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Common Iliac Vein  Median Sacral Veins  Ovarians Veins

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Common Iliac Vein  Median Sacral Veins  Ovarians Veins DR MOUIN ABBOUD PR OF ANATOMY In faculity of medecin ( Damascus and Sham uneversities ) Specialist in respiratory diseases الدكتور معين عبود استاذ التشريح في كلية الطب البشري في جامعة دمشق وجامعة الشام الخاصة اختصاصي في أمراض جهاز التنفس DR MOUIN ABBOUD pelvis – blood vessels - nerves Major Arteries of the Pelvis Arteries of the Pelvis are : The internal iliac artery : The major artery of the pelvis and perineum Other vessels that originate in the abdomen and contribute to the supply of pelvic structures include: the median sacral artery and, in women, the ovarian arteries. It originates at the bifurcation of the common iliac Internal iliac artery The internal iliac artery originates from the common iliac artery on each side, approximately at the level of the intervertebral disc between LV and SI and lies anteromedial to the sacro-iliac joint The vessel courses inferiorly over the pelvic inlet, then divides into anterior and posterior trunks at the level of the superior border of the greater sciatic foramen. Branches from the posterior trunk contribute to the supply of the lower posterior abdominal wall, the posterior pelvic wall, and the gluteal region. Branches from the anterior trunk supply the pelvic viscera, the perineum, the gluteal region, the adductor region of the thigh, and, in the fetus, the placenta. Anterior Trunk The anterior trunk gives rise to numerous branches that supply the pelvic organs, the perineum, and the gluteal and adductor regions of the lower limb. working anti-clockwise from obturator artery to inferior gluteal artery. Umbilical artery – Gives rise in (male) – the superior vesical artery Inferior vesical artery Middle rectal artery – The obturator artery Internal pudendal artery Inferior gluteal artery – The uterine artery Obturator artery Obturator artery – Travels through the obturator canal, accompanied by the obturator nerve and vein. It supplies the muscles of the thigh’s adductor region. Umbilical artery Umbilical artery – Gives rise to the superior vesical artery, which supplies the superior aspect of the urinary bladder. The umbilical artery also transports blood from the placenta to the fetus during gestation. After birth, it closes distally to the origin of the superior vesical artery, and forms the medial umbilical ligament. Inferior vesical and vaginal artery Inferior vesical artery (male) – Supplies the prostate gland, seminal vesicle and inferior aspect of the bladder. the equivalent artery in women is the vaginal artery. supplies branches to the vagina and to adjacent parts of the bladder and rectum. Uterine artery Uterine artery (female) Travels within the broad ligament to reach the cervix, where it ascends along the lateral aspect of the uterus. At origin of the fallopian tubes, it anastamoses with the ovarian artery. During its course, it crosses the ureters superiorly. Middle rectal artery Middle rectal artery : Travels medially to supply the distal part of the rectum. It also forms anastamoses with the superior rectal artery (derived from the inferior mesenteric) and the inferior rectal artery (derived from the internal pudendal) Internal pudendal artery Internal pudendal artery – Moves inferiorly to exit the pelvis via the greater sciatic foramen inferior to the piriformis muscle. Accompanied by the pudendal nerve, it then enters the perineum via the lesser sciatic foramen. It is the main artery responsible for the blood supply to the perineum.. Inferior gluteal artery Inferior gluteal artery – The terminal branch of the anterior trunk. It leaves the pelvic cavity via the greater sciatic foramen, emerging inferiorly to the piriformis muscle in the gluteal region. It contributes to the blood supply of the gluteal muscles and hip joint. Posterior Trunk The posterior trunk gives rise to arteries that supply the lower posterior abdominal wall, posterior pelvic wall and the gluteal region. There are typically three branches: Iliolumbar artery – Lateral sacral arteries (superior and inferior) – Superior gluteal artery – Iliolumbar artery Iliolumbar artery – Ascends to exit the lesser pelvis, dividing into a lumbar and iliac branch. The lumbar branch contributes to the supply of the posterior abdominal wall, psoas, quadratus lumborum muscles, and cauda equina via a small spinal branch that passes through the intervertebral foramen between LV and SI. The iliac branch passes laterally into the iliac fossa to supply muscle and bone. Lateral sacral arteries Lateral sacral arteries (superior and inferior) – Travel infero- medially along the posterior pelvic wall to supply structures in the sacral canal, and the skin and muscle posterior to the sacrum. Superior gluteal artery Superior gluteal artery – The terminal branch of the posterior trunk. It exits the pelvic cavity via the greater sciatic foramen, entering the gluteal region superiorly to the piriformis muscle. It is the major blood supply to the muscles and skin of the gluteal region. Minor Arteries of the Pelvis Gonadal Arteries Median Sacral Artery Superior Rectal Artery Gonadal Arteries Gonadal Arteries The ovarian artery is the major gonadal artery in females. It arises from the abdominal aorta, distal to the origin of the renal arteries. The artery descends towards the pelvis, crossing the pelvic brim and the origin of the external iliac vessels. It moves medially, dividing into an ovarian branch and tubal branches, which supply their respective structures. Note – the testicular artery reaches the scrotum via the inguinal canal, and therefore does not actually enter the pelvis. Median Sacral Artery Median Sacral Artery The median sacral artery originates from the posterior aspect of abdominal aorta, at its bifurcation into the common iliac arteries. It descends anteriorly to the L4 and L5 vertebrae, the sacrum and the coccyx, contributing to the arterial supply of these regions. Superior Rectal Artery Superior Rectal Artery The superior rectal artery is the terminal continuation of the inferior mesenteric artery. It crosses the left common iliac artery and descends in the mesentery of the sigmoid colon. It gives rise to branches that supply the rectum. Venous Drainage of the Pelvis Venous Drainage of the Pelvis– the external iliac vein, internal iliac vein and common iliac vein median sacral veins Ovarians veins External Iliac Vein The external iliac vein is a continuation of the femoral vein It ascends along the medial aspect of the external iliac artery, before joining with the internal iliac vein to form the common iliac vein. During its short course, the external iliac vein receives the inferior epigastric and deep circumflex iliac veins. Internal Iliac Vein Pelvic veins follow the course of all branches of the internal iliac artery except for : the umbilical artery and the iliolumbar artery It is formed near the greater sciatic foramen, ascending anteriorly to the sacroiliac joint, before combining with the external iliac vein to form the common iliac vein. With the exception of the iliolumbar vein (which drains into the common iliac), The tributaries of the internal iliac vein the tributaries of the internal iliac vein correspond with the branches of the internal iliac artery : Superior and inferior gluteal veins – drains the buttock and upper thigh. Internal pudendal vein – drains the reproductive organs and part of the rectum (via the inferior rectal vein). Obturator vein Lateral sacral veins – drains part of the sacrum. Middle rectal vein – drains the bladder, prostate (in males only), and part of the rectum. Vesical veins – drains the urinary bladder via the vesical venous plexus. Uterine and vaginal veins – drain the female reproductive organs via the vaginal and uterine venous plexuses. pelvic plexus Within the pelvic cavity, extensive interconnected venous plexuses are associated with the surfaces of the viscera (bladder, rectum, prostate, uterus, and vagina). Together, these plexuses form the pelvic plexus of veins Portacaval -rectum The part of the venous plexus surrounding the rectum and anal canal drains via superior rectal veins (tributaries of inferior mesenteric veins) into the hepatic portal system, and via middle and inferior rectal veins into the caval system. This pelvic plexus is an important portacaval shunt when the hepatic portal system is blocked Common Iliac Vein The common iliac vein is formed at the upper margin of the pubic symphysis by the union of the external and internal iliac veins. It receives two additional tributaries: Iliolumbar vein – drains the L4 and L5 vertebrae, and the iliopsoas muscle. Middle sacral veins – drain part of the sacrum. The left and right common iliac veins combine at L5 to become the inferior vena cava, which empties into the inferior aspect of the right atrium. the median sacral veins the median sacral veins coalesce to form a single vein that joins either the left common iliac vein or the junction of the two common iliac veins to form the inferior vena cava; the ovarian veins the ovarian veins follow the course of the corresponding arteries; on the left, they join the left renal vein and, on the right, they join the inferior vena cava in the abdomen. Nerves Somatic plexuses Sacral and coccygeal plexuses Visceral plexuses : Paravertebral sympathetic chain Parasympathetic fibers Somatic plexuses The somatic plexuses are : Sacral and coccygeal plexuses Sacral plexus The plexus is formed in relation to the anterior surface of the piriformis muscle, The sacral plexus
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