The Internal Iliac Artery

The internal iliac or hypogastric arteries (Aa. hypogastricæ) result from the bifurcation of the aorta under the fifth or sixth lumbar vertebra. They diverge at an angle of about 60 degrees, and each passes backward under the wing of the sacrum, then inclines downward on the pelvic surface of the shaft of the ilium, and divides a little above the psoas tubercle into iliaco-femoral and obturator arteries. The chief branches are as follows:

1. The last pair of lumbar arteries pass up through the foramina at the junction of the last lumbar vertebra and the sacrum.

2. The internal pudic artery (A. pudenda interna) arises near the origin of the internal iliac. It passes backward and somewhat downward, at first along the iliac head of the obturator internus, then above the superior ischiatic spine on the inner surface of the sacro-sciatic ligament, perforates the latter and runs for a variable distance in its substance or on its external face. It then re-enters the pelvic cavity, passes backward on the retractor ani to the ischial arch, and divides into the perineal and the artery of the bulb in the male, perineal and artery of the clitoris in the female. It is accompanied by the internal pudic nerve. Its chief branches are as follows:

(1) The umbilical artery is given off from the internal pudic about an inch (ca. 2 to 3 cm.) from the origin of that vessel. It is a very large artery in the fœtus, in which it curves downward and forward at the side of the bladder in the edge of the umbilical fold of peritoneum, passes through the umbilical opening, becomes a component of the umbilical cord and ramifies in the fœtal placenta. After birth it extends only to the vertex of the bladder and is much reduced. Its lumen is almost obliterated and its wall is very thick, giving the vessel a cord-like character, hence it is commonly termed the round ligament of the bladder. It gives off small vesical branches (Aa. vesicates craniales) to the bladder, and twigs to the prostate and vasa deferens in the male. In the mare a small branch runs forward along the ureter into the broad ligament of the uterus.

(2) The middle hæmorrhoidal or vesico-prostatic artery (A. hæmorrhoidalis media) in the male arises usually near the prostate and runs backward lateral to the rectum. It supplies branches to the rectum, bladder, urethra, and accessory genital glands. In the female the homologous vessel is much larger and gives off the posterior uterine artery (A. uterina caudalis). This runs forward on the side of the vagina, to which it gives branches, and ramifies on the body of the uterus, anastomosing with the anterior and middle uterine arteries. (In some cases this artery arises from the internal iliac or the umbilical.)

(3) The perineal artery (A. perinei) is relatively small in the male. It passes upward at the side of the anus, which it supplies, and gives twigs to the bulbo-cavernosus muscle and the skin of the perineum. In the female it is large and is distributed to the anus and vulva, and gives a large branch to the vestibular bulb.

(4) The artery of the bulb (A. bulbi urethræ) may be regarded as the direct continuation of the internal pudic in the male. It lies at the side of the urethra above the ischial arch, dips under the bulbo-cavernosus muscle, and ramifies in the corpus spongiosum. Before doing so it gives off a small branch which turns around the ischial arch to reach the dorsum penis, and anastomoses with the deep branch of the obturator.

(4a) The artery of the clitoris (A. clitoridis) is the homologue in the female of the preceding vessel, but is much smaller. It passes to the ventral surface of the vulva with the internal pudic nerve, supplies the clitoris, and gives twigs to the vulva.

3. The lateral sacral artery (A. sacralis lateralis) arises at the lumbo-sacral articulation (Fig. ). It passes backward under the wing of the sacrum, then along the pelvic surface of the bone below the inferior sacral foramina and the nerves emerging from them, and is continued by the lateral coccygeal artery. The branches are as follows:

(1) Spinal branches (Rami spinales) enter the vertebral canal through the foramen between the last lumbar vertebra and the sacrum and through the ventral sacral foramina. They give off branches to the spinal cord and its membranes which reinforce the ventral spinal artery, and others which emerge through the dorsal sacral foramina and supply the muscles and skin of the croup.

(2) The middle coccygeal artery (A. coccygea) is an unpaired vessel which arises from the right or left lateral sacral or from a lateral coccygeal artery. It passes backward on the pelvic surface of the sacrum to the median line and continues in that position along the tail between the depressor muscles, supplying these and the skin.

(3) The posterior gluteal or ischiatic artery (A. glutea caudalis) emerges through the upper part of the sacro-sciatic ligament and runs backward and downward on the latter under cover of the biceps femoris (Fig. ). It gives branches to that muscle and to the semitendinosus and semimembranosus, and anastomoses with the obturator, deep femoral, and posterior femoral arteries.

(4) The lateral coccygeal artery (A. caudalis lateralis ventralis) continues the direction of the lateral sacral, but is much smaller than the preceding vessel. It passes back between the depressor and intertransversales muscles of the tail and divides into two branches which supply twigs to the muscles and skin.

4. The ilio-lumbar artery (A. iliolumbalis) arises at a right angle from the internal iliac and runs outward behind the sacro-iliac joint, crossing the ventral surface of the ilium under cover of the iliacus muscle. It gives branches to the ilio-psoas and longissimus, and terminates by turning around the external border of the ilium a little behind the external angle, giving branches to the gluteus medius and tensor fasciæ latæ (Fig. ).

5. The anterior gluteal artery (A. glutea cranialis) is the largest branch of the internal iliac. It arises usually opposite to the preceding vessel and passes outward through the great sacro-sciatic foramen, dividing into several branches as it emerges; these enter the gluteal muscles (Fig. ).

6. The iliaco-femoral or external circumflex artery (A. cireumflexa femoris lateralis) passes downward and outward across and beneath the shaft of the ilium, under cover of the iliacus muscle, and dips in between the rectus femoris and vastus externus. It is accompanied by two satellite veins. It gives collateral branches to the ilio-psoas, the glutei, and the tensor fasciæ latæ, supplies the nutrient artery of the ilium, and terminates in the quadriceps femoris (Fig. ).

7. The obturator artery (A. obturatoria), the inner terminal branch of the internal iliac, passes downward and backward on the pelvic surface of the shaft of the ilium along the ventral border of the iliac head of the obturator internus, accompanied by the satellite vein and nerve, which lie in front of the artery (Fig. ). On reaching the anterior border of the obturator foramen it dips under the obturator internus and passes obliquely through the foramen. In this part of its course it gives off a vesical branch and twigs to the obturator internus and the hip joint. After its emergence from the pelvic cavity it runs backward on the ventral face of the ischium, passes through the semimembranosus and, in the male, enters the crus penis, forming the arteria profunda penis. It anastomoses with the internal pudic, and usually with the external pudic by a branch which runs forward on the dorsum penis. Large collateral branches are detached to the adductors of the thigh, the biceps femoris and semitendinosus, forming anastomoses with the deep femoral and posterior femoral arteries. In the female the terminal part is small and enters the root of the clitoris.