Pelvic & Perineal Angiology Flashcards
1
Q
Abdominal Aorta
A
- Main vessel bringing blood supply to the lower portion of the body
- Branches into Left and Right Common Iliac Artery around the level of L4 vertebrae
2
Q
External Iliac Artery exits under the ___ ____ (femoral artery) while the __ ___ ___ goes on to branch and supply the pelvic viscera
A
- Inguinal Ligament
- Internal Iliac Artery
3
Q
Branches from the Abdominal Aorta
A
- Gonadal Arteries
- Median Sacral Artery
- Superior Rectal Artery (via the inferior mesenteric artery that supplies the superior part of the rectum)
4
Q
Internal Iliac Artery
A
- Paired branch of the Common Iliac Artery around the pelvic brim
- Supplies the viscera and muscles of the pelvic region including the perineum and gluteal area
- Travels posteromedial into the lesser pelvis
- Internal Iliac Vein follows it
- Bifurcates around the greater sciatic foramen into an anterior and posterior division
5
Q
Branches of the Anterior Division of the Internal Iliac Artery in Females
A
(1) Umbilical Artery
(2) Obturator Artery
(3) Uterine Artery
(4) Vaginal Artery
(5) Middle Rectal Artery
(6) Internal Pudendal Artery
(7) Inferior Gluteal Artery
6
Q
Branches of the Anterior Division of the Internal Iliac Artery in Males
A
(1) Umbilical Artery
(2) Obturator Artery
(3) Inferior Vesical Artery
(4) Middle Rectal Artery
(5) Internal Pudendal Artery
(6) Inferior Gluteal Artery
7
Q
Anterior Division of the Internal Iliac Artery
A
- Travels anteriorly along the lateral pelvic wall giving off several branches
- Branches supply the pelvic viscera, perineum, and superior aspects of the thigh
8
Q
Umbilical Artery
A
- First branch off Anterior Division
- Paired branch
- Travels along the lateral pelvic wall to the anterior abdominal wall
- Produces the Superior Vesical Artery and becomes the Medial Umbilical Ligament
- In utero it moves superiorly and passes through the umbilical ring to the umbilical cord
- After birth it obliterates and its remnants are within the medial umbilical ligaments (covered by peritoneum = medial umbilical fold)
9
Q
Branch off Umbilical Artery
A
- Superior Vesical Artery
10
Q
Superior Vesical Artery
A
- Paired branch (or branches) off the umbilical artery
- Travels to the superior aspect of the urinary bladder
- Supplies the superior aspect of urinary bladder
- In males it may provide vascularization to the ductus deferens (artery to the ductus deferens) within the pelvic cavity
11
Q
Obturator Artery
A
- Paired branch off the internal iliac artery division originating often near where the umbilical artery is crossed by the ureter
- Travels towards the obturator foramen (anteroinferior) by running within the obturator fascia on the lateral pelvic wall
- Passes through the obturator canal along the obturator nerve to travel out of the pelvis
- Supplies the pelvic muscles, ilium, femoral head, and muscles of the medial thigh
12
Q
Accessory Obturator Artery
A
- Some people may have an extra vessel entering the obturator canal with the obturator artery
- It comes from a branch of the external iliac artery
13
Q
Aberrant Obturator Artery
A
- Some people can have a variation in where the obturator branches from
- Comes from the external iliac artery
14
Q
Uterine Artery
A
- Paired branch of the anterior division of the internal iliac artery in the female
- Runs in the transverse cervical ligament (cardinal) and/or broad ligament
- Supplies the ovaries, uterine tubes, uterus, and ureters
- Crosses the ureter to reach the cervix
“Water under the bridge” – clinically relevant for hysterectomies!! - Size can change during pregnancy, delivering more blood to the placenta
- Divides into several branches (vaginal, ovarian, tubal)
15
Q
Vaginal Artery
A
- Paired branch from the anterior division of the internal iliac artery that runs towards the lateral aspect of the vagina but can also come off the uterine artery
- Provides many branches to the lateral vagina, forming a network
- Provides branches to the urinary bladder and supplies the bulb of the vestibule and rectum
16
Q
What branches off the Inferior Vesical Artery?
A
- Artery to the Ductus Deferens
- Prostatic Artery
17
Q
Inferior Vesical Artery
A
- Males only!
- Paired branch of the anterior division of the internal iliac artery
- Runs in the lateral ligament of the bladder and gives off several branches near the posterior aspect of the bladder
- Supplies the inferior urinary bladder, ureter, prostate, seminal vesicles, and ductus deferens
18
Q
Artery to the Ductus Deferens
A
- Branch of the inferior vesical artery, but can come off from the superior vesical as well
- Travels to the ductus deferens to provide vascularization
19
Q
What is the female homolog of the Artery to the Ductus Deferens?
A
Uterine Artery
20
Q
Prostatic Artery
A
- Branch of the inferior vesical artery
- Descends towards the posterolateral aspect of the prostate gland
- Supplies the Prostate and Prostatic Urethra
21
Q
Internal Pudendal Artery
A
- Paired branch of the anterior division of the internal iliac artery
- Exits the pelvis through the greater sciatic foramen along with the piriformis (inferior to it)
- Runs along the ischial spine (sacrospinous ligament) and enters the perineum (ischioanal fossa) through the lesser sciatic foramen
- Branches after passing thru the Pudendal Canal (near the ischial tuberosity) ti reach the perineum including the urogenital and anal triangles
22
Q
What are the branches of the Internal Pudendal Artery in Females?
A
(1) Inferior Rectal Artery
(2) Perineal Artery
(3) Artery of the Vaginal Vestibule
(4) Deep Artery of the Clitoris
(5) Dorsal Artery of the Clitoris
23
Q
What are the branches of the Internal Pudendal Artery in Males?
A
(1) Inferior Rectal Artery
(2) Perineal Artery
(3) Artery of the Bulb of the Penis
(4) Deep Artery of the Penis
(5) Dorsal Artery of the Penis
24
Q
Inferior Rectal Artery
A
- Paired branch of the internal pudendal artery
- Exits the pudendal canal and goes thru the ischioanal fossa to the anal canal
- Supplies the anal canal inferior to the pectinate line including the sphincters and the skin around the anus
25
Perineal Artery
- Paired branch of the internal pudendal artery
- Runs thru the pudendal canal (obturator internus fascia) and enters into the superficial perineal pouch
- Supplies the superficial perineal muscles and the vaginal vestibule/scrotum
26
What is the terminal branch of the Perineal Artery in Females?
Posterior Labial Artery
27
What is the terminal branch of the Perineal Artery in Males?
Posterior Scrotal Artery
28
Posterior Labial Artery
- Females only!
- Paired terminal branch of the perineal artery
- Runs within the superficial fascia of the labia majora
- Supplies the Labia Majora and Minora
29
Artery of the Vaginal Vestibule
- Females only!
- Paired branch of the Internal Pudendal Artery
- Goes thru the perineal membrane to reach the vestibule of the vagina
- Supplies the bulb of the vestibule and the greater vestibular gland
30
Posterior Scrotal Artery
- Males only!
- Paired terminal branch of the perineal artery
- Runs within the scrotum's superficial fascia to supply the scrotum's skin
31
Artery of the Bulb of the Penis
- Males only!
- Paired branch of the internal pudendal artery
- Crosses the perineal membrane and runs to the bulb of the penis
- Supplies the bulb of the penis including the urethra and bulbourethral gland
32
What is the female homolog of the Artery of the Bulb of the Penis?
Artery of the Vaginal Vestibule
33
What are the two terminal branches of the Internal Pudendal Artery in Females?
- Deep Artery of the Clitoris
- Dorsal Artery of the Clitoris
34
What are the two terminal branches of the Internal Pudendal Artery in Males?
- Deep Artery of the Penis
- Dorsal Artery of the Penis
35
Deep Artery of the Clitoris
- Females only!
- Paired terminal branch of the internal pudendal artery
- Goes thru the perineal membrane to reach the Corpora Cavernosa of the clitoris
- Supplies the erectile tissue within the clitoris
36
Dorsal Artery of the Clitoris
- Females only!
- Paired terminal branch of the internal pudendal artery
- Goes thru the perineal membrane to enter the deep perineal pouch
- Travels within the suspensory ligament of the clitoris to reach the clitoral body
- Runs on the dorsal surface of the clitoris to the glans
- Supplies the deep perineal pouch, the tissue surrounding the clitoris and the glans clitoris
37
Dorsal Artery of the Penis
- Males only!
- Paired terminal branch of the internal pudendal artery
- Goes thru the perineal membrane to the Corpora Cavernosa of the penis
- Supplies the erectile tissue within the penis
38
Dorsal Artery of the Penis
- Males only!
- Paired terminal branch of the internal pudendal artery
- Goes thru the perineal membrane to the deep perineal pouch to travel towards the suspensory ligament of the penis; travels with it to the dorsum of the penis where it runs along the dorsal body to the glans penis
- Supplies the deep perineal pouch, the skin and surrounding tissue of the penis, spongy urethra and the glans penis
39
What is the female homolog of the Artery of the Bulb of the Penis?
Artery of the Vaginal Vestibule
40
Middle Rectal Artery
- Paired branch off of the anterior branch of the internal iliac artery
- Travels inferiorly to reach the inferior rectum
- Supplies the inferior rectum, anal canal, seminal vesicle (M), prostate (M), or vagina (F)
41
Inferior Gluteal Artery
- Paired branch of the anterior division of the internal iliac artery (can come off the posterior branch)
- Exits the pelvis thru the greater sciatic foramen inferior to the piriformis
- Supplies the pelvic diaphragm, piriformis, quadratus femoris, gluteal muscles, hamstrings and sciatic nerve
42
Posterior Division of the Internal Iliac Artery
- Second division of teh internal iliac artery
- Runs posteriorly and provides branches to the pelvic wall and the gluteal region
- Gives off 3 main branches
43
Branches of the Posterior Division of the Internal Iliac Artery
(1) Iliolumbar Artery
(2) Lateral Sacral Artery
(3) Superior Gluteal Artery
44
Iliolumbar Artery
- Paired branch of the posterior division of the internal iliac artery
- Runs superiorly along the SI joint near the lumbosacral trunk towards the iliac fossa
- Divides into branches (iliac and lumbar) that supply the psoas major, iliacus, quadratus lumborum and cauda equina
45
Lateral Sacral Artery
- Paired vessel off the posterior division of the internal iliac artery
- Runs across the piriformis towards the sacrum; enters the anterior then posterior sacral foramina
- Supplies the piriformis, erector spinae, sacral canal, and overlying skin
46
Superior Gluteal Artery
- Paired terminal branch of the posterior division of the internal iliac artery
- Passes between the lumbosacral trunk and anterior ramus of S1 to exit the pelvis thru the Greater Sciatic Foramen, running superior to the piriformis
- Supplies the piriformis, gluteal muscles, and tensor fascia lata
- Typically this is the largest of the posterior branches
47
Pelvic Venous Plexus includes what 3 pelxuses?
- Pampiniform Venous Plexus
- Internal Rectal Venous Plexus
- External Rectal Venous Plexus
48
Pampiniform Venous Plexus (Males)
- Located within the spermatic cord, traveling from the scrotum to the body wall in the male
- Made up of a network that forms the Testicular Vein
49
Pampiniform Venous Plexus (Females)
- Located within the suspensory ligament of the ovary, traveling from the ovary towards the body wall in the female
- Made up of a network that forms the Ovarian Vein
50
Internal Rectal Venous Plexus
- Superior most anastomosis of the superior, middle and inferior rectal veins
- Located in the submucosa of the anal canal
51
External Rectal Venous Plexus
- Located near the anus
- Created by the internetworking on the superior, middle, and inferior rectal veins
52
Internal Iliac Vein
- Paired vein found behind the internal iliac artery near the greater sciatic foramen
- Drains the same areas of the body it supplies
53
Common Iliac Vein
- Paired vein that forms when the internal and external iliac veins merge
- Common Iliac merge to create the IVC
54
External Iliac Lymph Node
- Group of lymph nodes that receive lymph from the inguinal nodes and the superior aspect of the anterior pelvic organs
- Located above the pelvic rim, near the external iliac vessels
- Lymph from these nodes goes into the common iliac nodes
55
Internal Iliac Lymph Nodes
- Group of lymph nodes that receive lymph from the inferior pelvic viscera, deep perineum and gluteal region
- Located near the anterior and posterior divisions of the internal iliac artery
- Lymph from these nodes goes into the common iliac nodes
56
Sacral Lymph Node
- Group of lymph nodes that receive lymph from the posterior pelvic viscera
- Located next to the median sacral vessels in the concavity of the sacrum
- Lymph from these nodes goes into the common iliac or internal iliac lymph nodes
57
Common Iliac Lymph Node
- Group of lymph nodes that receive lymph from the external iliac, internal iliac, and sacral lymph node groups
- Located along the Common Iliac Vessels
- Lymph travels into the lumbar or pre-aortic lymph nodes
