At the bifurcation of the aorta, the middle sacral artery arises posteriorly and travels on the pelvic surface of the sacrum to supply branches to the sacral foramina and the rectum. The common iliac arteries arise at the level of the fourth lumbar vertebra, run anterior and lateral to their accompanying veins, and bifurcate into the external and internal iliac arteries at the SI joint. The external iliac artery follows the medial border of the iliopsoas muscle along the arcuate line and leaves the pelvis beneath the inguinal ligament as the femoral artery. Its inferior epigastric artery is given off proximal to the inguinal ligament and ascends medial to the internal inguinal ring to supply the rectus muscle and overlying skin. Because the rectus is richly collateralized from above and laterally, the inferior epigastric arteries may be ligated with impunity. A rectus myocutaneous flap based on this artery has been used to correct major pelvic and perineal tissue defects. Near its origin, the inferior epigastric artery sends a deep circumflex iliac branch laterally and a pubic branch medially. Both vessels travel on the iliopubic tract and may be injured during inguinal hernia repair. Its cremasteric branch joins the spermatic cord at the internal inguinal ring and forms a distal anastomosis with the testicular artery. In 25% of people, an accessory obturator artery arises from the inferior epigastric artery and runs medial to the femoral vein to reach the obturator canal. This vessel must be avoided during obturator lymph node dissection.
[...] Pelvic Circulation Arterial Supply At the bifurcation of the aorta, the middle sacral artery arises posteriorly and travels on the pelvic surface of the sacrum to supply branches to the sacral foramina and the rectum. The common iliac arteries arise at the level of the fourth lumbar vertebra, run anterior and lateral to their accompanying veins, and bifurcate into the external and internal iliac arteries at the SI joint. The external iliac artery follows the medial border of the iliopsoas muscle along the arcuate line and leaves the pelvis beneath the inguinal ligament as the femoral artery. [...]
[...] Connections between the pelvic plexuses, the emissary veins of the pelvic bones, and the vertebral plexus have been proposed to be routes for the dissemination of infection or tumor from the pelvic viscera to the axial and pelvic skeleton. The internal iliac vein is joined by tributaries corresponding to the branches of the internal iliac artery and ascends medial and posterior to the artery. This vein is relatively thin walled and at risk for injury during dissection of the artery or the nearby pelvic ureter. [...]
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