The iliac arteries are one of the largest vessels in the body. They are paired vessels with a length of up to 7 cm and a diameter of up to 13 mm. 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 junction of the sacrum and ilium is located, these vessels are divided into the external and internal iliac arteries.
Iliac common artery
It should be laterally and down to the pelvis.
In the area of the iliac-sacral joint, the common iliac artery is divided into the internal and external arteries of the same name, following the thigh and pelvis.
A. iliaca interna
The internal iliac artery (2) feeds the organs and walls of the pelvis. It falls along the inner side of the lumbar (large) muscle.
In the region of the upper part of the sciatic large opening, parietal and visceral arteries branch from the vessel.
Wall branches
- Lumbar-iliac branch (3). It follows laterally and behind the lumbar large muscle, giving branches to the iliac muscle and the same bone, 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). They feed the deep muscles of the back, the sacrum, the spinal cord (nerve roots and membranes), the ligaments of the coccyx and sacrum, the piriformis muscle, the muscle that raises the anus.
- Obstructive artery (6). It follows the front on the sides of the pelvis. The branches of this vessel are: the pubic, anterior, posterior arteries that nourish the skin of the genitals, the obturator and adductor muscles of the thigh, the hip joint, the femur (its head), the pubic symphysis, the ileum, thin, crested, lumbar-iliac, square muscles, obturator (external, internal) muscles and muscles that raise the anus.
- Gluteal lower artery (7). From the small pelvis goes through the pear-shaped hole. It nourishes the skin in the gluteal region, the hip joint, square, semi-membranous, gluteus maximus, pear-shaped, semi-tendonous, adducting (large) muscles, twin (lower, upper), obstructive (internal, external) muscles and the biceps femoral muscle (its long head).
- Gluteal superior artery (5). It follows laterally and through the supra-pear-shaped opening passes to the muscles and skin of the gluteal region in the form of deep and superficial branches. These vessels nourish small, medium gluteal muscles, the hip joint, and the skin of the buttocks.
Visceral branches
- Umbilical artery (13, 14). It runs along the back surface of the abdominal wall, rising to the navel. In the antenatal period, this vessel functions fully. After birth, the main part of it starts up and becomes an umbilical ligament. However, a small part of the vessel still functions and gives up the urinary bladder upper arteries and the artery of the vas deferens, which feed the walls of the latter, as well as the bladder and ureter walls.
- Uterine artery. It follows between the leaves of the wide uterine ligament to the uterus, crossing the pathway with the ureter and giving back the tubular, ovarian and vaginal branches. R.tubarius feeds 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). It follows to the rectum (lateral wall of its ampoule), feeding the muscle that raises the anus, ureter, lower and middle rectal sections, in women - the vagina, and in men - the prostate and seminal vesicles.
- The genital (internal) artery (10) is the terminal branch from the iliac internal artery. The vessel comes out, accompanied by the gluteal inferior artery through the piriform aperture, around the sciatic spine, again enters the small pelvis (into the region of the rectum-sciatic fossa) through the sciatic (small) opening. In this fossa, the artery gives up the rectal inferior artery (11), and then branches into: dorsal artery of the penis (clitoris), perineal artery, urethral artery, deep clitoris artery (penis), a vessel that feeds the bulb of the penis and artery that feeds the bulb of the vestibule. All of the above arteries feed the corresponding organs (obstructive internal muscle, lower rectum, genital external organs, urethra, bulbourethral glands, vagina, muscles and perineal skin).
A. iliaca externa
The external iliac artery begins in the area of the iliac-sacral joint and is a continuation of the iliac common artery.
The iliac artery (marked by an arrow) follows downward and forward along the inner surface of the lumbar large muscle to the inguinal ligament, passing under which through a vascular lacuna, it turns into a femoral artery. The branches that give the iliac external artery feed the labia and pubis, scrotum, iliac muscle and muscles of the abdomen.
Branches of the iliac external artery
- Epigastric inferior artery (1). It follows medially, and then up the rectus abdominis muscle (its posterior part). The vessel gives up several branches: the pubic artery, which nourishes the periosteum and pubic bone; a cremasteric artery (branches in the region of the inguinal deep ring in men) that feeds the testicles of the spermatic cord and muscles, which raises the testicle or artery of the uterine uterus (in women), directed to the skin on the genitals.
- The deep artery that surrounds the ilium (2). It originates from under the inguinal ligament and sits outward and upward parallel to the ileal crest, forming an anastomosis with branches from the lumbar-iliac artery. The deep artery feeds the wall (front) of the abdomen and its constituent muscles: iliac, transverse, tailor, oblique, as well as straining the wide fascia on the thigh.
Iliac Artery Occlusion
The reasons for the development of occlusion / stenosis of these arteries are the presence of aortoarteritis, thromboangiitis obliterans, muscle-fibrous dysplasia and atherosclerosis.
The occurrence of this pathology leads to tissue hypoxia and disorders of tissue metabolism, and, as a consequence, to the development of metabolic acidosis and the accumulation of metabolic unoxidized products. The properties of platelets change, as a result of which the viscosity of the blood increases and multiple blood clots form.
There are several types of occlusion (in accordance with the etiology):
- Post-traumatic.
- Postembolic.
- Iatrogenic.
- Aortitis is nonspecific.
- Mixed forms of atherosclerosis, aortitis and arteritis.
In accordance with the nature of the damage to the iliac arteries, there are:
- The chronic process.
- Stenosis.
- Acute thrombosis.
This pathology is characterized by several syndromes:
- Ischemia of the lower extremities (the appearance of coldness of the legs, intermittent claudication, numbness, fatigue and paresthesia).
- Impotence (ischemia of organs in the pelvis, impaired blood supply to the spinal cord (its lower sections)).
Occlusion therapy is carried out both by conservative and surgical methods.
Conservative treatment is aimed at optimizing blood coagulation, eliminating pain and vasospasm. For this, ganglion blockers, antispasmodics and so on are prescribed.
In case of severe lameness, pain at rest, tissue necrosis, embolism, surgical operations are used. At the same time, the damaged part of the ileal artery is removed, plaque removal surgery, sympathectomy, or a combination of various techniques.
Iliac Artery Aneurysms
At first, it is asymptomatic, and only after a significant increase it begins to manifest clinically.
Aneurysm is a sack-like protrusion of the vascular wall, as a result of which the elasticity of the tissues is significantly reduced and replaced by connective tissue growths.
The causes of aneurysm can be: atherosclerosis of the iliac arteries, trauma, GB.
This pathology is dangerous by the development of a formidable complication - rupture of the aneurysm, which is accompanied by massive bleeding, lowering blood pressure, heart rate and collapse.
In case of blood supply disturbance, thrombosis of the vessels of the thigh, lower leg and pelvis may develop in the aneurysm, which is accompanied by dysuria and intense pain.
This pathology is diagnosed using ultrasound, CT or MRI, angiography and duplex scanning.