PELVIC BLOOD SUPPLY. Iliac Arteries Common iliac: Common iliac: External iliac: Travels lateral to...

PELVIC BLOOD SUPPLYPELVIC BLOOD SUPPLY

Iliac ArteriesIliac Arteries

Common iliac:Common iliac:External iliac:External iliac:

Travels lateral to superior pubic ramus.Travels lateral to superior pubic ramus.

Branches:Branches:

Deep circumflex iliac artery.Deep circumflex iliac artery.

Inferior epigastric artery:Inferior epigastric artery:

Travels deep to inguinal ligament.Travels deep to inguinal ligament.

Becomes femoral artery:Becomes femoral artery:

Moore, Fig. 3.11.Moore, Fig. 3.11.

Iliac ArteriesIliac Arteries

Common iliac:Common iliac:Internal iliac:Internal iliac:

Travels inferiorly and medially over pelvic Travels inferiorly and medially over pelvic brim.brim.Supplies:Supplies:

Pelvic organs.Pelvic organs.Gluteal muscles.Gluteal muscles.Perineum.Perineum.

Two divisions:Two divisions:Anterior.Anterior.Posterior.Posterior.

Internal Iliac ArteriesInternal Iliac Arteries

Anterior division:Anterior division:Umbilical artery:Umbilical artery:

Gives off superior vesicle arteries:Gives off superior vesicle arteries:

Supplies superior aspect of urinary Supplies superior aspect of urinary bladder.bladder.

Becomes either:Becomes either:

Obliterated umbilical artery.Obliterated umbilical artery.

Medial umbilical artery.Medial umbilical artery.


Anterior division:Anterior division:Obturator artery:Obturator artery:

Travels anteriorly and inferiorly along pelvic Travels anteriorly and inferiorly along pelvic wall.wall.Exits pelvic cavity through:Exits pelvic cavity through:

Obturator canal (in obturator Obturator canal (in obturator foramen).foramen).

Supplies:Supplies:Pelvic muscles.Pelvic muscles.Ilium.Ilium.Femoral head.Femoral head.Muscles of medial thigh.Muscles of medial thigh.


Anterior division:Anterior division:Inferior vesicle artery (male):Inferior vesicle artery (male):

Travels inferiorly and posteriorly to urinary Travels inferiorly and posteriorly to urinary bladder.bladder.

Analogous to female uterine artery.Analogous to female uterine artery.

Prostatic branch:Prostatic branch:

Supplies prostate gland.Supplies prostate gland.

Artery to ductus deferens.Artery to ductus deferens.


Anterior division:Anterior division:Uterine artery (female):Uterine artery (female):

Travels medially in broad ligament.Travels medially in broad ligament.

Analogous to male inferior vesicle artery.Analogous to male inferior vesicle artery.

Supplies uterus and vagina.Supplies uterus and vagina.


Anterior division:Anterior division:Internal pudendal artery (male):Internal pudendal artery (male):

Exits pelvic cavity through greater sciatic Exits pelvic cavity through greater sciatic foramen.foramen.

Loops around ischial spine.Loops around ischial spine.

Enters perineum through lesser sciatic Enters perineum through lesser sciatic foramen.foramen.

Enters pudendal canal.Enters pudendal canal.


Anterior division:Anterior division:Internal pudendal artery (male):Internal pudendal artery (male):

Branches:Branches:Inferior rectal.Inferior rectal.Perineal artery:Perineal artery:

Posterior scrotal artery.Posterior scrotal artery.Artery of bulb of penis.Artery of bulb of penis.Deep artery of penis:Deep artery of penis:

Supplies corpora cavernosa Supplies corpora cavernosa of of penis.penis.

Dorsal artery of penis.Dorsal artery of penis.


Anterior division:Anterior division:Internal pudendal artery (female):Internal pudendal artery (female):

Branches:Branches:

Inferior rectal.Inferior rectal.

Perineal artery:Perineal artery:

Posterior labial artery.Posterior labial artery.

Artery of vestibule of vagina.Artery of vestibule of vagina.

Deep artery of clitoris.Deep artery of clitoris.

Dorsal artery of clitoris.Dorsal artery of clitoris.


Anterior division:Anterior division:Inferior gluteal artery:Inferior gluteal artery:

Exits pelvic cavity through greater sciatic Exits pelvic cavity through greater sciatic foramen.foramen.Usually passes inferior to piriformis muscle.Usually passes inferior to piriformis muscle.Supplies:Supplies:

Coccygeus muscle.Coccygeus muscle.Three levator ani muscles.Three levator ani muscles.Piriformis and quadratus femoris muscles.Piriformis and quadratus femoris muscles.Uppermost posterior thigh muscles.Uppermost posterior thigh muscles.Gluteus maximus.Gluteus maximus.Sciatic nerve.Sciatic nerve.


Anterior division:Anterior division:Middle rectal artery:Middle rectal artery:

Travels inferior to lower rectum.Travels inferior to lower rectum.

Supplies lower rectum and seminal Supplies lower rectum and seminal vesicles vesicles in males.in males.


Posterior division:Posterior division:Iliolumbar artery:Iliolumbar artery:

Travels posterior to sacroiliac joint posterior Travels posterior to sacroiliac joint posterior to common iliac vessels and psoas major to common iliac vessels and psoas major muscle.muscle.

Supplies;Supplies;

Psoas major muscle.Psoas major muscle.

Iliacus muscle.Iliacus muscle.

Quadratus lumborum muscle.Quadratus lumborum muscle.

Cauda equina (in vertebral canal).Cauda equina (in vertebral canal).


Posterior division:Posterior division:Lateral sacral artery:Lateral sacral artery:

Travels on anteromedial aspect of Travels on anteromedial aspect of piriformis piriformis muscle.muscle.

Sends branches to ventral sacral foramina.Sends branches to ventral sacral foramina.

Supplies:Supplies:

Piriformis muscle.Piriformis muscle.

Sacral canal structures.Sacral canal structures.

Erector spinae muscles.Erector spinae muscles.


Posterior division:Posterior division:Superior gluteal artery:Superior gluteal artery:

Exits pelvic cavity through greater sciatic Exits pelvic cavity through greater sciatic foramen superior to piriformis muscle.foramen superior to piriformis muscle.

Supplies:Supplies:

Piriformis muscle.Piriformis muscle.

Gluteus medius muscle.Gluteus medius muscle.

Gluteus minimus muscle.Gluteus minimus muscle.

Tensor fascia latae muscle.Tensor fascia latae muscle.

Abdominal AortaAbdominal Aorta

Branches to pelvis:Branches to pelvis:Testicular (male):Testicular (male):

Travels through inguinal canal into Travels through inguinal canal into scrotum.scrotum.

Travels inside spermatic cord.Travels inside spermatic cord.

Supplies testis.Supplies testis.


Branches to pelvis:Branches to pelvis:Ovarian (female):Ovarian (female):

Travels inferiorly over pelvic brim to ovary:Travels inferiorly over pelvic brim to ovary:

Through suspensory ligament.Through suspensory ligament.


Branches to pelvis:Branches to pelvis:Inferior mesenteric:Inferior mesenteric:

Superior rectal artery:Superior rectal artery:

Travels over left common iliac Travels over left common iliac vessels vessels into pelvic cavity.into pelvic cavity.

Supplies superior aspect of rectum.Supplies superior aspect of rectum.

Anastomoses with middle and Anastomoses with middle and inferior inferior rectal arteries.rectal arteries.


Branches to pelvis:Branches to pelvis:Median sacral:Median sacral:

From posterior aspect of termination of From posterior aspect of termination of aorta.aorta.

Travels in median plane over L4-5, sacrum, Travels in median plane over L4-5, sacrum, coccyx.coccyx.

VeinsVeins

Most analogous and named for Most analogous and named for corresponding arteries.corresponding arteries.

Pampiniform plexus:Pampiniform plexus:Inside spermatic cord.Inside spermatic cord.

Drains testicular vein.Drains testicular vein.

VeinsVeins

Internal rectal venous plexus:Internal rectal venous plexus:Superior-most anastomosis of the three Superior-most anastomosis of the three

rectal veins.rectal veins.External rectal venous plexus:External rectal venous plexus:

Inferior-most anastomosis of the three Inferior-most anastomosis of the three rectal rectal veins.veins.

Near anus.Near anus.

Internal HemorrhoidsInternal Hemorrhoids

““Piles”Piles”Prolapse of mucosa containing internal Prolapse of mucosa containing internal

rectal venous plexus.rectal venous plexus.Pain and impeded blood flow.Pain and impeded blood flow.

External HemorrhoidsExternal Hemorrhoids

Produced by blood clots in external rectal Produced by blood clots in external rectal venous plexus.venous plexus.

Bulging out of skin and mucosa from Bulging out of skin and mucosa from external rectal venous plexus.external rectal venous plexus.

PELVIC INNERVATIONPELVIC INNERVATION

Sacral PlexusSacral Plexus

L4-S4:L4-S4:Superior gluteal nerve (L4-S1):Superior gluteal nerve (L4-S1):

To gluteus medius and minimus.To gluteus medius and minimus. Inferior gluteal nerve (L5-S2):Inferior gluteal nerve (L5-S2):

To gluteus maximus.To gluteus maximus.

Moore, Fig. 3.10 and Table Figure 3.4Moore, Fig. 3.10 and Table Figure 3.4


Muscular branches:Muscular branches:Quadratus femoris (L4-S1).Quadratus femoris (L4-S1).

Obturator internus (L5-S2).Obturator internus (L5-S2).

Piriformis (S1-2).Piriformis (S1-2).

Levator ani and coccygeus (S3-4).Levator ani and coccygeus (S3-4).


Posterior femoral cutaneous (S1-S3):Posterior femoral cutaneous (S1-S3):To buttock and uppermost region of To buttock and uppermost region of

posterior posterior thigh.thigh.


Pudendal (S2-4):Pudendal (S2-4):To perineum:To perineum:

Inferior rectal nerve:Inferior rectal nerve:Innervates anal canal.Innervates anal canal.

Dorsal nerve of penis.Dorsal nerve of penis.

Perineal nerve:Perineal nerve:Posterior scrotal nerve.Posterior scrotal nerve.


Sciatic nerve (L4-S3):Sciatic nerve (L4-S3):Passes through greater sciatic foramen.Passes through greater sciatic foramen.

Tibial nerve (L4-S3).Tibial nerve (L4-S3).

Common peroneal nerve (L4-S2).Common peroneal nerve (L4-S2).

Coccygeal PlexusCoccygeal Plexus

S4, S5, coccygeal nerve.S4, S5, coccygeal nerve.Anococcygeal nerve.Anococcygeal nerve.

Lumbar PlexusLumbar Plexus

(T12) L1-5.(T12) L1-5. Ilioinguinal nerve:Ilioinguinal nerve:

Lateral to psoas major.Lateral to psoas major.

Anterior scrotal nerve (male):Anterior scrotal nerve (male):To scrotum.To scrotum.

Labial branch (female):Labial branch (female):To labia majora.To labia majora.

Lumbar PlexusLumbar Plexus

Genitofemoral nerve (L1-2):Genitofemoral nerve (L1-2):Anterior to psoas major.Anterior to psoas major.

Genital branch:Genital branch:To scrotum (male).To scrotum (male).

To labia majora (female).To labia majora (female).

Lumbosacral trunk (L4-5).Lumbosacral trunk (L4-5).

Sympathetic SystemSympathetic System

Lumbar splanchnic nerves:Lumbar splanchnic nerves:Sympathetic.Sympathetic.

From lumbar plexus to:From lumbar plexus to:Abdominal sympathetic plexus.Abdominal sympathetic plexus.

Inferior mesenteric ganglion.Inferior mesenteric ganglion.

Superior hypogastric plexus:Superior hypogastric plexus:

To uterine tubes in female.To uterine tubes in female.


Sacral splanchnic nerves:Sacral splanchnic nerves:Sympathetic.Sympathetic.

From sacral plexus.From sacral plexus.

Feed into sacral sympathetic trunk and Feed into sacral sympathetic trunk and then then into inferior hypogastric plexus.into inferior hypogastric plexus.


Sacral sympathetic trunk:Sacral sympathetic trunk:Paravertebral ganglia.Paravertebral ganglia.

Ganglion impar:Ganglion impar:

Coccygeal ganglion.Coccygeal ganglion.

Superior hypogastric:Superior hypogastric:

Sympathetic.Sympathetic.

From lumbar and sacral splanchnic From lumbar and sacral splanchnic nerves.nerves.

Feed into inferior hypogastric Feed into inferior hypogastric plexus.plexus.


Sacral sympathetic trunk:Sacral sympathetic trunk:Paravertebral ganglia.Paravertebral ganglia.

Inferior hypogastric plexus:Inferior hypogastric plexus:Mixed parasympathetic.Mixed parasympathetic.In males innervates urethra, ductus In males innervates urethra, ductus deferens, prostate gland, and ejaculatory deferens, prostate gland, and ejaculatory ducts.ducts.In females, innervates urethra and In females, innervates urethra and

produces produces uterovaginal plexus.uterovaginal plexus.Produces vesicle plexus (urinary bladder).Produces vesicle plexus (urinary bladder).Supplies rectum.Supplies rectum.Uterovaginal plexus (uterus, vagina, Uterovaginal plexus (uterus, vagina,

ovaries.ovaries.

Parasympathetic SystemParasympathetic System

Pelvic splanchnic nervesPelvic splanchnic nervesParasympathetic.Parasympathetic.

S2-4.S2-4.

Feed into inferior hypogastric plexus.Feed into inferior hypogastric plexus.

Parasympathetic SystemParasympathetic System

Inferior hypogastric plexus:Inferior hypogastric plexus:In females:In females:

Innervates:Innervates:

Urethra.Urethra.

Rectum.Rectum.

Produces:Produces:

Uterovaginal plexus (uterus, vagina, Uterovaginal plexus (uterus, vagina, ovaries).ovaries).

PELVIC BLOOD SUPPLY. Iliac Arteries Common iliac: Common iliac: External iliac: Travels lateral to...

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Transcript of PELVIC BLOOD SUPPLY. Iliac Arteries Common iliac: Common iliac: External iliac: Travels lateral to...