hi let's talk about the arteries of the pelvis and lower limbs
as you may recall the abdominal aorta splits into the common iliac arteries at
about the level of l4 those common iliac arteries are going to ride the ridge of
the division between the abdominal cavity and the pelvic cavity before dividing into
the external iliac and internal iliac arteries the external iliac artery is destined
to exit the pelvis and become the femoral artery and that transition point is the inguinal ligament
so after it passes underneath the inguinal ligament that external iliac artery becomes
the femoral artery and we'll pick that back up in a moment the internal iliac artery enters into
the pelvic cavity where it's going to supply the various pelvic viscera with blood as well as the
majority of the perineum so let's look at that now on the left side sorry to be so binary here um
we have a stereotypically female pelvis on the right side we have a stereotypically male pelvis
and let me give you the the lay of the land in terms of some of the the landmarks and viscera so
here we have the sacrum you can see that here as well um here's the the rectum and the anal canal
um here's the pubic symphysis
here are the urinary bladders
uh the urethra i'm sorry the ureter
notice the ureter passes into the pelvis at approximately the branching of the
internal iliac and the external iliac here it is over here also there's the internal the external
iliac so in that vicinity um and additionally we have the uterus and vagina and a seminal vesicle
so let's take a look at the major divisions of the internal iliac of which there are two probably the
the easiest or at least the most straightforward will be the posterior division so i can see
that posterior division right there here's the posterior division here the the posterior division
supplies the body wall of the pelvis uh and hip through several branches so the the first
is typically the ilio lumbar and in this case the iliolumbar is coming off of
the internal iliac before it splits into divisions that's ascending up out of the pelvis then we have
typically two lateral sacral arteries these lateral sacral arteries are going to travel
through the sacral foramina to supply the uh the wall of the the pelvis posteriorly and then the
terminal branch is the superior gluteal artery the spirit gluteal artery is going to supply some of
the muscles of the hip and its name is a reference to how that artery exits the pelvis into the hip
region it is superior to the piriformis muscle you'll notice there is also an inferior gluteal
artery from the anterior division and that's because that artery exits into the hip from the
pelvis inferior to the piriformis muscle then we have our anterior division our anterior division
it's probably worthy of note that many of these branches are named for their targets and so if you
can see where they're going you can oftentimes get a positive id for what they are let's just work
our way through one of the first major branches is the umbilical artery the umbilical artery
heads out to the anterior body wall and typically throws superior vesicle branches
those superior vesicle branches or arteries are supplying the urinary bladder with blood
when the umbilical artery gets to the abdominal wall
it is obliterated and turns into the medial umbilical ligament that medial
umbilical ligament is going to travel up to the uh the belly button the umbilicus
it would have been the full pathway of the umbilical artery out to the umbilical cord
in a fetus but after birth there's no need to send blood up through there because there's no
return of blood to the placenta hence you know the obliteration of the artery at that stage the next
major artery is the obturator artery the obturator artery is actually heading out of the pelvis
through the obturator canal and it's going to be part of the blood supply to
the medial thigh so the the adductor compartment of the thigh the next set of arteries are
are really named for their targets and what's what's sometimes challenging is that many of these
arteries will have branches that also supply adjacent viscera so over here we we see
that there's a common trunk that's branching into the uterine artery and a vaginal artery
so the uterine artery is actually let me i'm going to erase some of this so that we
can see it more clearly i want you to pay attention to the ureter coming down here
the uterine artery at about the level of the internal loss of the uterus is going to cross
over the ureter that relationship there is immortalized in the mnemonic
water under the bridge with the uterine artery as the bridge and the ureter
as the water that's so that an ob gyn can understand those relationships very quickly
and easily so that they don't ligate the ureter during a hysterectomy then we have
um a large trunk here and this is going to be the um the median rectal
artery which is not on this list going down to supply the rectum we can also see that there
and coming from this is the vaginal artery and possibly an inferior vesicle branch there we
can see an inferior vesicle branch coming off that median rectal artery or middle
rectal artery there so sorry about that that's the middle rectal so just add that to the list
and then we have really the the terminal branches of the internal iliac
the internal pudendal and the inferior gluteal arteries so there's the inferior gluteal
and the internal pudendal uh the inferior gluteal artery is going out to supply blood to the hip
the internal pudendal artery is going off to be the dominant blood supply to the perineum
so now let's look to see the
pathway of the external iliac artery so with the external iliac argument we can see the
division between internal and external as we pass under the inguinal ligament there
it becomes the femoral artery and that's going to be in a region known as the femoral triangle
so we can see there's the femoral nerve there the artery and the vein excuse me
and deep within that triangle the femoral artery is going to give off the deep artery of the thigh
oftentimes referred to as the deep femoral um and then the femoral will continue on that
femoral artery is going to supply be the dominant supply to the anterior compartment of the thigh
as well as the medial compartment of the thigh or the adductor compartment
and that adductor compartment is supplemented by that obturator artery from the anterior division
of the internal iliac artery whereas the deep artery of the thigh is the blood supply to the
posterior compartment of the thigh so now we're looking at the popliteal fossa it's been kind of
dissected away here so we can see all of the the deepest contents and within the popliteal
fossa we could see the tibial nerve we can also see the popliteal vein and popliteal artery and
the popliteal artery is going to be the deepest structure within the popliteal fossa which makes
for obtaining a pulse at this point very difficult but still still possible so that popliteal artery
which is just the continuation of the femoral artery as it exits from the adductor
hiatus continues on down through the popliteal fossa and it's going to turn into the posterior
tibial artery so there's coming down and that posterior tibial artery gives off a fibular artery
the fibular artery is going to be a supplemental blood supply to the lateral compartment of the leg
and that posterior tibial artery will continue inferiorly and be the dominant blood supply to the
posterior compartment of the leg at about the level of the calcaneus we can't see it here
it's actually going to divide into a medial and a lateral plantar artery that lateral plantar artery
is going to be a large contributor to the plantar
arterial arch and it's going to anastomose with a deep plantar artery which
we'll talk about shortly that is a continuation from the anterior tibial artery so let's
let's look at that now so here we're looking at an anterior view of the leg so there is the knee
there and coming down we can see the anterior tibial artery that anterior tibial artery
is the dominant blood supply to the anterior compartment of the leg as well as the lateral
compartment of the leg so it's supplemented by that fibular artery from the posterior tibial
and as we transition down into the foot that anterior tibial artery becomes the dorsalis
pedis artery and so we have an opportunity for a pulse palpation point and then the dorsalis
pedis artery dives deeply into the substance of the foot and it is going to contribute
to the deep plantar artery that deep plantar artery is what helps to give rise to the plantar
arterial arch and as you recall the other main substantive conduit to that arterial arch is the
lateral plantar artery coming from the posterior tibial artery so that is the the major flow of
blood between the the pelvis and the lower limbs we have external and internal iliac arteries
coming from the common iliac internal serves the pelvis and has a posterior and an anterior
division posterior is predominantly body wall anterior is abdominal viscera as well as perineum
that external iliac artery becomes the femoral artery at the inguinal ligament the femoral artery
divides into the deep femoral artery within the femoral triangle that deep femoral artery supplies
the posterior thigh whereas the femoral artery supplies the anterior and middle compartments of
the thigh the femoral artery exiting from the adductor hiatus becomes the popliteal artery
the popliteal artery is going to continue down the posterior lower limb and in the leg becomes
the posterior tibial artery posterior tibial artery supplies the posterior compartment of
the leg it gives off the fibular artery which is a supplemental branch to the lateral leg
and that posterior tibial artery divides into medial and lateral plantar arteries
the lateral plantar artery supplies the plantar arterial arch the anterior tibial artery is a
branch of the popliteal artery which supplies the anterior and lateral compartments of the leg
it becomes the dorsalis pedis artery in the foot and when that dives into the substance
of the foot becomes the deep plantar artery and that deep plantar artery anastomoses with
the lateral plantar artery to form the plantar arterial arch thank you very much for your time