The iliac arteries are one of the largest blood 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 divide into the external and internal iliac arteries.
Common iliac artery
Follow laterally and down to the pelvis.
In the region of the iliac-sacral joint, the common iliac artery divides into the 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 upper part of the sciatic foramen, the parietal and visceral arteries branch off from the vessel.
Wall branches
- Lumboiliac branch (3). Follows laterally and behind the psoas major muscle, giving branches to the iliacmuscle and 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.
- Sacral lateral arteries (4). Nourish the deep muscles of the back, sacrum, spinal cord (nerve roots and sheaths), ligaments of the coccyx and sacrum, piriformis muscle, 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 the 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.
Visceral branches
- Umbilical artery (13, 14). Runs along the posterior surface of the abdominal wall, rising tonavel. 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 vesical superior 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). Follows to 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.
- Genital (internal) artery (10) - the final branch from the iliac internal artery. The vessel leaves, accompanied by the gluteal inferior artery, through the subpiri-shaped foramen, bending around the ischial spine, again penetrates into the small pelvis (in the area of the recto-sciatic fossa) through the ischial (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 arteriesnourish the relevant organs (obturator internus, lower rectum, genital external organs, urethra, bulbourethral glands, vagina, 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.
Follows the iliac artery (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. Branches from the external iliac artery supply the labia and pubis, scrotum, iliac muscle, and abdominal muscles.
Branches of the external iliac artery
- Inferior epigastric artery (1). It follows medially and then up the rectus abdominis (its posterior part). The vessel gives off several branches: the pubic artery, which feeds the periosteum and pubic bone; cremaster artery (branches in the region of the inguinal deep ring in men), which feeds the membranes of the testicles of the spermatic cords and muscle, which raises the testicle or the artery of the round uterine ligament (in women), heading to the skin on the genitals.
- Deep artery that goes around the ilium (2). It originates from under the inguinal ligament and sedates outward and upward parallel to the iliac crest, forming an anastomosis with branches from the lumboiliac artery. The deep artery feeds the wall(anterior) abdomen and its constituent muscles: iliac, transverse, tailor, oblique, and also straining the fascia lata on the thigh.
Iliac artery occlusion
The causes 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 tissue metabolism disorders, 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, blood viscosity increases and multiple blood clots form.
There are several types of occlusion (according to etiology):
- Post-traumatic.
- Postembolic.
- Iatrogenic.
- Aortitis nonspecific.
- Mixed forms of atherosclerosis, aortitis and arteritis.
In accordance with the nature of the damage to the iliac arteries, they are distinguished:
- Chronic process.
- Stenosis.
- Acute thrombosis.
This pathology is characterized by several syndromes:
- Ischemia of the lower extremities (appearance of chilly legs, intermittent claudication, numbness, fatigue and paresthesia).
- Impotence (ischemia of organs in the pelvis, impaired blood supply to the spinal cord (its lower parts)).
Occlusion is treated with both conservative and surgical methods.
Conservative treatmentIt is aimed at optimizing blood coagulation, eliminating pain and vasospasm. For this, ganglionic blockers, antispasmodics, and so on are prescribed.
In 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, plaque removal surgery, sympathectomy, or a combination of various techniques.
Iliac artery aneurysms
Initially asymptomatic, and only after a significant increase begins to manifest itself clinically.
Aneurysm is a sac-like protrusion of the vascular wall, as a result of which tissue elasticity is significantly reduced and replaced by connective tissue growths.
Aneurysm can be caused by: atherosclerosis of the iliac arteries, trauma, HD.
This pathology is dangerous for the development of a formidable complication - aneurysm rupture, which is accompanied by massive bleeding, lowering blood pressure, heart rate and collapse.
In case of circulatory disorders in the aneurysm area, 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.
