of the thigh passes together with femoral vein and saphenous nerve through the adductor canal transitions into the popliteal artery after passing through the adductor hiatus
Branches	Superficial epigastric artery Superficial circumflex iliac artery Deep femoral artery (main artery for supplying the thigh!) External pudendal arteries Descending genicular artery
Supply area	Thigh Skin of the abdominal wall External genitalia Knee joint and proximal/medial lower leg

1.2. Important branches of the femoral artery

	Branches	Supply area
Superficial epigastric artery	Ø	Skin of the abdominal wall up to the umbilical region
Superficial circumflex iliac artery	Ø	Anterior superior iliac spine
Deep femoral artery	Medial circumflex femoral artery runs between iliopsoas muscle and pectineus muscle dorsally → trochanteric fossa; anastomosis with lateral circumflex femoral artery Lateral circumflex femoral artery runs between rectus femoris muscle and vasti muscles laterally; anastomosis with medial circumflex femoral artery Perforating arteries pass through the adductors to the back of the thigh	Thigh
External pudendal arteries	Ø	External genitalia Scrotum or labia majora
Descending genicular artery	Articular branches → genicular arterial network Saphenous branch → runs medially together with great saphenous vein and saphenous nerve to the calf	Knee Medial calf proximal

2. Popliteal artery

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2.1. Overview

Origin	Continuation of the femoral artery after its passage through the adductor hiatus
Course	runs through popliteal fossa runs between the heads of the gastrocnemius muscle transitions into the tibiofibular trunk after giving off the anterior tibial artery
Branches	Anterior tibial artery
Supply area	Popliteal fossa Knee joint

2.2. Important branches of the popliteal artery

	Course	Branches	Supply area
Anterior tibial artery	Branch of the popliteal artery is accompanied by 2 veins and in the lower part by the deep peroneal nerve passes through the interosseous membrane of the leg and runs on its anterior side runs behind the tendon of the extensor hallucis longus muscle transitions into the dorsalis pedis artery	Posterior and anterior tibial recurrent arteries Lateral and medial anterior malleolar arteries Dorsalis pedis artery (terminal branch of the anterior tibial artery)	Anterior lower leg Dorsum of the foot

3. Posterior tibial artery

3.1. Overview

Origin	Continuation of the popliteal artery after the departure of the anterior tibial artery
Course	runs together with the tibial nerve under the tendinous arch of the soleus muscle → medial malleolar groove → medial malleolus Division into medial and lateral plantar arteries
Branches	Fibular artery Medial and lateral plantar arteries
Supply area	Dorsal part of the lower leg Sole of the foot

3.2. Important branches of the posterior tibial artery

	Course	Branches	Supply area
Fibular artery	runs on the back of the fibula runs between posterior tibial muscle and flexor hallucis longus muscle	Communicating branch: Transverse connection to the posterior tibial artery Lateral malleolar branches	Lateral-dorsal lower leg
Medial plantar artery	runs in the medial vascular-nerve bundle of the sole of the foot (medial plantar artery, vein, and nerve) between abductor hallucis muscle and flexor digitorum brevis muscle	Ø	Medial sole of the foot
Lateral plantar artery	runs in the lateral vascular-nerve bundle of the sole of the foot (lateral plantar artery, vein, and nerve) between flexor digitorum brevis muscle and quadratus plantae muscle	Deep plantar arch: Anastomosis between lateral plantar artery and the deep plantar branch of the dorsalis pedis artery in the area of the metatarsal bones	Lateral sole of the foot Toes