Arteries, Veins and Lymphatics of Pelvis and Gluteal Region

Question 1

Common iliac artery

Answer 1

o Splits between L5-S1

Question 2

External iliac artery

Answer 2

o External iliac is the larger terminal branch
o Runs along medial border of psoas major m.
o Runs from intervertebral disc to inguinal ligament
o Deep to ligament between symphysis pubis and ASIS

Question 3

External iliac artery is crossed by…

Answer 3

• Ureter
• Ovarian A/V
• Gential branch genitofemoral n
• Deep circumflex iliac v
• Ductus deferens
• Round ligament

Question 4

Inferior epigastric artery

Answer 4

• Branch of external iliac
• Ascends superior/medial subperitoneal tissues - through transversalis fascia and between rectus abdominis and posterior rectus sheath
• Forms lateral umbilical fold
• Anastomoses w/ branches superior epigastric a. above umbilicus

Question 5

Deep circumflex iliac artery

Answer 5

• Branch of external iliac
• Opposite origin inferior epigastric on medial side
• Lateral deep to inguinal ligament
• Ascends toward ASIS

Question 6

Femoral artery in the pelvis

Answer 6

Branches in the pelvis

• Superficial external pudendal
• Deep external pudendal
• Profunda femoris
• Lateral femoral circumflex
• Medial femoral circumflex

Question 7

Deep external pudendal

Answer 7

• Distal to superifical branch
• Medially across pectinues/adductor longus
• Anastomoses internal puedendal artery

Question 8

Profunda femoris

Answer 8

• 2-5 cm distal to inguinal ligament
• Largest branch of femoral
• From lateral aspect femoral
• Spirals posteriorinferior then to medial

Question 9

Lateral femoral circumflex

Answer 9

• Branch of profunda femoris (most often)
• Goes form rectus femoris & sartorius
• Ascending branch: superior and deep to fascia lata, enter fibrous capsule as retinacular branches and anastomoses with medial femoral circumflex, superior gluteal and deep circumflex iliac

Question 10

Medial femoral circumflex

Answer 10

• MOST IMPORTANT ADULTS FOR NECK OF FEMUR
• 25% comes off femoral
• Disappear btwn pectineus & psoas
• Enter fibrous capsule as retinacular branches
• Acetabular branches: opposite acetabular notch, enters with acetabular branch of obturator, supplies fat in acetabular fossa & around round ligament to head of femur
• Anastamose with lateral femoral circumflex

Question 11

Internal iliac artery

Answer 11

Supplies viscera, walls of pelvis

Question 12

Obturator artery

Answer 12

• Branch of internal iliac artery
• Joins obturator nerve in the lateral wall of the pelvis, they then enter obturator canal together
• Foveolar branch – travels in ligament head of femur, supplies head femur
• NEED FOR KIDS! –during ossification
• Adults doesn’t matter

Question 13

Internal iliac vein

Answer 13

Two veins drain into the internal iliac vein

• Superior gluteal vein
• Inferior gluteal vein

Question 14

Superior gluteal vein

Answer 14

• Located above piriformis

- Goes through greater sciatic foramen

Question 15

Inferior gluteal vein

Answer 15

• Anastomoses with medial femoral circumflex and 1st perforating
• Greater sciatic foramen is inferior to piriformis muscle

Question 16

Lymphatics of pelvis and gluteal region

Answer 16

• Superficial inguinal nodes
• Deep inguinal nodes
• External iliac nodes
• Internal iliac nodes

Question 17

Superficial inguinal nodes

Answer 17

• Form a lop-sided T
• Stem of T is parallel to the great saphenous vein
• Cross of T is parallel to the inguinal ligament

Question 18

Lymph nodes parallel to great saphenous vein

Answer 18

o Known as Inferior group
o Foot, leg, thigh, perineum
o 4-6 nodes

Question 19

Lymph nodes parallel to inguinal ligament

Answer 19

o Known as superior group
o Superifical, lateral protion gluteal region, anterior abdominal wall
o 5-7 nodes
o Pass primarily to external iliac nodes within false pelvis
o Some go deep inguinal lymph nodes

Question 20

Deep inguinal nodes

Answer 20

o 1-3 nodes
o Within femoral sheath
o Medial to femoral vein
o Lowest/most constant node below termination of great saphenous vein in femoral vein
o Intermediate node: most variable, midway along length femoral canal
o Uppermost: near femoral ring, superior to femoral canal – cloquet or node of Rosenmuller
o Vessles from: femoral, deep femoral, perineum, superirfical inguinal nodes
o Efferent go to external iliac

Question 21

External iliac nodes

Answer 21

o Above pelvic brim
o Afferent-from inguinal nodes
o Efferent- merge to common iliac

Question 22

Internal iliac nodes

Answer 22

o Within pelvis
o Afferent- pelvic organs, deeper gluteal regions
o Coruse with superior/inferior gluteal bv
o Efferent- common iliac