Pelvic and Perineal Angiology Lecture (Dr. Olinger)

Question 1

Abdominal Aorta (continuation of Thoracic Aorta after passing through Aortic
Hiatus of Diaphragm)

Answer 1

1. (♂) TESTICULAR A. (travels inferiorly through Inguinal Canal into the scrotum, inside the Spermatic Cord, supplies the Testis)
2. (♀) OVARIAN A. (branches from the Abdominal Aorta between the Renal A. and the Inferior Mesenteric A., travels inferiorly into the Pelvis through the Suspensory L. of the Ovary, branches into Ovarian and Tubal Branches)
   a. OVARIAN Branches (supply the Ovary)

b. TUBAL Branches (supply the Uterine Tubes)

3. INFERIOR MESENTERIC A. (see Gastrointestinal Section)
   a. SUPERIOR RECTAL A. (travels over Left Common Iliac vessels into Pelvis to supply the superior aspect of the Rectum, anastomoses with Middle and Inferior Rectal A.)
4. MEDIAN SACRAL A. (from posterior aspect of Abdominal Aorta, just prior to Common Iliac branching, travels inferiorly in the Median Plane, over L4, L5, Sacrum and Coccyx)
5. COMMON ILIAC A. (paired terminal branches of the Abdominal Aorta)

Question 2

Common Iliac A. (paired terminal branches of the Abdominal Aorta)

Answer 2

A). EXTERNAL ILIAC A. (see Gastrointestinal Section)

B). FEMORAL A. (continuation of External Iliac A., distal to the
Inguinal L.)
1. SUPERFICIAL and DEEP EXTERNAL PUDENDAL A. (producesAnterior Scrotal A. and Anterior Labial A.)
a. (♂) ANTERIOR SCROTAL A. (supply the Scrotum)

b. (♀) ANTERIOR LABIAL A. (supply the Labia Majora)

C). INTERNAL ILIAC A. (enters the Pelvic Cavity, supplies Pelvic
Organs, Gluteal muscles and Perineum)

Question 3

Internal Iliac Artery

ANTERIOR DIVISION

Answer 3

A). Umbilical A. (travels anteriorly, produces Superior Vesical A. and becomes the Medial Umbilical L.) i. SUPERIOR VESICAL A. (numerous branches, supply the superior aspect of Urinary Bladder)

B). OBTURATOR A. (travels anteroinferiorly along lateral Pelvic Wall, exits Pelvic Cavity through Obturator Canal, supplies Pelvic muscles, Ilium B., Femoral Head, muscles of Medial Thigh)

C). (♂) INFERIOR VESICAL A. (travels inferiorly to posterior aspect of Urinary Bladder, supplies Seminal Vesicles, Prostate Gland, Ductus Deferens, Ureters and Urinary Bladder, analogous to Vaginal A. in Female)
i. PROSTATIC BRANCH (travels on posterolateral aspect of Prostate Gland to supply

ii. ARTERY to DUCTUS DEFERENS (travels retroperitoneally to Ductus Deferens)

D). (♀) UTERINE A. (travels medially in Broad L. of the Uterus, supplies the Uterus, Uterine Tubes, Ovaries and Ureters, developmentally homologous to the Artery of the Ductus Deferens in the Male)
i. VAGINAL BRANCH (supplies Vagina and Cervix)

ii. OVARIAN BRANCHES (supply the Ovary)
iii. TUBAL BRANCHES (supply the Uterine Tubes)

E). VAGINAL A. (can originate from Uterine A., lateral to Uterus, travels inferiorly to lateral aspect of Vagina)

F). MIDDLE RECTAL A. (travels inferiorly to inferior part of the Rectum, supplies inferior Rectum, Anal Canal and Seminal Vesicles in Males)

G). INFERIOR GLUTEAL A. (exits Pelvic Cavity through Greater Sciatic Foramen, inferior to Piriformis M., supplies the Coccygeus M., the three Levator Ani muscles, Piriformis M., Quadratus Femoris M., upper most posterior Thigh muscles, Gluteus Maximus M. and Sciatic N.)

F). INTERNAL PUDENDAL A. (exits Pelvic Cavity through Greater Sciatic Foramen, turns around Ischial Spine and enters Perineum through Lesser Sciatic Foramen, before entering the Pudendal Canal)

Question 4

Internal Pudendal Artery

Answer 4

i. INFERIOR RECTAL A. (exits Pudendal Canal crossing Ischioanal Fossa to Anal Canal, supplies distal Anal Canal)

ii. PERINEAL A. (exits Pudendal Canal enters Superficial Perineal Space)
A. (♂) POSTERIOR SCROTAL A. (terminal branches of Perineal A., travels in superficial fascia of posterior aspect of Scrotum)

(B.♀) POSTERIOR LABIAL A. (terminal branches of Perineal A., travels in superficial fascia of Labia Majora)

iii. (♂) ARTERY OF BULB OF PENIS (pierces Perineal Membrane to supply Bulb of Penis and Bulbourethral Gland, analogous to Artery of Vestibule of Vagina in Female)
iv. (♂) DEEP A. OF PENIS (terminal branch of Internal Pudendal A., pierces Perineal Membrane to enter and supply Corpora Cavernosa of Penis)
v. (♂)DORSAL A. OF PENIS (terminal branch of Internal Pudendal A., pierces Perineal Membrane, passes through Suspensory L. of Penis, travels on dorsum of Penis, supplies the Skin of the Penis and erectile tissue)
vi. (♀) ARTERY OF VESTIBULE OF VAGINA (pierces Perineal Membrane, supplies Vaginal Vestibule and Greater Vestibular Gland, analogous to Artery of Bulb of Penis)

vii. (♀) DEEP A. OF CLITORIS (terminal
branch of Internal Pudendal A., pierces Perineal
Membrane to enter and supply the Clitoris)

viii. (♀) DORSAL A. OF CLITORIS (terminal branch of Internal Pudendal A., pierces Perineal Membrane, supplies the Skin over the Clitoris and erectile tissue)

Question 5

Internal Iliac Artery

POSTERIOR DIVISION

Answer 5

A). ILIOLUMBAR A. (travels superolaterally to enter the Iliac Fossa, branches into an Iliac Branch and a Lumbar
Branch)
i. ILIAC BRANCH (supplies the Ilium and Iliacus M.)

ii. LUMBAR BRANCH (supplies the Psoas Major M. and Quadratus Lumborum M.)

B). LATERAL SACRAL A. (travels on anteromedial aspect of Piriformis M., sending branches into the ventral Sacral Foramina, supplies the Piriformis M., structures in Sacral Canal and Erector Spinae muscles)

C). SUPERIOR GLUTEAL A. (exits Pelvic Cavity through Greater Sciatic Foramen, superior to Piriformis M., supplies Piriformis M., Gluteus Maximus M., Gluteus Medius M., Gluteus Minimus M. and Tensor Fascia Lata M.)

Question 6

Veins (primarily analogous and named for corresponding artery)

Answer 6

1. PAMPINIFORM VENOUS PLEXUS ((♂) inside Spermatic Cord, drains to Testicular V., (♀) inside the Suspensory L. of the Ovary drains to the Ovarian V.)
2. INTERNAL RECTAL VENOUS PLEXUS (superior most anastomosis of the Superior, Middle and Inferior Rectal V.)
3. EXTERNAL RECTAL VENOUS PLEXUS (near the anus, inferior most anastomosis of the Superior, Middle and Inferior Rectal V.)

Question 7

Clinical Note: Internal and External Hemorrhoids

Answer 7

• INTERNAL Hemorrhoids “Piles” are the prolapse of the mucosa containing the Internal Rectal Venous Plexus, impede blood flow.
• EXTERNAL Hemorrhoids are produced by blood clots in the External Rectal Venous Plexus, which bulge out the mucosa and overlying Skin and are painful.

Question 8

Lymphatics

Pelvic Lymph Nodes

Answer 8

A). LATERAL AORTIC (Lumbar) LYMPH NODES (drain the Ureters, Fundus of the Uterus, Uterine Tubes and Ovaries)

B). INFERIOR MESENTERIC LYMPH NODES (see Abdomen)

C). COMMON ILIAC LYMPH NODES (drain the Ureters, Urinary Bladder and inferior part of the Vagina)

D). INTERNAL ILIAC LYMPH NODES (drain the Ureters, posterior Urinary bladder, Urethra, Seminal Vesicles, Prostate Gland, superior and middle Vagina, Uterine Cervix, Rectum and superior part of the Anal Canal)

E). EXTERNAL ILIAC LYMPH NODES (drain the Ureters, anterior Urinary Bladder, Ductus Deferens, Ejaculatory Ducts, superior Vagina, Fundus and Body of the Uterus)

F). SUPERFICIAL INGUINAL LYMPH NODES (drain the inferior Vagina, Fundus of the Uterus, Inferior Anal Canal, Scrotum, Penis and Female Pudendum)

G). DEEP INGUINAL LYMPH NODES (drain the Spongy Urethra)

H). SACRAL LYMPH NODES (drain the Urinary Bladder, Urethra,Prostate Gland, inferior Vagina and Uterine Cervix)

I). PARARECTAL LYMPH NODES (drain the Rectum)