Arteries and Veins of the Pelvis and Abdomen

Arteries of the Pelvis

Common Iliac Arteries

• The aorta divides at approximately the level of vertebra L4 into the left and right common iliac arteries. It continues as the median sacral artery into the sacrum.
• The common iliac arteries supply blood to the pelvic region and lower limbs.
• They split into external and internal iliac arteries approximately at the level of the lumbar-sacral articulation.

Internal Iliac Artery

• Branches supply blood to:
  • Urinary bladder
  • Walls of the pelvis
  • External genitalia
  • Medial portion of the femoral region
  • In females: uterus and vagina

External Iliac Artery

• Larger than the internal iliac.
• Supplies blood to each of the lower limbs.

Vessels of the Abdominal Aorta (Table 20.8)

• Celiac Trunk:
  • Also called the celiac artery.
  • Major branch of the abdominal aorta.
  • Gives rise to:
    • Left gastric artery.
    • Splenic artery.
    • Common hepatic artery, which forms:
      • Hepatic artery (to the liver).
      • Right gastric artery (to the stomach).
      • Cystic artery (to the gall bladder).
• Left Gastric Artery:
  • Branch of the celiac trunk.
  • Supplies blood to the stomach.
• Splenic Artery:
  • Branch of the celiac trunk.
  • Supplies blood to the spleen.
• Common Hepatic Artery:
  • Branch of the celiac trunk.
  • Forms the hepatic artery, right gastric artery, and cystic artery.
• Hepatic Artery Proper:
  • Branch of the common hepatic artery.
  • Supplies systemic blood to the liver.
• Right Gastric Artery:
  • Branch of the common hepatic artery.
  • Supplies blood to the stomach.
• Cystic Artery:
  • Branch of the common hepatic artery.
  • Supplies blood to the gall bladder.
• Superior Mesenteric Artery:
  • Branch of the abdominal aorta.
  • Supplies blood to:
    • Small intestine (duodenum, jejunum, and ileum).
    • Pancreas.
    • Majority of the large intestine.
• Inferior Mesenteric Artery:
  • Branch of the abdominal aorta.
  • Supplies blood to:
    • Distal segment of the large intestine.
    • Rectum.
• Inferior Phrenic Arteries:
  • Branches of the abdominal aorta.
  • Supply blood to the inferior surface of the diaphragm.
• Adrenal Artery:
  • Branch of the abdominal aorta.
  • Supplies blood to the adrenal (suprarenal) glands.
• Renal Artery:
  • Branch of the abdominal aorta.
  • Supplies blood to each kidney.
• Gonadal Artery:
  • Branch of the abdominal aorta.
  • Supplies blood to the gonads or reproductive organs.
  • Also described as ovarian or testicular arteries, depending on the sex of the individual.
• Ovarian Artery:
  • Branch of the abdominal aorta.
  • Supplies blood to the ovary, uterine (fallopian) tube, and uterus.
• Testicular Artery:
  • Branch of the abdominal aorta.
  • Travels outside the body cavity to the testes.
  • Forms one component of the spermatic cord.
• Lumbar Arteries:
  • Branches of the abdominal aorta.
  • Supply blood to the lumbar region, the abdominal wall, and spinal cord.
• Common Iliac Artery:
  • Branch of the aorta that leads to the internal and external iliac arteries.
• Median Sacral Artery:
  • Continuation of the aorta into the sacrum.
• Internal Iliac Artery:
  • Branch from the common iliac arteries.
  • Supplies blood to the urinary bladder, walls of the pelvis, external genitalia, and the medial portion of the femoral region.
  • In females, also provides blood to the uterus and vagina.
• External Iliac Artery:
  • Branch of the common iliac artery that leaves the body cavity and becomes a femoral artery.
  • Supplies blood to the lower limbs.

Branches of the Anterior Trunk of the Internal Iliac Artery

• The internal iliac artery branches into the anterior and posterior trunks.
• Superior Vesical Artery:
  • Travels forward on the surface of the obturator internus to supply the bladder.
• Inferior Vesical Artery:
  • Travels forward on the surface of the levator ani to supply the bladder and ureter.
• Middle Rectal Artery:
  • Travels medially to supply the middle of the rectum.
• Vaginal Artery:
  • Often splits into three branches as it descends into the pelvic cavity to supply the vagina and the bulb of the vestibule.
• Uterine Artery:
  • Runs medially on the levator ani to reach the cervix, where it bifurcates.
  • One branch ascends along the uterus to join the ovarian artery; the other descends to join the vaginal artery.
• Obturator Artery:
  • Passes forward along the obturator internus and passes into the thigh through the obturator foramen.
  • Supplies pelvic muscles, the medial thigh, and the hip.
• Internal Pudendal Artery:
  • Descends anterior to the sacral plexus to pass through the lesser sciatic foramen and enter the perineum.
  • Supplies the external genitalia, anal canal, and perineum.
• Inferior Gluteal Artery:
  • Descends between the sacral plexus and traverses the greater sciatic foramen to follow the sciatic nerve into the thigh.
  • Supplies the pelvic floor and gluteal muscles.

Other Arteries

• Iliolumbar Artery:
  • Ascends anterior to the sacroiliac joint to reach psoas major.
• Lateral Sacral Artery:
  • Descends on the front of the sacrum, giving off branches that run into the pelvic sacral foramina and out of the dorsal sacral foramina.
  • Supplies the sacral canal and muscle and skin posterior to the sacrum.
• Superior Gluteal Artery:
  • Descends over the sacral plexus and traverses the greater sciatic foramen before it branches to supply the gluteal muscles and their overlying skin.

Veins of the Thoracic and Abdominal Regions

• Most of the blood inferior to the diaphragm drains into the inferior vena cava before it is returned to the heart.

Inferior Vena Cava

• Lies just beneath the parietal peritoneum in the abdominal cavity, parallels the abdominal aorta.

Lumbar Veins

• Drain the lumbar portions of the abdominal wall and spinal cord.
• Usually four on each side.
• Ascending lumbar veins drain into either the azygos vein on the right or the hemiazygos vein on the left and return to the superior vena cava.
• The remaining lumbar veins drain directly into the inferior vena cava.

Other Veins Draining into the Inferior Vena Cava:

• Renal Vein:
  • Drains the kidneys and flows into the inferior vena cava.
• Adrenal Vein:
  • Drains the adrenal or suprarenal glands.
  • The right adrenal vein enters the inferior vena cava directly, and the left adrenal vein enters the left renal vein.
• Testicular Vein:
  • Drains the testes and forms part of the spermatic cord.
  • The right testicular vein empties directly into the inferior vena cava, and the left testicular vein empties into the left renal vein.
• Ovarian Vein:
  • Drains the ovary.
  • The right ovarian vein empties directly into the inferior vena cava, and the left ovarian vein empties into the left renal vein.
• Gonadal Vein:
  • Generic term for a vein draining a reproductive organ; may be either an ovarian vein or a testicular vein, depending on the sex of the individual.
• Phrenic Vein:
  • Drains the diaphragm.
  • The right phrenic vein flows into the inferior vena cava, and the left phrenic vein empties into the left renal vein.
• Hepatic Vein:
  • Drains systemic blood from the liver and flows into the inferior vena cava.
• The left renal vein is longer, as are the left phrenic, adrenal, and gonadal veins because the inferior vena cava lies primarily to the right of the vertebral column and aorta.
• The longer length of the left renal vein makes the left kidney the primary target of surgeons removing this organ for donation.

Major Veins of the Abdominal Region (Table 20.15)

• Inferior Vena Cava:
  • Large systemic vein that drains blood from areas largely inferior to the diaphragm; empties into the right atrium.
• Lumbar Veins:
  • Series of veins that drain the lumbar portion of the abdominal wall and spinal cord; the ascending lumbar veins drain into the azygos vein on the right or the hemiazygos vein on the left; the remaining lumbar veins drain directly into the inferior vena cava.
• Renal Vein:
  • Largest vein entering the inferior vena cava; drains the kidneys and flows into the inferior vena cava.
• Adrenal Vein:
  • Drains the adrenal or suprarenal; the right adrenal vein enters the inferior vena cava directly, and the left adrenal vein enters the left renal vein.
• Testicular Vein:
  • Drains the testes and forms part of the spermatic cord; the right testicular vein empties directly into the inferior vena cava, and the left testicular vein empties into the left renal vein.
• Ovarian Vein:
  • Drains the ovary; the right ovarian vein empties directly into the inferior vena cava, and the left ovarian vein empties into the left renal vein.
• Gonadal Vein:
  • Generic term for a vein draining a reproductive organ; may be either an ovarian vein or a testicular vein, depending on the sex of the individual.
• Phrenic Vein:
  • Drains the diaphragm; the right phrenic vein flows into the inferior vena cava, and the left phrenic vein empties into the left renal vein.
• Hepatic Vein:
  • Drains systemic blood from the liver and flows into the inferior vena cava.