hi let's talk about the internal iliac artery in this video we're going to talk about the origins
of the internal iliac artery and its branches within the pelvis we'll focus on one of those
branches the internal pudendal artery and look at some of its branches and targets in the perineum
so the abdominal aorta is going to bifurcate into the common iliac arteries
at approximately the level of the fourth lumbar vertebra each of those common iliac arteries
will then shortly thereafter bifurcate into the external iliac artery
and the internal iliac artery the external iliac artery runs under the inguinal
ligament to become the femoral artery which is the major source of blood for the lower limb
the internal iliac artery oftentimes referred to by clinicians as the hypogastric artery
is going to ramify within the pelvis to serve the walls of the pelvis the pelvic
viscera as well as leave the pelvis to supply the hip joint and associated muscles
as well as the perineum as well as portions of the proximal lower limbs with blood so if
you hear someone refer to the hypogastric artery it's the same thing as the internal iliac artery
so let's take a look at that internal iliac artery it is an amazingly variable
artery um and it's extraordinarily sexually polymorphic as well now to help show some of the
extremes of that sexual polymorphism i'm going to show you uh representations or conceptualization
of the assigned female at birth internal iliac artery and i'll also show you an illustration of
an assigned male at birth internal iliac artery as well now let me switch over
to green here so there's not an over abundance of red on this slide conceptually the internal
iliac artery is divided into divisions these divisions sometimes are very nice and neat trunks
and sometimes they're not nice and neat trunks but here we have somewhat of a posterior trunk
and that might be as as good as the posterior trunk really gets we can see the first branch here
the ilio lumbar ascending up out of the pelvis to supply the posterior body wall with blood
we can also see some lateral sacral arteries here going out to supply the uh the posterior
and the lateral pelvic walls with blood and then the terminal branch of that posterior division
is the superior gluteal artery that superior gluteal artery is going to escape the pelvis
to supply the hip joint and associated muscles with blood and we'll talk about that
in more granular detail when we discuss the hip joint as part of MSK now the anterior division has
very many branches and you're really going to have to pay close attention to where these branches are
not just originating from the anterior division of internal iliac but also their targets as well and
we'll talk about that as we progress through so one of the uh the early major branches
is that of the umbilical artery the umbilical artery is going to run anteriorly through the
the pelvis towards the anterior body wall and it's going to lose its patency so that umbilical artery
becomes the medial umbilical ligament and so that medial umbilical ligament will be found within
the medial umbilical fold heading up towards the umbilicus so in fetal circulation it would
be patent it would still be an umbilical artery heading up towards the uh the umbilical cord and
the placenta beyond now in the adult this artery is significant because there are branches of it
that descend down into and serve the urinary bladder we call these superior vesicle arteries
so when you see vesicle i want you to think urinary bladder
now another major branch that we can see coming off of the anterior division here let's see is
an inferior vesicle artery also descending down and serving the urinary bladder sometimes this
inferior vesicle artery may be a branch of the uterine or the vaginal artery it can be
quite variable with respect to its origin another branch especially allied with the umbilical artery
is the obturator artery and i say allied because their proximate courses are in roughly the same
direction except the obturator artery is going to be a little more inferior and it's going to
exit the pelvis through the obturator canal and head towards the medial portion of the thigh
where it's a major source of blood for that medial compartment so it's serving blood to those
adductors of the thigh we can also see here um there's a common trunk it's not always necessarily
the case but in this illustration it is the uterine artery we can imagine by its name
that the uterine artery is going to supply the uterus with blood and if we turn our attention
up here you may recall that the uterine artery at the internal loss of the cervix
is going to be found running over the ureter we say then that water runs under the bridge
in this case water is the ureter and the bridge is the uterine artery so recall that relationship
burn that into the the back of your mind at the internal loss of the cervix the uterine
artery runs over the ureter coming from that common trunk we can also see a vaginal artery
that vaginal artery is going down to serve
the vagina with blood and there's going to be um very frequent anastomoses between the
uterine artery and the vaginal artery so there's going to be quite a bit of collateral blood flow
between these two vessels we'll also see collateral blood flow between the uterine artery
and the ovarian artery as well so this is a very vascularly rich area for blood
um and in in that vein not only can we see inferior vesicle branches from this vaginal artery
but the vaginal artery may have uterine branches the uterine artery may have vaginal branches
and so just pay attention to the totality of the vessel um that it's originating from you know the
internal division of or the anterior division of the internal iliac artery and what that
vessel is mainly supplying and how it derives its name moving right along we can also see
quite an impressive branch here this is the internal pudendal artery and we'll pick that up
in a second that's going to exit the the pelvis and here the middle rectal artery
is a branch of that internal pudendal artery the middle rectal artery is supplying the rectum
with blood the internal pudendal artery is going to supply the perineum with blood and then another
branch is the inferior gluteal artery that inferior gluteal artery is also
going to exit the pelvis to serve the the hip joint and associated muscles with blood along
the way it will also supply the muscles of the pelvic diaphragm with blood so
levator ani as well as the coccygeus muscles and it can even supply some of the proximal portions
of the posterior thigh muscles the hamstrings with blood as well so let's look at the internal
pudendal artery the internal pudendal artery is going to exit through the greater sciatic foramen
and then pass through the lesser sciatic foramen heading through the pudendal or Alcock's canal it
will also be joined by the pudendal nerve as well as the internal pudendal vein within that canal
when it exits from the pudendal canal so that space through the fascia of operator internus
we're going to see branches heading out towards the external anal sphincter
these are the inferior rectal or inferior anal arteries there are also going to be
um perineal branches uh the these perineal branches or arteries are going to serve the uh
the ischial cavernosus muscles the bulbocavernosus muscle as well as some of the the skin
that is about the perineum and then we have the arteries that are serving the erectile tissue so
for instance uh there's the artery of the bulb to serve the uh bulk the bulbospongiosus um or the
the corpus spongiosum then there's the deep artery of the clitoris or penis which is going to serve
the corpora cavernosa or the the crura of the uh the clitoris or the penis there's also a dorsal
artery of the clitoris or penis and that takes a similar tact to the the deep artery
except it stays outside of the erectile tissue and it serves the super tissue superficial tissues
about either the clitoris or the penis on the uh the dorsal surface of the uh of the penis so there
are several branches here of the internal pudendal artery serving various entities um specifically
serving those erectile tissues however are the arteries of the bulb and the deep arteries of the
clitoris or penis the arteries of the bulb serves the corpus spongiosum whereas the deep arteries
serve the corpora cavernosa so we've discussed the origin of the internal iliac artery as well
as its branches within the pelvis and outside of the pelvis with an emphasis on the branches of the
internal pudendal artery this is your summary slide thank you for