Vasculature of the Pelvis

Vaginal artery

(female) Descends to the vagina, supplying additional branches to the inferior bladder & rectum

Uterine Artery

(female) Travels within the broad ligament to reach the cervix, where it ascends along the lateral aspect of the uterus. At origin of the fallopian tubes, it anastamoses with the ovarian artery. During its course, it crosses the ureters superiorly

Inferior Vesical artery

(male) Supplies the prostate gland, seminal vesicle & inferior aspect of the bladder. The equivalent artery in women is the vaginal artery

Lateral sacral arteries

(superior & inferior) Travel infero-medially along the posterior pelvic wall to supply structures in the sacral canal, & the skin & muscle posterior to the sacrum

Iliolumbar artery

Ascends to exit the lesser pelvis, dividing into a lumbar & iliac branch. The lumbar branch supplies psoas major, quadratus lumborum & posterior abdominal wall. The iliac branch supplies the muscles & bone around the iliac fossa

Umbilical Artery

Gives rise to the superior vesical artery, which supplies superior aspect of urinary bladder. Transports blood from the placenta to the fetus during gestation. After birth, it closes distally to the origin of the superior vesical artery, & forms the medial umbilical ligament

Internal Pudendal Artery

Moves inferiorly to exit the pelvis via the greater sciatic foramen. Accompanied by the pudendal nerve, it then enters the perineum via the lesser sciatic foramen. Main artery responsible for the blood supply to the perineum

Middle Rectal artery

Travels medially to supply the distal part of the rectum. It also forms anastamoses with the superior rectal artery (derived from the inferior mesenteric) & the inferior rectal artery (derived from the internal pudendal)

Obturator artery

Travels through the obturator canal, accompanied by obturator nerve & vein. Supplies muscles of the thigh's adductor region

Pelvic cavity

contains the organs of reproduction, urinary bladder, pelvic colon, rectum & numerous muscles

External iliac vein

continuation of the femoral vein (major vessel draining lower limb), arising when femoral vein crosses under the inguinal ligament. It ascends along the medial aspect of the external iliac artery, before joining with the internal iliac vein to form the common iliac vein. During its short course, external iliac vein receives the inferior epigastric & deep circumflex iliac veins.

Internal iliac artery path

descends inferiorly, crossing the pelvic inlet to enter the lesser pelvis. During its descent, it is situated medially to the external iliac vein & obturator nerve. At the superior border of the greater sciatic foramen, it divides into anterior & posterior trunks

Middle sacral veins

drain part of the sacrum

Uterine & vaginal veins

drain the female reproductive organs via the vaginal & uterine venous plexuses

Lateral sacral veins

drains part of the sacrum

Iliolumbar vein

drains the L4 & L5 vertebrae, & the iliopsoas muscle

Middle rectal vein

drains the bladder, prostate (in males only), & part of the rectum

Superior & inferior gluteal veins

drains the buttock & upper thigh

Internal pudendal vein

drains the reproductive organs & part of the rectum (via the inferior rectal vein)

Vesical veins

drains the urinary bladder via the vesical venous plexus

Common iliac vein

formed at upper margin of pubic symphysis by the union of the external & internal iliac veins. It receives 2 additional tributaries: 1. Iliolumbar veins 2. Middle Sacral veins

Posterior trunk of internal iliac artery

gives rise to arteries that supply the lower posterior abdominal wall, posterior pelvic wall & gluteal region. Typically 3 branches: 1. Iliolumbar artery 2. Lateral Sacral arteries (inferior & superior) 3. Superior gluteal artery

Anterior trunk of internal iliac artery

gives rise to numerous branches that supply the pelvic organs, the perineum, & the gluteal & adductor regions of lower limb. -obturator -umbilical -uterine (female) -Vaginal (female)/inferior vesical (male) -middle rectal -internal pudendal -inferior gluteal

Inferior vena cava

left & right common iliac veins combine at L5 to become the _________, which empties into the inferior aspect of the right atrium

Internal Iliac Artery

main arterial supply to the pelvic cavity

internal iliac artery course

major artery of the pelvis. Originates at the bifurcation of the common iliac artery into its internal & external branches. This approximately occurs at vertebral level L5-S1

Ovarian artery

major gonadal artery in females. Arises from abdominal aorta, distal to origin of the renal arteries. Descends towards the pelvis, crossing the pelvic brim & the origin of the external iliac vessels. It moves medially, dividing into an ovarian branch & tubal branches, which supply their respective structures. Note - testicular artery reaches the scrotum via the inguinal canal,& therefore does not actually enter the pelvis

Median Sacral Artery

originates from the posterior aspect of abdominal aorta, at its bifurcation into the common iliac arteries. It descends anteriorly to the L4 & L5 vertebrae, the sacrum & the coccyx, contributing to the arterial supply of these regions

Internal iliac vein

responsible for majority of pelvic venous drainage, & receives numerous tributaries from veins that drain the pelvic region. Formed near the greater sciatic foramen, ascending anteriorly to the sacroiliac joint, before combining with the external iliac vein to form the common iliac vein. With the exception of the iliolumbar vein (which drains into the common iliac), the tributaries of the internal iliac vein correspond with the branches of the internal iliac artery. It receives venous blood from the: -superior & inferior gluteal veins -Internal pudendal -obturator -lateral sacral -middle rectal -vesical veins -uterine & vaginal veins

Inferior Gluteal Artery

terminal branch of the anterior trunk. Leaves the pelvic cavity via the greater sciatic foramen, emerging inferiorly to the piriformis muscle in the gluteal region. It contributes to the blood supply of the gluteal muscles & hip joint

Superior gluteal artery

terminal branch of the posterior trunk. It exits the pelvic cavity via the greater sciatic foramen, entering the gluteal region superiorly to the piriformis muscle. Major blood supply to the muscles & skin of the gluteal region

Superior rectal artery

terminal continuation of the inferior mesenteric artery. It crosses the left common iliac artery & descends in the mesentery of the sigmoid colon. It gives rise to branches that supply the rectum

Pelvic Congestion Syndrome

veins in pelvis, particularly ovarian veins in women, are prone to valve failure that may cause them to become dilated & tortuous (similar to varicose veins of the leg). This can cause intense pain within the pelvis, known as ___________. The pelvis contains too many structures to successfully dissect out a vein, & so pelvic venous embolisation is performed instead. Using a venous catheter a guide wire is fed through, a contrast dye is used & affected vessels are embolised (blocked) with various substances, such as metal coils. Due to the rich venous anastomoses in the pelvis, one smaller vein can be tied off without compromising venous return.

Veins of the pelvis

veins of the pelvis drain deoxygenated blood & return it to the heart. 3 major vessels involved in the venous drainage of the pelvis - external iliac vein, internal iliac vein & common iliac vein