QuestionSBA
QuestionChoice
The external iliac artery is a terminal branch of the common iliac artery. It is the main blood supply to the lower limb as it continues down into the thigh as the femoral artery at the level of the inguinal ligament.
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External Iliac artery
QuestionChoice
The internal iliac artery is the major artery of the pelvis. It originates at the bifurcation of the common iliac artery at the vertebral level L5-S1, into its internal and external branches.
Many branches then arise from the internal iliac. These can be thought of as arising from the anterior trunk or the posterior trunk of the internal iliac.
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Internal Iliac Artery
QuestionChoice
The internal pudendal artery arises from the anterior trunk of the internal iliac artery. It exits the pelvis via the greater sciatic foramen and enters the perineum via the lesser sciatic foramen. It is the main blood supply to the perineum.
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Internal pudendal artery
QuestionChoice
The Lateral Sacral arteries (superior and inferior) again arise from the posterior trunk of the internal iliac artery. They supply skin and muscle posterior to the sacrum.
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Lateral sacral artery
QuestionChoice
The superior gluteal artery is a terminal branch of the posterior branch and exits the pelvic cavity via the Greater Sciatic Foramen. It enters the gluteal region superiorly to the Piriformis muscle.
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Superior Gluteal artery
Concept
Chapter
## Summary

Arterial supply to the pelvis is primarily supplied by the internal iliac artery. This is a paired artery formed at the bifurcation of the common iliac artery.

The internal iliac artery has a posterior and anterior trunk.

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## Posterior trunk

The ***posterior trunk*** contains :

1. **Iliolumbar artery** - supplying the posterior and superior parts of the pelvis
2. **Lateral sacral arteries** - gives branches that pass into the anterior sacral foramina
3. **Superior gluteal artery** - the largest branch, leaves the pelvic cavity through the greater sciatic foramen above the piriformis muscle, supplying gluteus medius and minimus as well as tensor fasciae latae.

## Anterior trunk

The ***anterior trunk*** contains:

1. **Umbilical artery** - this reaches the abdominal wall and umbilicus. After birth, the vessel closes and becomes a solid fibrous cord. The fibrous remnant is the medial umbilical ligament.
2. **Superior vesical artery** - normally from the root of the umbilical artery, and supplies the superior aspect of the bladder and distal parts of the ureter
3. **Inferior vesical artery** - in men this supplies the bladder, ureter, seminal vesicle and prostate. In women, this is the vaginal artery, and supplies branches of the vagina and adjacent parts of the bladder and rectum
4. **Middle rectal artery** - this :
	* anastomoses with the superior rectal from the inferior mesenteric artery
	* anastomoses with the inferior rectal artery from the internal pudendal artery
5. **Obturator artery** - this supplies the adductor region of the thigh
6. **Internal pudendal artery** - this follows the course of the pudendal nerve to exit out of the greater sciatic foramen and back into the lesser sciatic foramen along the pudendal canal. It supplies the erectile tissues of the clitoris and penis.
7. **Inferior gluteal artery** - this is the terminal branch of the anterior trunk of the internal iliac artery
8. **Uterine artery** - this is the major blood supply to the uterus, ovary and vagina, and anastomoses with the ovarian artery (from the abdominal aorta). It courses medially and anteriorly in the base of the broad ligament to reach the cervix. It crosses the ureter and passes superiorly to the lateral vaginal fornix.


## Clinical points
Bleeding from branches of the internal iliac artery can be difficult to control surgically because of their deep location within the pelvis. They are therefore most commonly treated by endovascular occlusion (i.e. treatment through the arteries).
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Arteries of the pelvis
Topic
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Pelvic Anatomy
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Topic
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Pelvic Anatomy
Identify the annotated structure.

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