Branches, functions and pathologies of the iliac artery. Arteries of the walls and organs of the pelvic cavity Branches of the internal iliac artery

The iliac arteries are one of the largest vessels in the body. They are paired vessels up to 7 cm long and up to 13 mm in diameter. The beginning of the arteries is located in the region of the 4th lumbar vertebra and is a continuation of the abdominal aorta (its bifurcation).

Where the articulation of the sacrum and iliac bones is located, these vessels are divided into external and internal iliac arteries.

Iliac common artery

It should be laterally and down to the small pelvis.

In the area of ​​​​the iliac-sacral joint, the common iliac artery is divided into internal and external arteries of the same name, following to the thigh and small pelvis.

A. iliaca interna

The internal iliac artery (2) feeds the organs and walls of the pelvis. It descends along the inner side of the lumbar (large) muscle.

In the region of the upper part of the sciatic foramen magnum, the parietal and visceral arteries branch off from the vessel.

Parietal branches

• Lumbar-iliac branch (3). It follows laterally and behind the lumbar large muscle, giving branches to the iliac muscle and the bone of the same name, as well as to the square and lumbar large muscles. In addition, they supply blood to the membranes and nerves of the spinal cord.
• The sacral lateral arteries (4). They nourish the deep muscles of the back, the sacrum, the spinal cord (nerve roots and membranes), the ligaments of the coccyx and sacrum, the piriformis muscle, the muscle that raises the anus.
• Obturator artery (6). It follows the front on the sides of the small pelvis. The branches of this vessel are: the pubic, anterior, posterior arteries that feed the skin of the genital organs, the obturator and adductor muscles of the thigh, the hip joint, the femur (its head), the pubic symphysis, the ilium, thin, comb, lumboiliac, square muscles, obturator (external, internal) muscles and a muscle that raises the anus.
• Gluteal inferior artery (7). It leaves the pelvis through the piriform opening. Nourishes the skin in the gluteal region, hip joint, square, semimembranosus, gluteus maximus, piriformis, semitendinosus, adductor (large) muscles, twin (lower, upper), obturator (internal, external) muscles and the biceps femoris muscle (its long head).
• Gluteal superior artery (5). It follows laterally and passes through the suprapiriform opening to the muscles and skin of the gluteal region in the form of deep and superficial branches. These vessels nourish the small, medium gluteal muscles, the hip joint, the skin of the buttocks.

Branches visceral

• Umbilical artery (13, 14). It runs along the posterior surface of the abdominal wall, rising to the navel. In the antenatal period, this vessel functions fully. After birth, the main part of it starts to empty and becomes the umbilical ligament. However, a small part of the vessel still functions and gives off the upper bladder arteries and the artery of the vas deferens, which feed the walls of the latter, as well as the bladder and the walls of the ureter.
• Uterine artery. It follows between the sheets of the broad uterine ligament to the uterus, crossing along the way with the ureter and giving off the tubal, ovarian and vaginal branches. R.tubarius nourishes the fallopian tubes, r. ovaricus through the thickness of the mesentery approaches the ovary and forms an anastomosis with branches of the ovarian artery. Rr. vaginales follow down to the walls of the vagina (lateral).
• Rectal (middle) artery (9). It follows the rectum (the lateral wall of its ampulla), nourishing the muscle that raises the anus, ureter, lower and middle rectal sections, in women - the vagina, and in men - the prostate and seminal vesicles.
• Sexual (internal) artery (10) - the final branch from the iliac internal artery. The vessel leaves, accompanied by the gluteal inferior artery, through the subpiri-shaped opening, bending around the sciatic spine, again penetrates into the small pelvis (in the area of ​​the recto-sciatic fossa) through the sciatic (small) foramen. In this fossa, the artery gives off the rectal inferior artery (11), and then branches into: the dorsal penis (clitoris) artery, the perineal, urethral artery, the deep clitoral (penis) artery, the vessel that feeds the bulb of the penis and the artery that feeds the bulb of the vestibule of the vagina. All of the above arteries feed the corresponding organs (the obturator internal muscle, the lower part of the rectum, the genital external organs, the urethra, the bulbourethral glands, the vagina, the muscles and skin of the perineum).

A.Iliaca externa

The external iliac artery originates at the iliosacral joint and is a continuation of the common iliac artery.

The iliac artery follows (marked with an arrow) downwards and anteriorly along the inner surface of the lumbar large muscle to the inguinal ligament, passing under which through the vascular lacuna, it turns into the artery of the thigh. The branches that give off the iliac external artery nourish the labia and pubis, the scrotum, the iliac muscle and the muscles of the abdomen.

Branches of the external iliac artery

Occlusion of the iliac arteries

The reasons for the development of occlusion / stenosis of these arteries are the presence of aortoarteritis, thromboangiitis obliterans, muscular fibrous dysplasia and atherosclerosis.

The occurrence of this pathology leads to tissue hypoxia and disorders of tissue metabolism, and, as a result, to the development of metabolic acidosis and the accumulation of metabolic underoxidized products. The properties of platelets change, as a result of which the viscosity of the blood increases and multiple blood clots form.

There are several types of occlusion (according to etiology):

• Post-traumatic.
• Post-embolic.
• Iatrogenic.
• Aortitis is nonspecific.
• Mixed forms of atherosclerosis, aortitis and arteritis.

In accordance with the nature of damage to the iliac arteries, there are:

• chronic process.
• Stenosis.
• Acute thrombosis.

This pathology is characterized by several syndromes:

Occlusion therapy is carried out by both conservative and surgical methods.

Conservative treatment is aimed at optimizing blood coagulation, eliminating pain and vasospasm. For this, ganglion blockers, antispasmodics, and so on are prescribed.

In the case of severe lameness, pain at rest, tissue necrosis, embolism, surgical operations are used. In this case, the damaged part of the iliac artery is removed, an operation to remove plaques, sympathectomy, or a combination of various techniques is carried out.

Aneurysms of the iliac arteries

Initially, it is asymptomatic, and only after a significant increase does it begin to manifest itself clinically.

An aneurysm is a sac-like protrusion of the vascular wall, as a result of which the elasticity of tissues is significantly reduced and replaced by connective tissue growths.

May become: atherosclerosis of the iliac arteries, trauma, GB.

This pathology is dangerous for the development of a formidable complication - aneurysm rupture, which is accompanied by massive bleeding, a decrease in blood pressure, heart rate and collapse.

In the event of impaired blood supply in the area of ​​the aneurysm, thrombosis of the vessels of the thigh, lower leg and small pelvis may develop, which is accompanied by dysuria and intense pain.

This pathology is diagnosed using ultrasound, CT or MRI, angiography and duplex scanning.

The structure of the iliac artery includes an external and internal canal. They nourish the organs of the pelvic region, muscles and skin of the thigh, provide blood supply to the lower leg and foot, and affect the activity function of the lower extremities.

Anatomy and function of the common iliac artery system

The common iliac artery originates from the fourth lumbar vertebra at the point where the aorta bifurcates. It is considered one of the largest: a paired vessel 5–7 centimeters long and 11–13 mm in diameter.

In the area of ​​articulation of the sacrum and bones, it is divided into two parts: internal and external.

internal iliac artery

Delivers blood to all organs and walls of the pelvis. It diverges into the following branches:

• middle rectal;
• ilio-lumbar;
• sacral;
• lateral;
• obturator;
• lower and upper gluteal;
• internal sexual;
• lower bladder;
• uterine.

In addition to these parts, the branches of the internal iliac artery are divided, in turn, into parietal and visceral.

External iliac artery

It leaves the pelvic cavity and then diverges along the walls, stretches to the lower extremities and into the femoral canal. It branches into the lower and deep epigastric parts, which supply blood to the skin of the thigh and muscles. It divides into smaller arteries that feed the legs and feet.

The external iliac artery consists of channels that saturate the abdomen, genitals, and pelvic muscles.

The epigastric lower branch continues along the rectus abdominis. It passes into the inguinal, pubic, which nourish the membranes of the testicles or uterus.

The deep artery goes around the bone. It starts from the inguinal ligament and follows in parallel, provides blood supply to the abdomen and muscles:

• transverse;
• tailor;
• oblique;
• straining.

parietal branches

The lumbar-iliac canal runs behind the large muscle of the lumbar region, stretches to the muscle of the same name and bone. It supplies blood to the membranes and nerve endings of the spinal cord.

The sacral lateral arteries feed:

• spinal cord;
• back muscles;
• sacrum;
• coccyx;
• piriformis muscle;
• muscle that lifts the anus.

The obturator canal stretches along the sides and in front of the small pelvis, its branches: pubic, anterior and posterior. These vessels provide blood to:

• hip joint;
• femur;
• adductor, obturator muscles;
• genital skin;
• pubic symphysis.

The gluteal inferior artery stretches through the opening from the small pelvis, supplies blood to the skin in this area, nourishes:

• biceps femoris;
• hip joint;
• adductor, semitendinosus, obturator, piriformis muscle.

Gluteus superior extends through the suprapiriform opening to the skin and muscles of the buttocks, is divided into superficial and deep branches that nourish the hip joint, skin and muscles of the buttocks.

Visceral branches

The umbilical vessel passes behind the surface of the abdominal wall, stretches to the navel. The main part after birth is not active, it is a ligament. Small functions - feeds the bladder, ureter, vas deferens.

The uterine artery follows the uterus, crosses with the ureter, supplies the tubal, vaginal, ovarian branches. Saturates the fallopian tubes, ovaries, vagina.

The rectal artery runs directly to the rectum, is responsible for the blood supply:

• lower and middle sections of the rectum;
• anus;
• ureter;
• prostate;
• vagina;
• seminal vesicles.

The genital branch of the iliac artery is located in the buttocks. Passes through the pear-shaped opening into the small pelvis. Nourishes the genital external organs, perineum, urethra.

Pathology of the artery

The vessel is especially vulnerable to the development of pathologies that pose a serious threat to human life. In case of violation of the patency of the channel, it is noted:

• pale skin;
• fragility of nails;
• amyotrophy;
• foot ulcers;
• gangrene of fingers;
• impaired motor function of the limbs.

The most common diseases are atherosclerosis and aneurysm.

With atherosclerosis, cholesterol plaques appear on the walls of the vessel. They cause narrowing of the lumen and prevent the passage of blood. The disease must be treated so that there are no complications.

Perhaps the development of occlusion - a complete blockage of the vessel, in which fatty deposits grow, sticking of epithelial cells and blood occurs. Cholesterol plaques provoke stenosis - vasoconstriction. As a result, hypoxia and metabolic disorders occur. Due to oxygen starvation, acidosis develops - the accumulation of metabolic products. The viscosity of the blood increases, blood clots form.

Occlusion can develop against the background of:

• thromboangiitis obliterans;
• embolism;
• fibromuscular dysplasia;
• aortoarteritis.

With this pathology develops:

• syndrome of ischemia of the lower extremities, in which fatigue, numbness, chilliness of the legs, lameness occur;
• impotence syndrome - occurs due to a violation of the blood supply to the lower back in the pelvic area.

Aneurysm is a fairly rare disease that develops against the background of atherosclerosis. Protrusions form on the walls of large vessels, weakened by plaques. The canal wall becomes less elastic and is replaced by connective tissue. An aneurysm can be caused by trauma or hypertension. This pathology may not manifest itself for a long time. As the saccular protrusions grow, they put pressure on the organs, making blood flow difficult.

Possible complications:

• aneurysm rupture;
• bleeding;
• strong pressure drop;
• collapse.

In the event of a violation of the blood supply in the aneurysm, thrombosis of the femoral artery or vessels of the pelvic organs can form. This leads to a violation of the sensitivity of the legs, lameness, paresis.

An aneurysm can be diagnosed with:

• Ultrasound with duplex scanning;
• Computed tomography;
• angiography.

Treatment of diseases of the iliac artery

With occlusion of the iliac artery, it is necessary to normalize blood clotting, stop pain and relieve vasospasm. Medical treatment or surgery will be required.

For conservative treatment use:

• painkillers;
• antispasmodics (No-shpa, Papaverine);
• drugs to reduce blood clotting.

If conservative methods fail, the patient is scheduled for surgery. The plaques are surgically removed and the affected area is excised, replaced with a graft.

An aneurysm is treated with surgery to prevent thrombosis and rupture of the vessel.

To maintain the health of veins and arteries, you need to monitor the general condition of the body. It is important to eat natural products, give up fats in order to avoid an increase in cholesterol in the blood, spend more time in the fresh air and play sports.

1. The iliac-lumbar artery (a. iliolumbalis) goes behind the psoas major back and laterally and gives off two branches:
   • lumbar branch(r. lumbalis) goes to the large lumbar muscle and the square muscle of the lower back. A thin spinal branch (r. spinalis) departs from it, heading into the sacral canal;
   • iliac branch(r. illiacus) supplies blood to the ilium and the muscle of the same name, anastomoses with the deep circumflex iliac artery (from the external iliac artery).
2. Lateral sacral arteries (aa. sacrales laterales), upper and lower, are sent to the bones and muscles of the sacral region. Their spinal branches (rr. spinales) go through the anterior sacral openings to the membranes of the spinal cord.
3. The superior gluteal artery (a. glutealis superior) exits the pelvis through the suprapiriform opening, where it is divided into two branches:
   • superficial branch(r. superficialis) goes to the gluteal muscles and to the skin of the gluteal region;
   • deep branch(r. profundus) splits into upper and lower branches (rr. superior et inferior), which supply blood to the gluteal muscles, mainly the middle and small, and adjacent pelvic muscles. The lower branch, in addition, is involved in the blood supply to the hip joint.

The superior gluteal artery anastomoses with branches of the lateral circumflex femoral artery (from the deep femoral artery).

1. The lower gluteal artery (a. glutealis inferior) is sent along with the internal pudendal artery and the sciatic nerve through the piriformis opening to the gluteus maximus muscle, gives a thin long artery accompanying the sciatic nerve(a. comitans nervi ischiadici).
2. Obturator artery (a. obturatoria), together with the nerve of the same name along the side wall of the small pelvis, is directed through the obturator canal to the thigh, where it is divided into anterior and posterior branches. The anterior branch (r. anterior) supplies blood to the external obturator and adductor muscles of the thigh, as well as the skin of the external genital organs. The posterior branch (r. posterior) also supplies the external obturator muscle and gives the acetabular branch (r. acetabularis) to the hip joint. The acetabular branch not only nourishes the walls of the acetabulum, but as part of the ligament of the femoral head reaches the femoral head. In the pelvic cavity, the obturator artery gives off a pubic branch (r. pubicus), which, in the medial semicircle of the deep ring of the femoral canal, anastomoses with the obturator branch from the inferior epigastric artery. With a developed anastomosis (in 30% of cases), it can be damaged during hernia repair (the so-called corona mortis).

Visceral (splanchnic) branches of the internal iliac artery

1. The umbilical artery (a. umbilicalis) functions throughout only the embryo; goes forward and up, rises along the back side of the anterior wall of the abdomen (under the peritoneum) to the navel. In an adult, it is stored as a medial umbilical ligament. From the initial part of the umbilical artery depart:
   • superior vesical arteries(aa. vesicales superiores) give ureteral branches (rr. ureterici) to the lower ureter;
   • vas deferens artery(a. ductus deferentis).
2. The lower vesical artery (a. vesicalis inferior) in men gives off branches to the seminal vesicles and the prostate gland, and in women to the vagina.
3. The uterine artery (a. uterina) descends into the pelvic cavity, crosses the ureter and between the sheets of the broad uterine ligament reaches the cervix. Gives away vaginal branches(rr. vaginales), pipe branch(r. tubarius) and ovarian branch(r. ovaricus), which in the mesentery of the ovary anastomoses with the branches of the ovarian artery (from the abdominal part of the aorta).
4. The middle rectal artery (a. rectalis media) goes to the lateral wall of the ampulla of the rectum, to the muscle that raises the anus; gives off branches to the seminal vesicles and prostate in men and to the vagina in women. Anatomizes with branches of the superior and inferior rectal arteries.
5. The internal pudendal artery (a. pudenda interna) exits the pelvic cavity through the piriform opening, and then through the small sciatic foramen follows into the ischiorectal fossa, where it is adjacent to the inner surface of the obturator internus muscle. In the ischiorectal fossa gives inferior rectal artery(a. rectalis inferior), and then divided into perineal artery(a. perinealis) and glad of other vessels. For men it is urethral artery(a. urethralis), artery of the bulb of the penis(a. bulbi penis), deep and dorsal arteries of the penis(aa. profunda et dorsalis penis). Among women - urethral artery(a. urethralis), bulb artery of vestibule[vagina] (bulbi vestibuli), deep and dorsal clitoral artery(aa. profunda et dorsalis clitoridis).

The external iliac artery (a. iliaca externa) serves as a continuation of the common iliac artery. Through the vascular lacuna, it goes to the thigh, where it receives the name of the femoral artery. The following branches depart from the external iliac artery.

1. The lower epigastric artery (a. epigastrica inferior) rises along the back side of the anterior abdominal wall retroperitoneally to the rectus abdominis muscle. From the initial section of this artery departs pubic branch(r. pubicus) to the pubic bone and its periosteum. A thin obturator branch (r. obturatorius) is separated from the pubic branch, anastomosing with the pubic branch from the obturator artery, and the cremaster artery (a. cremasterica - in men). The cremasteric artery departs from the inferior epigastric artery at the deep inguinal ring, supplies blood to the membranes of the spermatic cord and testicle, as well as the muscle that lifts the testicle. In women, this artery is similar to the artery of the round ligament of the uterus (a. lig. teretis uteri), which, as part of this ligament, reaches the skin of the external genital organs.
2. The deep artery that surrounds the ilium (a. circumflexa iliaca profunda) goes along the iliac crest posteriorly, gives branches to the abdominal muscles and nearby pelvic muscles; anastomoses with branches of the iliac-lumbar artery.

common iliac artery, a . iliaca communis (diameter 11 - 12.5 mm) (Fig. 62), follows the direction of the small pelvis and at the level of the sacroiliac joint is divided into internal and external iliac arteries.

internal iliac artery,a. Shasainterna, blood supply to the walls and organs of the pelvis. It descends along the medial edge of the psoas major muscle down into the cavity of the small pelvis and, at the upper edge of the large sciatic foramen, is divided into the posterior and anterior branches (trunks), which supply the walls and organs of the small pelvis with blood. The branches of the internal, iliac artery are the iliac-lumbar, middle rectal, lateral sacral, superior and inferior gluteal, umbilical, inferior vesical, uterine, internal pudendal and obturator arteries.

1. Iliac-lumbar artery,a. iliolumbalis, goes behind the psoas major back and laterally and gives off two branches: 1) the lumbar branch, G.lumbalis, to the psoas major and quadratus lumborum; a thin spinal branch, d.spinalis, heading into the sacral canal; 2) iliac branch, G.ilidcus, which supplies the iliac bone and the muscle of the same name and anastomoses with the deep circumflex iliac artery (from the external iliac artery).

2 lateral sacral arteries,aa.sacrales taterales, top and bottom, sent to the bones and muscles of the sacral region. Them spinal branches,rr. spinales, go through the anterior sacral foramen to the membranes of the spinal cord.

3superior gluteal artery,a. glutedlis superior, exits the pelvis through the suprapiriform opening, where it divides into superficial branch,superficial, to the gluteal muscles and skin, and deep branch,profundus. The latter, in turn, breaks down into upper and lower branchesrr. superior et inferior, which supply blood to the gluteal muscles, mainly the middle and small, and adjacent pelvic muscles. The lower branch, in addition, is involved in the blood supply to the hip joint. The superior gluteal artery anastomoses with branches of the lateral circumflex femoral artery (from the deep femoral artery).

4umbilical artery,a. umbilicdlis (functions throughout the entire length only in the embryo), goes forward and upward, rises along the back surface of the anterior wall of the abdomen (under the peritoneum) to the navel. In an adult, it is stored as a medial umbilical ligament. From the initial part of the artery depart superior vesical arteries, aa.vesicates supe­ priores, who give ureteral branches,rr. ureterici, to the lower ureter, and vas deferens artery,a. ductus deferentis.

5inferior vesical artery,a. vesicalis inferior, in men it gives off branches to the seminal vesicles and the prostate gland, and in women to the vagina.

6uterine artery,a. uterina, descends into the pelvic cavity, crosses the ureter and between the sheets of the broad uterine ligament reaches the cervix. Gives away vaginal branches,rr. vagindles, tubal and ovarian branches,tubarius etG.ovaricus. ovarian branch in the mesentery of the ovary anastomoses with the branches of the ovarian artery (from the abdominal aorta).

7middle rectal artery,a. rectalis media, goes to the lateral wall of the ampulla of the rectum, to the muscle that lifts the anus, gives off branches to the seminal vesicles and the prostate gland in men and to the vagina in women. Anastomoses with branches of the superior and inferior rectal arteries.

8internal pudendal artery,a. pudenda interna, exits the pelvic cavity through the subpiri-shaped opening, and then through the small sciatic opening follows into the ischiorectal fossa, where it is adjacent to the inner surface of the obturator internus muscle. In the ischiorectal fossa gives inferior rectal artery,a. rectalis inferior, and then divided by perineal artery,a. perinealis, and a number of other vessels: in men it is urethral artery,a. urethralis, artery of the bulb of the penis,a. bulbi penis, deep and dorsal arteries of the penis,aa. profunda et dorsdlis pe­ nis; women also urethral artery,a. urethralis, artery of the bulb of the vestibule (vagina),aa. bulbi vestibuli (va­ ginae), deep and dorsal arteries of the clitoris,aa. profunda et dorsalis clitoridis.

9obturator artery,a. obturatoria, along with the nerve of the same name along the side wall of the small pelvis is sent through the obturator canal to the thigh, where it is divided into anterior branch,anterior, blood supply to the external obturator and adductor muscles of the thigh, as well as the skin of the external genitalia, and posterior branch,posterior, which also supplies blood to the obturator externus muscle and gives acetabular branch,acetabularis, to the hip joint. The acetabular branch not only nourishes the walls of the acetabulum, but as part of the ligament of the femoral head reaches the femoral head. In the pelvic cavity, the obturator artery gives pubic branch, g. ri-bicus, which, at the medial semicircle of the annulus of the femoral canal, anastomoses with the obturator branch from the inferior epigastric artery. With a developed anastomosis (at 30 % cases) a. obturatdrius thickened and can be damaged by hernia repair (so-called corona Mortis).

10. inferior gluteal artery,a. glutealis inferior, goes along with the internal pudendal artery and the sciatic nerve through the piriformis opening to the gluteus maximus muscle, gives off a thin long artery that accompanies the sciatic nervea. comitans nervous ischiadici.

external iliac artery,a. iliaca externa, serves as a continuation of the common iliac artery. Through the vascular lacuna, it goes to the thigh, where it receives the name of the femoral artery. The following branches depart from the external iliac artery:

1. inferior epigastric artery, a. epigastrica inferior, rises along the posterior surface of the anterior abdominal wall retroperitoneally to the rectus abdominis muscle; departs from its initial department pubic branch, Mr.pubicus, to the pubic bone and its periosteum, from which, in turn, a thin obturator branch, g.obturatdrius, anastomosing with a pubic branch from the obturator artery (see above), and cremaster artery,a. cremasterica (in men). The cremasteric artery departs from the inferior epigastric artery at the deep inguinal ring, supplies blood to the membranes of the spermatic cord and testicle, as well as the muscle that lifts the testicle. In women, this artery is similar artery of the round ligament of the uterus,a. lig. teretis uteri, which, as part of this ligament, reaches the skin of the external genitalia. 2. Deep circumflex artery of the iliuma. cir­ cumflexa iliaca profunda, goes along the iliac crest posteriorly, gives off branches to the abdominal muscles and nearby pelvic muscles, anastomoses with the branches of the iliac-lumbar artery.