Pelvic Vasculature

Question 1

Clinical significance of atherosclerosis of right common iliac artery – why is this (anatomic-wise?)

Answer 1

Right common iliac artery crosses over the left common iliac vein - atherosclerosis may cause compression of this vein = stasis of venous return from the left lower limb = thrombus formation and pain during exercise

Question 2

What does the anterior division of the internal iliac vessels supply?

Answer 2

VISCERAL branches to all pelvic and perineal viscera except the ovaries and testes

Question 3

What does the posterior division of the internal iliac vessels supply?

Answer 3

PARIETAL branches to abdominal wall, gluteal region, lower back, spinal meninges

Question 4

Internal pudendal artery is a branch of what artery and what does it supply?

Answer 4

Internal iliac artery

Supplies all of the perineum

Question 5

Obturator artery is a branch of what artery? Does it supply pelvic structures?

Answer 5

Internal iliac artery

NO pelvic structure supply

Question 6

In the female, where do the arteries of the abdomen, pelvis, and perineum anastomose?

Answer 6

Within the walls of the uterus and vagina

Question 7

What does the superior rectal artery (only 1) supply?

Answer 7

Upper rectum and anal canal

Question 8

What do the right and left inferior arteries (2 of them!) supply?

Answer 8

The anal canal below the pectinate line

Question 9

Function of middle rectal arteries

Answer 9

Anastomoses between superior and inferior rectal arteries

Question 10

What 2 arteries supply blood to the gonads (testes and ovaries)? Describe their path

Answer 10

1. Ovarian artery - crosses the pelvic brim within the suspensory ligament
2. Testicular artery - transverses the inguinal canal within the spermatic cord

Question 11

Venous drainage of gonads?

Answer 11

Pampiniform venous plexus - converges to form ovarian and testicular veins which drain to IVC (on the right) and left renal vein

Question 12

Most pelvic viscera are surrounded by what plexuses? Where do these plexuses drain?

Answer 12

Visceral venous plexuses - drain to the internal iliac and common iliac veins – then to the IVC

Question 13

How can the visceral pelvic plexus drain to the azygous system? Why is this significant?

Answer 13

Can drain via the vertebral venous plexus

Significant in the spread of prostate cancer to vertebrae and brain

Question 14

How do the rectum/anal canal drain into the portal and caval system?
Why is this significant?

Answer 14

Portal system via superior rectal vein
Caval system via middle and inferior rectal veins
- anastomoses between the systems is significant in portal hypertension

Question 15

What are the 2 branches of the submucosal rectal venous plexus?

Answer 15

external and internal

Question 16

What does the external rectal plexus communicate with? Thromboses of these veins is called what?

Answer 16

• Communicates with other pelvic visceral venous plexuses

- external hemorrhoids

Question 17

What does the internal rectal plexus communicate with and what does this form?

Answer 17

• Communicates with rectal arteries via arterio-venous anastomosis to form an internal hemorrhoidal plexus that surrounds the anorectal junction – forms anal cushions (prolapse of these cushions = internal hemorrhoids)

Question 18

Blood supply and venous drainage to most perineal structures

What is the exception?

Answer 18

Blood supply: internal pudendal artery
Venous drainage: internal pudendal vein to the internal iliac veins

Exception: erectile tissues drain via deep dorsal veins that don’t join the internal pudendal vein – instead they pass under the pubic symphysis to join venous plexuses in the pelvis