Vessel course and topography
The internal iliac artery originates at the bifurcation of the common iliac artery. From there, it courses inferiorly, entering the lesser pelvis cavity, and reaches the superior margin of the greater sciatic foramen (foramen ischiadicum majus). At this exact level, the vessel most frequently divides into two main branches. The first is the anterior trunk, which predominantly supplies visceral branches to the internal organs. The second is the posterior trunk, which provides blood supply to the parietal structures (muscles and fascia). Classical anatomy identifies precisely this pattern of bifurcation, although individual variations in branching are possible in practice.
Branches of the anterior trunk (visceral)
The anterior trunk supplies blood to the urogenital organs and the rectum. Its key branches include:
- Umbilical artery (a. umbilicalis) — in adults, its proximal part remains patent and gives rise to the superior vesical arteries (aa. vesicales superiores). The distal segment of the vessel obliterates, forming the medial umbilical ligament.
- Inferior vesical artery (a. vesicalis inferior) — supplies the neck of the urinary bladder, and in males, additionally supplies the prostate and seminal vesicles. In females, this function is frequently assumed by branches of the uterine or vaginal arteries.
- Middle rectal artery (a. rectalis media) — courses toward the ampulla of the rectum, forming anastomoses with the superior and inferior rectal arteries.
- Uterine artery (a. uterina) — a critical vessel of the female pelvis. It runs within the base of the broad ligament of the uterus, crossing the ureter, and gives off branches to the uterus, vagina, uterine tubes, and ovaries (where it anastomoses with the a. ovarica).
- Vaginal artery (a. vaginalis) — courses toward the vaginal fornices and the cervix of the uterus.
- Internal pudendal artery (a. pudenda interna) — a complex vessel that exits the pelvis through the infrapiriform foramen (foramen infrapiriforme), hooks around the ischial spine, and re-enters through the lesser sciatic foramen. It travels through Alcock's canal (pudendal canal), giving off the inferior rectal and perineal arteries, as well as the deep and dorsal arteries of the penis or clitoris.
- Obturator artery (a. obturatoria) — courses along the lateral pelvic wall into the obturator canal. It gives off pubic, anterior, and posterior branches. The posterior branch contains the important acetabular branch (r. acetabularis), which supplies the hip joint via the ligament of the head of the femur.
Branches of the posterior trunk (parietal)
The posterior trunk is dedicated to supplying the musculo-fascial structures of the pelvis and back. It includes the following vessels:
- Iliolumbar artery (a. iliolumbalis) — divides into lumbar and iliac branches, supplying the psoas major and iliacus muscles.
- Lateral sacral arteries (aa. sacrales laterales) — descend along the anterior surface of the sacrum. They pass through the pelvic sacral foramina to reach the spinal nerve roots and the erector spinae muscles.
- Superior gluteal artery (a. glutea superior) — the largest vessel of the posterior trunk. It exits the pelvis through the suprapiriform foramen (foramen suprapiriforme). Its superficial and deep branches supply the gluteus maximus, medius, and minimus muscles.
- Inferior gluteal artery (a. glutea inferior) — exits through the infrapiriform foramen alongside the sciatic nerve. It gives off a dedicated companion artery to the nerve (a. comitans n. ischiadici) and supplies the posterior compartment of the thigh.
Important anastomoses and clinical significance
The internal iliac artery system forms a number of critical vascular anastomoses, a thorough knowledge of which is essential for surgeons and traumatologists:
- Corona mortis (corona mortis): A specific vascular connection between the pubic branch of the obturator artery and the pubic branch of the inferior epigastric artery. During pelvic fractures or surgical approaches to the groin, injury to this large anastomosis carries a risk of massive and refractory hemorrhage.
- Ureter-uterine artery crossover: During gynecological procedures (such as a hysterectomy), the physician must account for the fact that the ureter lies strictly inferior to the uterine artery, creating a risk of accidental ligation.
- Gluteal network: An extensive vascular network connecting the superior and inferior gluteal arteries with branches of the femoral circumflex arteries and the perforating arteries of the thigh.
简述：主题相关问答
What branches does the internal pudendal artery give off in the ischioanal fossa and perineum?
In the ischioanal fossa and perineum, the internal pudendal artery gives off several branches to the pelvic organs and external genitalia.
- Inferior rectal arteries (aa. rectales inferiores)
- Perineal artery (a. perinealis) — gives off the posterior scrotal or labial branches.
- Artery of the bulb of the penis / vestibule (a. bulbi penis / a. bulbi vestibuli)
- Deep artery of the penis/clitoris (a. profunda penis/clitoridis)
- Dorsal artery of the penis/clitoris (a. dorsalis penis/clitoridis)
The vessel also gives off bulbar, urethral, and cavernosal branches.
With which arteries does the uterine artery anastomose?
The uterine artery forms anastomoses with vessels supplying the female reproductive organs.
- Ovarian artery (a. ovarica) — anastomoses with the ovarian branches of the uterine artery within the broad ligament of the uterus.
- Artery of the round ligament of the uterus (a. lig. teretis uteri) — connects with branches of the uterine artery ascending along the lateral margin of the uterus.
Which specific femoral arteries participate in forming the gluteal arterial network alongside the gluteal arteries?
Branches of the deep artery of the thigh participate in forming the gluteal arterial network (cruciate anastomosis) together with the superior and inferior gluteal arteries.
- Lateral femoral circumflex artery (a. circumflexa femoris lateralis) — participates via its ascending branch (r. ascendens).
- Medial femoral circumflex artery (a. circumflexa femoris medialis) — participates via its ascending branch.
- Perforating arteries (aa. perforantes) — specifically, the first perforating artery.
Which veins accompany the internal iliac artery and what venous plexuses do they form?
The internal iliac artery is accompanied by the corresponding internal iliac vein (v. iliaca interna), which lies posterior to the artery. Its tributaries, accompanying the branches of the artery, form a series of venous plexuses:
- Superior gluteal veins (vv. gluteae superiores) — accompany the artery as paired trunks, forming a plexus around it.
- Lateral sacral veins (vv. sacrales laterales) — form the sacral venous plexus (plexus venosus sacralis) on the pelvic surface of the sacrum.
Which groups of lymph nodes are located along the course of the internal iliac artery and its branches?
The internal iliac lymph nodes (nodi lymphoidei iliaci interni) are located along the course of the internal iliac artery. They include the following groups:
- Superior and inferior gluteal nodes (nodi gluteales superiores et inferiores)
- Sacral nodes (nodi sacrales)
Visceral pelvic lymph nodes include:
- Paravesical nodes (nodi lymphoidei paravesicales)
- Parauterine nodes (nodi lymphoidei parauterini)
- Paravaginal nodes (nodi lymphoidei paravaginales)
- Pararectal / anorectal nodes
The English mnemonic "Water under the bridge" is very helpful for remembering the topography in the female pelvis: urine (water/ureter) always flows strictly under the artery (bridge/uterine artery).
课堂与考试常见问题
阴部内动脉是如何离开盆腔的？
它经梨状肌下孔 (foramen infrapiriforme) 离开盆腔，绕过坐骨棘，再经坐骨小孔返回，进入坐骨直肠窝。
成年人脐动脉的特点是什么？
成年人仅其近端正常功能，分发出膀胱上动脉。该血管远端闭锁（纤维化），转化为脐内侧韧带。
闭孔动脉供应哪些结构？
它营养大腿内收肌、闭孔肌和大腿内侧皮肤。重要的一点是，它发出髋臼支 (r. acetabularis) 供应股骨头，这在儿童时期尤为重要。
该主题的其他拓展内容
- 阿尔科克管内阴部动脉的解剖及分支
- 臀部动脉网的形成机制
- 男女盆腔器官血液供应的区别
- 闭孔动脉的起始变异及“死亡之冠”的外科意义
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