Blood supply of female pelvis.
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Blood supply of female pelvis.
- 1. Blood supply of female pelvis Dr.M.Gokul Reshmi Post graduate Obg.
- 2. General principles... • The pelvic vessels play an important role in pelvic support. • There is significant anatomic variation between individuals in the branching pattern of the internal iliac vessels.
- 3. General principles... • The pelvic vasculature is a high-volume, high-flow system with enormous expansive capabilities throughout reproductive life. • The pelvic vasculature is supplied with an extensive network of collateral connections that provides a rich anastomotic communication between different major vessel systems.
- 4. Artery... • Iliac artery • Umbilical artery • Ovarian artery • Superior rectal artery.
- 5. Veins... • In general the venous system draining the pelvis closely follows the arterial supply and is named accordingly.
- 6. Iliac artery... • The common Iliac artery bifurcate Into external and internal iliac artery at the level of Lumbosacral joint.
- 7. • It is the principal artery of the Pelvis, supplies Most of the blood to pelvic viscera and some to Msk. Part of pelvis. Internal iliac artery...
- 8. Internal iliac artery... • Each internal Iliac artery is~4cm Long. • The ureter crosses the common iliac artery or its terminal branch at or immediately distal to the bifurcation. • The internal iliac artery is separated from the sacroiliac joint by internal iliac vein and lumbosacral trunk.
- 10. Internal iliac artery... • It descends posteromedially into the lesser pelvis, medial to the external iliac vein and obturator nerve and lateral to the peritoneum. • Although variations are common , internal iliac artery usually ends at the superior edge of the greater sciatic foramen by dividing into anterior and posterior division.
- 12. Internal iliac artery... Internal iliac artery Posterior divisionAnterior division • Superior gluteal • Iliolumbar • Lateral sacral • Superior vesical • Uterine • Inferior vesical • Middle rectal • Vaginal • Inferior gluteal • Obturator • Internal pudendal V P P
- 13. • In the fetal life the umbilical arteries are the main continuation of the internal iliac arteries, passing along the lateral pelvic wall and then ascending the anterior abdominal wall to and through the umbilical arteries. • Once the umbilical cord is cut , the distal part forms fibrous cords called medial umbilical ligament or cord of umbilical arteries. Umbilical artery...
- 14. Superior vesical artery... • Postnatally the patent part of the umbilical artery runs anterioinferiorly between the urinary bladder and the lateral wall of the pelvis,giving off the SUPERIOR VESICAL ARTERY. • It supplies the funds of the bladder by numerous branches.
- 16. Uterine artery... • ORIGIN: • Arises either directly from the internal iliac artery or in common with the obliterated umbilical artery. • COURSE: • It desends on the lateral wall of the pelvis and runs anteriomedially in the base of the broad ligament, gives vaginal branch then crosses the ureter anteriorly at the level of internal Os , at about 1.5 to 2 cm lateral to it.
- 17. Uterine artery... • It reaches the lateral aspect of the cervix and ascends up giving spiral course along the lateral uterine wall between the layers of broad ligament and ultimately anastomoses with the tubal branch of the ovarian artery in the mesosalpinx.
- 19. Uterine artery... • BRANCHES: • Ureteric • Decending cervical • Circular artery to the cervix .
- 20. Uterine artery... • BRANCHES: • Segmental arcuate arteries • Short basal artery. • Spiral artery.
- 21. Uterine artery... • BRANCHES: • Funds branch. • Twigs to the round ligament. • Tubal branch. • Ovarian anastomotic branch.
- 22. Iatrogenic injury to the ureter during ligation of arteries... • Ureter passes immediately posterior to the uterine artery near the internal Os of the cervix or ~ 2cm superior to the ischial spine is clinically important. • As it is in danger of being inadvertently damaged during abdominal hysterectomy when uterine artery is ligated and cut to remove the uterus.
- 23. Iatrogenic injury to the ureter during ligation of arteries... • Ureter lies close in relation to ovarian vessels as they crosses the pelvic brim.
- 24. Inferior vesical artery... • ORIGIN: • Anterior division of internal iliac artery or patent proximal umbilical artery or from the uterine artery. • SUPPLIES: • Middle third of the vagina and urethra.
- 25. Vaginal arteries... • ORIGIN: • The vaginal artery arises either from the uterine artery or from the anterior division of internal iliac artery. • COURSE: • In relation to the lateral fornix it descends down along the lateral wall of the vagina.
- 26. Vaginal arteries... • Numerous transverse branches are sent off anteriorly and posteriorly anastomose with the similar branch of other side to form azygos arteries of vagina. • Other arteries contributing to azygos artery, • Decending cervical artery • Circular artery to the cervix • Inferior vesical artery • Internal pudendal artery.
- 28. Middle rectal arteries... • ORIGIN: • It arises either directly from the anterior division of internal iliac artery or in common with inferior vesical artery. • COURSE: • Descends in pelvis to the inferior part of the rectum.
- 29. Middle rectal arteries... • SUPPLIES: • It gives branches to the inferior rectum and to the midvagina . • Anastomose with the superior and inferior rectal arteries.
- 30. Internal pudendal artery ... • ORIGIN: • Parietal branch of the anterior division of the internal iliac artery. • COURSE: • It leaves the pelvic cavity along with its vein and pudendal nerve through the greater sciatic foramen to lie in the pudendal canal(Alcocks canal) after winding round the ischial spine.
- 31. Internal pudendal artery ... • BRANCHES: • Inferior rectal artery. • Numerous branches to supply the perineal and vulvar structure including vestibular bulb and clitoris . • Terminal branch anastomosis with the superior and deep pudendal artery branch of femoral artery.
- 32. Internal pudendal artery ...
- 33. Inferior gluteal artery ... • ORIGIN: • Anterior division of internal iliac artery. • COURSE: • Exits pelvis via infra piriform port of the greater sciatic foramen to supply the muscles and skin of the buttock and the posterior surface of the thigh.
- 34. Obturator artery ... • ORIGIN: • Parietal branch of anterior division of internal iliac artery. • COURSE: • Runs anterioinferiorly on the obturator fascia of the lateral pelvic wall,exiting pelvis via obturator canal.
- 35. Obturator artery ... • Supplies the pelvic muscle, nutrient artery to ilium and head of femur , and muscles of medial compartment of thigh. • Pubic branch arises just before the obturator artery leaves the pelvis.
- 36. Superior gluteal artery ... • ORIGIN: • Posterior division of the internal iliac artery • COURSE: • It passes posteriorly and runs between the lumbosacral trunk and the anterior ramya of the s1 nerve. • Exits the pelvis via suprapiriform portion of the greater pelvis.
- 37. Superior gluteal artery ... • SUPPLIES: • Gluteal muscles • Piriform • • Tensor fascia lata.
- 38. Iliolumbar artery... • ORIGIN: • Posterior division of the internal iliac artery. • COURSE: • It runs superolaterally in a recurrent fashion , (turning sharply backward relative to its source) to the iliac fossae and gives iliac and lumbar branch.
- 39. Iliolumbar artery... • SUPPLIES: • Iliac branch: iliacus muscle and ilium. • Lumbar branch: psoas major and quadratus lumborum muscle.
- 40. Lateral sacral artery... • ORIGIN: • Posterior division of internal iliac artery. • COURSE: • The lateral sacral arteries pass medially and descend anterior to the sacral anterior rami giving off spinal branches,which passes through the anterior sacral foramina, and some branches passes from the sacral canal through the posterior sacral foramina.
- 41. Lateral sacral artery... • SUPPLIES: • The spinal meninges enclosing the roots of the sacral nerves. • The erector spinae muscles of the back and skin overlying the sacrum.
- 42. Ligation of the internal iliac artery... • Occasionally the internal iliac artery is ligated to control pelvic hemorrhage. • Because of numerous anastomosis between the artery branch and the adjacent arteries, ligation does not stop blood flow, but it does reduce blood pressure allowing hemostasis to occur.
- 43. Ligation of the internal iliac artery... • . Ligation of the internal iliac artery 5 cm distal to the common iliac bifurcation will usually avoid the pos-terior division branches (Bleich, 2007)
- 44. Ligation of the internal iliac artery...
- 49. Applied anatomy... • STEP WISE DEVASCULARIZATION OF UTERUS. Right uterine artery ligation. Left uterine artery ligation. Low bilateral uterine artery ligation. Right ovarian vessel ligation. Left ovarian vessel ligation.
- 50. Applied anatomy... • SITES OF UTERINE ARTERY LIGATIONS.
- 51. Applied anatomy... • UAE TO TREAT UTERINE FIBROID.
- 52. Ovarian artery... • ORIGIN: • It arises from the abdominal aorta inferior to the renal artery, but considerably superior to the inferior mesenteric artery. • COURSE: • It passes inferiorly adhering to the parietal peritoneum and runs anterior to the ureter on the posterior abdominal, wall usually giving branch to it.
- 53. Ovarian artery... • As it enters the lesser pelvis it crosses the origin of the external iliac vessels. It then runs medially in the suspensory ligament of the ovary and enters the superolateral part of the broad ligament(mesoovarium) dividing into ovarian and tubal branch and supply the respective organ. • These branches anastomose with the corresponding branches of the uterine artery.
- 54. Ovarian artery... • SUPPLIES: • Ovaries • Uterine tubes • Round ligament • Uterine anastomotic branch.
- 55. Superior rectal artery... • ORIGIN: • It is the direct continuation of the inferior mesentric artery. • COURSE: • It crosses the left common iliac vessels and descends in the sigmoid mesocolon to the lesser pelvis.
- 56. Superior rectal artery... • At the level of S3 vertebra, the superior rectal artery divides into two branches, which descend on each side of the rectum and supply it as far as the internal anal sphincter. • SUPPLIES: • Superior part of the rectum. • Anastomose with the middle rectal artery(br. IIA) • And with the inferior rectal artery(br. IPA).
- 58. Medial sacral artery... • ORIGIN: • It is a small unpaired artery that usually arises from the posterior surface of the abdominal aorta, just superior to its bifurcation but, it may also arise from its anterior surface. • COURSE: • It runs we anterior to the body of the last one or two lumbar vertebra, the sacrum and the coccyx, and ends in a series of anastomotic loops.
- 59. Medial sacral artery... • It represents the caudal end of the embryonic dorsal aorta, which reduced in size as the the tail-like caudal eminence of the embryonic disappears. • SUPPLIES: • Parietal branch - lateral sacral. • Visceral branch to the posterior part of the rectum. • Anastomose with the superior and middle rectal artery.
- 60. Pelvic veins... • The peculiarities of the pelvic veins are: • There are tendency to form plexuses • The plexuses anastomose freely with each other. • The veins may not follow the course of the artery. • They have no valves.
- 61. Pelvic veins... • The pelvic venous plexuses are formed by the interjoining veins surrounding the pelvic viscera. • These intercommunicating veins are clinically important.
- 62. Pelvic veins...
- 63. Ovarian veins... • The ovarian veins on each side begin from the pampiniform plexus, which lies in between the layers of broad ligament, near mesoovarium. • Beyond the infundibulopelvic ligament, there are two ovarian veins on each side, which ascends up along the course of the corresponding artery.
- 64. Ovarian veins... • Higher up the veins become one and ultimately drains into left renal vein on left side and inferior venacava on the right side.
- 65. Internal iliac veins... • Venous drainage from the uterus, vagina, plexuses chiefly drain into internal iliac vein. • Internal iliac vein merge with the external iliac veins to form the common iliac vein, which unite at the level of vertebra L4 or L5 to form the inferior venacava.
- 66. Internal iliac veins... • The internal iliac vein lie posterior to the internal iliac arteries, except that there are no veins accompanying the umbilical arteries between the pelvis and the umbilicus.
- 67. Pelvic veins...
- 68. Iliolumbar veins... • Iliolumbar veins from the iliac fossae of the greater pelvis usually drains into the common iliac vein. • The superior gluteal veins, the accompanying veins of the superior gluteal arteries of the gluteal region, are the largest tributaries of the internal iliac vein, except during pregnancy, when the uterine veins become larger.
- 69. Iliolumbar veins... • Additional paths of venous drainage from the lesser pelvis include the parietal median sacral vein, superior rectal vein(to portal system).
- 70. Superior rectal veins... • Venous drainage from the rectal plexus drains via superior rectal vein into the inferior mesenteric vein. • The middle and the inferior rectal veins drains into the internal pudendal vein and thence to the internal iliac vein.
- 72. Applied anatomy... • The free anastomosis between the superior rectal vein of the portal with the middle and inferior rectal veins of the systemic circulation explains, the liver metastasis from the genital organ. • The uterine veins communicate with the vaginal plexus, thus accounting for vaginal metastases in endometrial carcinoma or choriocarcinoma.
- 73. Applied anatomy... • A free communication between pelvic plexuses with the sacral and lumbar channels of the vertebral venous plexuses explains not only the development of vertebral metastases but also explains the intracranial malignant metastases bypassing the lungs through jugular vein . • This collateral pathway is also related with supine hypotension syndrome in late pregnancy.
- 74. •HAVE A NICE DAY☺ Thank you...