Pelvis & Perineum Vasculature/Lymphatics

Inferior gluteal artery

- Exits pelvis through greater sciatic foramen to emerge inferior to piriformis muscle in the gluteal region. - Supplies blood to gluteal region.

Superior gluteal artery

- Exits pelvis through greater sciatic foramen to emerge superior to piriformis muscle in the gluteal region. - Supplies blood to gluteal region.

Umbilical artery

- In utero, the umbilical artery transports deoxygenated blood from the fetus to the placenta. Becomes obliterated after birth. - Gives branches called superior vesical arteries to supply superior part of bladder. - Common variation in 20% of population where "aberrant obturator artery" branches from the external iliac artery

Internal pudendal artery

- Main artery supplying blood to the perineum (muscles of perineum, external genitalia, and erectile tissues of the penis and clitoris). - Exits pelvis via the greater sciatic foramen and follows same course as the pudendal nerve to enters the perineum via the lesser sciatic foramen.

Inferior vesical artery (in male only)

- Supplies blood to inferior aspect of the bladder, prostate gland and seminal vesicles.

Superior vesical artery

- Supplies blood to superior aspect of urinary bladder and only in males gives blood supply to vas (ductus) deferens.

Middle rectal artery

- Supplies blood to the middle part of the rectum - Forms anastomoses with superior and inferior rectal arteries.

Uterine artery (female only)

- Supplies blood to uterus, uterine tubes, part of ovaries, and vagina. - Forms an anastomosis with the ovarian artery which also supplies blood to ovary. - Important to note that the ureter travels inferior to uterine artery within the pelvic cavity.

Vaginal artery

- Supplies blood to vagina - inferior part of bladder in females.

Obturator artery

- Travels through the obturator canal with the obturator nerve and vein. - Supplies blood to muscles of medial thigh.

iliolumbar artery

- ilium and back muscles

Branches of Internal Iliac Artery

.....see below

External iliac artery has two branches:

1 - Inferior epigastric artery 2 - Deep circumflex iliac artery External iliac is branch from the common iliac artery. • It exits the pelvis by traveling inferior to the inguinal ligament. • It enters the femoral region where it then changes name to femoral artery.

The Main Blood Supply To Pelvic Organs and Structures of The Perineum?

Internal Iliac Artery (via its branches) • Additional arteries also enter the pelvic cavity: 1 - Superior rectal artery (branches from inferior mesenteric artery) 2 - Ovarian artery (branches directly from abdominal aorta)

Ureter Vulnerable To Injury During A Hysterectomy Due To

Its Proximity To Uterine Artery • Ureter travels inferior to the uterine artery on its way to the bladder. • "Water under the bridge" = ureter/urine underneath uterine artery). • Ureter at risk of being clamped and ligated instead of uterine artery during hysterectomy (surgical removal of uterus.

All Venous Drainage From Pelvis & Perineum Travels Through

The Internal Iliac Vein • The veins have similar names as their artery counterparts. • Internal iliac vein will merge with external iliac vein to form the common iliac vein. • Right and left common iliac veins join to form the Inferior Vena Cava (IVC).

lateral sacral artery

see pic

Internal Pudendal Artery & Its Branches

• Internal pudendal artery follows same path as the pudendal nerve to reach the perineum. • Branch names for internal pudendal artery are similar to pudendal nerve branches.

Middle rectal vein drains into

• caval system (IVC) via the internal iliac vein.

Inferior rectal vein drains into

• the internal pudendal vein and then into the internal iliac vein to get to the caval system (IVC).

Superior rectal vein drains into

• the portal system (portal vein) via the inferior mesenteric vein.

Glans penis (or clitoris) drains into

→ deep inguinal lymph nodes

Superior bladder drains into

→ external iliac lymph nodes

Inferior bladder drains into

→ internal iliac lymph nodes

Prostate drains into

→ internal iliac lymph nodes

Testis drains into

→ lumbar (or aortic) nodes

Ovary/uterine tube, fundus of uterus drains into

→ lumbar (or aortic, or para-aortic) lymph nodes

Scrotum drains into

→ superficial inguinal lymph nodes