Vessels of the pelvis

Vessels of the pelvis
Review anatomy of pelvic vessels for MRCOG part 1

1. Vessels of the pelvis
REVIEW ANATOMY OF OBS/GYN
WRITTEN BY: DRLOWTALKSOG

2. The pelvic blood vessels supply genital
structures as well as the following:
•Urinary and gastrointestinal tracts
•Muscles of the abdominal wall, pelvic
floor and perineum, buttocks, and
upper thighs
•Fasciae, other connective tissue, and
bones
•Skin and other superficial structures
Classically, vessels supplying organs are
known as visceral vesselsand
those supplyingsupporting structures are
called parietal vessels.

4. right and left
common iliac arteries
covered in
parietal peritoneum

5. •Posteriorly
inferior vena cava.
anterolateral
sacroiliac joint
internal &
externa divisions.

6. •Origin:
•Course:
•Venous drainage:

7. •Branches:
1)Superficial epigastric
2)External pudendal
3)Superficial circumflex iliac
4)Inferior epigastric
5)Deep circumflex iliac

8. 3) Internal iliac artery, IIA (hypogastric a.)
Origin:
Courses : internal arteries are
crossed anteriorly by the ureters as
they enter the pelvis.
Arising anterior to the sacroiliac
joint, the IIA continues to the level
of upper margin of the greater
sciatic notch, where they divide
into ant and post divisions.

9. •Courses of post division:
1.Superior gluteal
2.Lateral sacral
3.Iliolumbar arteries.

10. Courses of ant division:
URETER
OVARIAN ARTERY

11. obturator nerve
the division
of the common iliac vessels
the obturator canal
medial
compartment of the thigh.

12. 1)Umbilical artery
sup vesical branches
median umbilical ligament.

13. 2) Obturator artery

14. 3) Uterine artery
Through its course, apart from supplying numerous branches to
the uterine muscle, the uterine artery also supplies the cervix,
round ligament of uterus & vagina through vaginal branches.

15. ）vaginal artery
Middle rectal artery(hemorrhoidal
) Inferior vesical arteries
Internal pudendal artery & inferior
gluteal artery (terminal branches of
IIA

16. internal pudendal artery
between coccygeus& piriformis
pudendal nerve
perineum
or Alcock’s

17. Clinical relevance
It is IMPORTANT to know the relationship between
the uterine artery & the ureter at the junction with the
cervix to prevent accidental ligation of the ureter at
this level !

18. ischioanal
fossa
2 veins & the pudendal
nerve.
the 2 terminal
branches of the pudendal nerve

19. pudendal
artery
2 veins & the pudendal
nerve.
the 2 terminal branches of
the pudendal nerve

21. The inferior rectal artery
branches from the internal
pudendal artery at the start of the
pudendal canal.
Just superior to the ischial
tuberosity it emerges from the
medial wall of the sheath, crossing
the ischioanalfossa to supply the
skin and muscles of the anal
region.

22. perineal artery

23. •The inferior gluteal artery

24. “Control Blood Supply” & “Maintain meticulous hemostasis”
surgical practice:
1)The pelvic vessels play an important role in pelvic support.
2)There is significant anatomic variation between individuals in the branching
pattern of the internal iliac vessels.
3)The pelvic vasculature is a high volume, high-flow system with enormous
expansive capabilities throughout reproductive life.
4)The pelvic vasculature is supplied with an extensive network of collateral
connections that provides a rich anastomotic community between different
major vessel systems.

25. 1.The pelvic vessels play an important
role in pelvic support.
They provide condensations of endopelvicfascia that
act to reinforce the normal position of pelvic organs.

26. 2. There is significant anatomic variation
between individuals in the branching pattern
of the internal iliac vessels.
•No constant order in which branches divide from the parent vessels.
•A branch may arise from another vessel entirely:
Ex 1: Obturator artery may arise from the external iliac artery OR
inferior epigastric artery.
Ex 2: Ovarian arteries may arise from renal arteries OR from the front or
aorta on occasion.
Ex 3: Inferior gluteal artery may originate from post or ant branch of
internal iliac (hypogastric) artery.

27. 3. The pelvic vasculatureis a high volume,
high-flow system with enormous expansive
capabilities throughout reproductive life.
•Blood flow through the uterine arteries increases to about 500 mL/min in
late pregnancy. In non-pregnant women, certain conditions, such as
uterine fibroids or malignant neoplasms, may be associated with
neovascularization & hypertrophy of existing vessels & a corresponding
increase in pelvic blood flow.
•Understanding the volume & flow characteristics of the pelvic vasculature
in different clinical situations will enable the surgeon to anticipate
problems & take appropriate preoperative & intraoperative measures (
including the blood product availability) to prevent or manage
hemorrhage).

28. 4. The pelvic vasculature is supplied with an extensive network
of collateral connectionsthat provides a rich anastomotic
community between different major vessel systems.
•This degree of redundancy is important to ensure adequate supply of oxygen
& nutrients in the event of major traumaor other vascular compromise.
•Hypogastric artery ligation continues to be used as a strategy for
management of massive pelvic hemorrhage when other measures have failed.
•Bilateral hypogastric artery ligation, particularly when combined with
ovarian artery ligation, dramatically reduces pulse pressure in the pelvis,
converting flow characteristics from that arterial system to a venous system
& allowing use of collateral channels of circulation to continue blood supply
to pelvic structures.
•The significance of collateral blood flow is demonstrated by reports of
successful pregnancies occurring after bilateral ligation of both hypogastric
& ovarian arteries.

29. Thank you
for your attention!
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WRITTEN BY: DRLOWTALKSOG