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Anatomy - Right knee disarticulation for Fontaine stage IV peripheral arterial disease (PAD).

  1. Arterial supply of the pelvis

    Arterial supply of the pelvis
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    • The abdominal aorta divides at the aortic bifurcation (around the level of L4) into the two common iliac arteries
    • Each common iliac artery in turn divides into an internal and an external iliac artery
    • With its visceral branches, the internal iliac artery supplies mainly the pelvic viscera, while with its parietal branches it contributes to the blood supply of the lower extremities
    • The external iliac artery contributes to the blood supply of the pelvis and, after passing through the lacuna vasorum, becomes the femoral artery
    1. Internal iliac artery

    Origin

    • Arises from the common iliac artery immediately caudal to the aortic bifurcation

    Course

    • Courses caudad over the superior border of the sciatic foramen

    Anatomical Relationship

    • Posterior: internal iliac vein, piriformis muscle, lumbosacral plexus
    • Anterior: ureter
    • Lateral: external iliac vein, psoas major
    • Inferior: obturator nerve

    Branches

    Visceral branches:

    • Umbilical arteries
    • Inferior vesical artery
    • Middle rectal artery
    • In women: uterine artery

    Parietal branches:

    • Iliolumbar artery
    • Lateral sacral arteries
    • Superior gluteal artery
    • Inferior gluteal artery
    • Obturator artery
    • Internal pudendal artery

    Vascular territory

    • Pelvic organs, gluteal muscles
     
    2. External iliac artery

    Origin

    • Arises from the common iliac artery caudal to the internal iliac artery

    Course

    • Courses along the psoas major muscle to the inguinal ligament, passing through the lacuna vasorum where it becomes the femoral artery

    Anatomical Relationship

    • The right external iliac artery courses beneath the ureter
    • On the left, the ureter crosses somewhat lower, anterior to the bifurcation of the external iliac artery

    Branches

    • The deep circumflex iliac artery courses to the superior iliac spine and anastomoses with the iliolumbar artery and the superior gluteal artery
    • The inferior epigastric artery runs craniad medial to the deep inguinal ring and between the transverse abdominis and rectus abdominis muscles; other branches include the cremasteric artery and the artery of the round ligament of the uterus

    Vascular territory

    • Iliac bone, inferior aspect of the abdominal wall
Arterial blood supply to the lower extremity

1. Femoral artery1.1. OverviewOriginExternal iliac artery, which becomes the femoral artery after p

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