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| internal iliac artery | |
|---|---|
| Name | Internal iliac artery |
| Latin | Arteria iliaca interna |
| Branchfrom | Common iliac artery |
internal iliac artery The internal iliac artery is a major pelvic artery that supplies blood to the pelvis, gluteal region, medial thigh, perineum and pelvic viscera. It arises from the Common iliac artery and divides into anterior and posterior trunks with multiple visceral and parietal branches. Knowledge of its course, branches and variations is essential in general surgery settings such as pelvic trauma, obstetrics and vascular interventions.
The internal iliac artery originates at the bifurcation of the Common iliac artery near the pelvic brim anterior to the Sacroiliac joint and descends into the pelvis alongside the Ureter and Internal iliac vein. It typically divides into anterior and posterior divisions within the pelvic cavity near the level of the Greater sciatic foramen; the anterior trunk gives mainly visceral branches while the posterior trunk gives predominantly parietal branches. Relations include the Piriformis muscle, Obturator internus muscle, Lumbosacral trunk and the pelvic walls; important adjacent structures are the Ureter, Sympathetic trunk (thoracolumbar), Pelvic splanchnic nerves and the Hypogastric plexus.
Major branches from the anterior division include the Uterine artery (in females), Vaginal artery, Internal pudendal artery, Inferior vesical artery, Superior vesical artery (occasionally from the umbilical artery), Middle rectal artery and Obturator artery when arising from the internal iliac. Posterior division branches classically include the Superior gluteal artery, Iliolumbar artery and Lateral sacral arteries. Accessory and collateral vessels commonly encountered clinically include the Median sacral artery (from the posterior aspect of the aortic bifurcation), anastomoses with the External iliac artery, Femoral artery via the deep circumflex iliac and Inferior epigastric artery, and cross-pelvic connections with contralateral branches. Variants such as a persistent Sciatic artery or aberrant obturator arising from the Inferior epigastric artery are important in pelvic hemorrhage and hernia surgery.
Embryologically, the internal iliac artery develops from the distal portion of the embryonic Umbilical artery and the axial artery of the lower limb; remodeling during fetal life produces the definitive anterior and posterior divisions. The proximal common internal iliac segment derives from the dorsal aorta derivatives that also form the Common iliac artery and External iliac artery. Developmental anomalies may be associated with congenital conditions described in literature from teams at institutions such as Johns Hopkins Hospital, Mayo Clinic and Great Ormond Street Hospital where vascular malformations and embryopathy are studied.
The internal iliac artery supplies arterial blood to pelvic organs including the Urinary bladder, Rectum, Uterus, Prostate, Vagina, Penis (via branches), and muscles of the pelvic floor, gluteal region and medial thigh. Hemodynamic regulation involves local autoregulation and systemic influences mediated by the Renin–angiotensin system, sympathetic pathways via the Hypogastric plexus and hormonal factors from organs such as the Adrenal gland and Placenta during pregnancy. Collateral flow through anastomoses with the Inferior mesenteric artery, Femoral artery and contralateral internal iliac artery maintains perfusion when occlusion or ligation occurs.
Injury, atherosclerotic disease, aneurysm, thrombosis and iatrogenic complications of the internal iliac artery lead to pelvic ischemia, buttock claudication, sexual dysfunction and severe hemorrhage. Ruptured internal iliac artery aneurysms are life-threatening and are managed in centers like Royal Infirmary of Edinburgh and Massachusetts General Hospital. Obstetric hemorrhage often involves the uterine branch of the internal iliac artery and is a leading indication for arterial ligation or embolization in facilities such as Karolinska University Hospital and St Thomas' Hospital. Neoplastic invasion by Cervical cancer, Rectal cancer and Prostate cancer can encase branches producing hemorrhage or ischemia; interventional radiology services at Cleveland Clinic and University College Hospital, London frequently perform endovascular embolization for control.
Surgical ligation of the internal iliac artery or its anterior division is used to control pelvic hemorrhage in obstetrics, trauma and pelvic surgery; this technique is practiced in obstetric units at Addenbrooke's Hospital and trauma centers like Royal London Hospital. Endovascular approaches include coil embolization, stent grafting for aneurysms and covered stents deployed by teams at Albert Einstein Medical Center and Toronto General Hospital. Iatrogenic injury risks arise during procedures such as Pelvic lymphadenectomy, Radical prostatectomy, Cesarean section and repair of Inguinal hernia, requiring familiarity with variant anatomy and preservation of branches like the Inferior gluteal artery and Obturator artery. Preoperative imaging with Computed tomography angiography and intraoperative Doppler or angiography guides interventions in centers including Mayo Clinic and Johns Hopkins Hospital.
Anatomic variation is common: the internal iliac artery may have variable origin of the Obturator artery (corona mortis), accessory or replaced Superior gluteal artery, or early bifurcation high in the pelvis. Hypoplasia or aplasia can be associated with congenital limb anomalies studied at Great Ormond Street Hospital and Boston Children's Hospital. Arterial branching patterns classified in surgical literature from institutions such as Rutgers University and University of Toronto inform operative planning; awareness of uncommon anomalies like a persistent Sciatic artery or pelvic arterial trifurcation minimizes intraoperative hemorrhage.
Category:Arteries of the pelvis