Description

This video covers an easy way to remember the side branches of the Internal Iliac Artery (A. Iliaca Interna) using the 2+4+4 mnemonic. Understanding these branches is crucial for anatomy, surgery, and clinical relevance.

Mnemonic: 2+4+4

2 Arteries to the Back Body Wall:

• Iliolumbar Artery (A. Iliolumbalis):
  • Divides into the Lumbar branch (R. Lumbalis) and Iliac branch (R. Iliacus).
• Lateral Sacral Artery (A. Sacrales Laterales):
  • Gives off spinal branches (Rr. Spinales), which supply the sacral vertebrae and meninges.

4 Arteries Leaving the Pelvic Cavity:

• Obturator Artery (A. Obturatoria):
  • Passes through the obturator canal and divides into anterior and posterior branches.
  • Side Branches:
    • Pubic Branch (R. Pubicus): Communicates with the pubic branch of the inferior epigastric artery, forming the Corona Mortis (important in surgery due to risk of excessive bleeding).
    • Acetabular Branch (R. Acetabularis): Runs through the ligament of the femoral head to supply Caput Femoris.
• Superior Gluteal Artery (A. Glutea Superior):
  • Leaves the pelvis above the Piriformis muscle through the greater sciatic foramen.
• Inferior Gluteal Artery (A. Glutea Inferior):
  • Leaves the pelvis below the Piriformis muscle.
• Internal Pudendal Artery (A. Pudenda Interna):
  • Leaves below the Piriformis muscle and travels between the perineal and pelvic diaphragm muscles.
  • Terminates as:
    • Deep and Dorsal Arteries of the Penis (A. Dorsalis Penis & A. Profunda Penis) or the Deep and Dorsal Arteries of the Clitoris (A. Dorsalis Clitoridis & A. Profunda Clitoridis).
  • Side Branches:
    • Inferior Rectal Artery (A. Rectalis Inferior): Supplies the anal canal.
    • Perineal Artery (A. Perinealis): Gives off:
      • Posterior Scrotal Artery (Rr. Scrotales Posteriores) in males.
      • Posterior Labial Artery (Rr. Labiales Posteriores) in females.
    • Urethral Branch (A. Urethralis): Supplies the urethra.
    • Artery of the Bulb of the Penis (A. Bulbi Penis) or Artery of the Bulb of the Vestibule (A. Bulbi Vestibuli) in females.

4 Arteries Staying Inside the Pelvic Cavity:

• Umbilical Artery (A. Umbilicalis):
  • Partially obliterated after birth, forming the Medial Umbilical Fold (Plica Umbilicalis Medialis).
  • Remaining Part:
    • Superior Vesical Artery (Aa. Vesicales Superiores): Supplies the bladder.
    • Artery of the Ductus Deferens (A. Ductus Deferentis): Supplies the vas deferens, with branches to the urethra.
• Inferior Vesical Artery (Aa. Vesicales Inferiores):
  • Supplies the lower bladder, prostate, and seminal vesicles (present in males).
• Uterine Artery (A. Uterina):
  • Runs along the uterus and divides into:
    • Tubal Branch (R. Tubarius): Supplies the Fallopian Tube and Mesosalpinx.
    • Ovarian Branch (R. Ovaricus): Communicates with the Ovarian Artery from the abdominal aorta.
• Middle Rectal Artery (A. Rectalis Media):
  • Supplies the middle part of the rectum and anastomoses with the superior and inferior rectal arteries.

Blood Supply of the Rectum:

• Superior Rectal Artery: From the Inferior Mesenteric Artery (IMA).
• Middle Rectal Artery: From the Internal Iliac Artery.
• Inferior Rectal Artery: From the Internal Pudendal Artery.

Clinical Relevance:

• Corona Mortis: Surgeons must be cautious of the anastomosis between the pubic branch of the obturator and inferior epigastric artery due to bleeding risk.
• Uterine Artery Ligation: Done in hysterectomy procedures, ensuring ovarian arteries are preserved for continued blood supply.
• Rectal Arteries: Important in hemorrhoidal disease, with superior, middle, and inferior rectal arteries contributing to vascular supply.

Sources Used:

• Memorix Anatomy (2nd Edition) – Hudák Radovan, Kachlík David, Volný Ondřej.
• Complete Anatomy by 3D4Medical.
• Biorender.
• University Notes and Lectures.

Transcript

Introduction
0:00
alright guys so this video is going to
0:02
be about the internal iliac artery along
0:04
with a couple of tips on how to remember
0:06
the branches easier
0:07
i’m going to share the way i used to
0:09
remember these branches
0:10
so as you know the abdominal outer will
0:13
continue downwards so approximately the
0:15
fourth lumbar vertebrae
0:16
and then it will divide into what is
0:18
called the common iliac arteries
0:20
they will continue to approximately the
0:22
sakurai leaf joint as you see here
0:24
and then further divide into the
0:26
external iliac and the internal iliac
0:28
arteries
0:29
now let’s make a cross-section and look
0:31
at them both from this perspective to
0:33
visualize them easier
0:34
and then from here we can finally focus
0:36
on the internal iliac artery
0:38
the first thing to understand is that
0:40
the branching pattern of the internal
0:42
iliac
0:42
is very variable meaning any particular
0:45
branching pattern of the internal elec
0:47
artery
0:48
whether it’s an anatomical atlas or a
0:49
lecture will probably have no
0:51
bearing whatsoever on the on the
0:53
branching pattern and the next person
0:55
you encounter
0:56
even the variation between the right and
0:58
the left side in a single person
1:00
can be as great as among different
1:02
people so
1:03
instead of focusing on the branching
1:05
sequence instead
1:07
concentrate on matching the arteries to
1:09
the target
1:10
which i will try to show you in this
1:12
video it will be much much more easier
1:15
to remember the branches of this artery
1:17
now the internal iliac will travel along
1:20
the lateral wall of the
1:21
of the lesser pelvis and then split into
1:24
two divisions
The 2+4+4 Rule
1:26
there are typically 10 branches of the
1:28
internal iliac artery
1:29
and if you know these 10 you’ll be fine
1:31
in almost any conceivable purpose
1:33
there are a lot of ways to remember the
1:35
branches of the internal iliac
1:37
but a simple scheme for remembering them
1:39
is remembering the numbers
1:40
two plus four plus four that gives you
1:44
two to the back body wall four leaving
1:47
the pelvis entirely
1:48
and four to the pelvic viscera so let’s
2 Branches to the Back Body Wall
1:51
first look at the two branches going
1:53
along the posterior
1:54
body wall the first one is an artery
Iliolumbar Artery (a. iliolumbalis)
1:57
called the ilio lumbal artery
1:59
it’s it ascends and then eventually
2:02
divides
2:03
into two branches the lumbar branch
2:05
which supplies the muscles of the
2:06
posterior wall of the abdominal cavity
2:09
and the iliac branch which passes along
2:12
the iliac crest
2:13
and supplies the muscles of the anterior
2:15
wall of the abdominal cavity
2:17
the iliac branch will anesthetize with
2:19
the deep
2:21
elect circumflex artery of the external
2:23
iliac
Iliac Branch (r. iliacus)
2:24
the other branch is the lateral sacral
2:27
artery
2:27
it descends along the anterior wall of
2:30
the sacrum
2:31
to supply the muscles of the pelvic
2:33
girdle and the peritoneum
2:35
they give off some imp spinal branches
2:37
which which go through the anterior
2:39
sacral foramina
2:41
to enter the secular sacral canal and
2:43
supply the cow dye aquina
2:45
uh it keeps going downwards to supply
2:47
the epiderm
2:49
so that was all the arteries going
2:51
towards the posterior body wall
4 Branches Leaving the Pelvis
2:53
now let’s do the four arteries leaving
2:55
the pelvis cavity
2:56
entirely the first one is the obturator
Obturator Artery (a. obturatoria)
2:59
artery
3:00
which runs towards which runs forward
3:03
and
3:03
downwards along the lateral wall of the
3:05
lesser pelvis
3:06
and then goes through the up to outer
3:08
canal as you see here
3:10
and then once it’s on the thigh it
3:12
divides into two branches
3:14
an anterior branch and a posterior
3:17
branch and these branches
3:19
supply the muscles of the medial
3:21
compartment of the thigh
3:22
and remember these are the pectineus
3:25
gracilis
3:26
and the abducted longus brevis among us
3:29
it also has a side branch for the
3:31
obturator externus muzzle
3:33
now the archery on its pathway give off
3:35
two side branches
3:37
one called the pubic branch which
3:39
anastomose with the
3:40
pubic branch of the inferior epigastric
3:42
artery
3:43
and when they connect they get the name
3:45
corona motis
3:47
and the term corona multis translates as
3:49
the crown of death
3:50
and i mentioned this in last video but
3:52
the crown of death it indicates the
3:54
importance of this structure
3:56
in orthopedic surgery because accidental
3:58
damage to the structure
4:00
can cause significant hemorrhaging which
4:02
may be difficult to achieve hemostasis
4:05
so it must therefore be considered
4:06
cautiously during surgery
4:09
so that’s the pubic branch the other
4:11
branch is the acid tubular branch
4:14
let’s repeat some joint anatomy a little
4:16
bit so that you understand this branch
4:18
fully
4:18
here you see the isotobular fossa with
4:21
the lunate surface up here
4:23
and the transverse osotopic ligament
4:25
forming a complete circle together with
4:27
the lunate surface
4:28
but you see this white arrow going under
4:31
the transverse of the tubal ligaments
4:33
this is where the isotubular branch of
4:35
the optodaughter artery
4:36
will go through it runs inside the
4:39
ligament of the femoral head
4:41
to supply a carpet femoris so
4:44
that’s basically the optodaughter artery
4:47
next
4:48
we need to add a muscle called the
4:50
pitiful muscle
4:51
because out of the next three arteries
4:54
one
4:54
will leave above the piriform muscle and
4:57
two
4:58
below it so now the next artery is a
Superior Gluteal Artery (a. glutea superior)
5:00
superior
5:01
gluteal artery which leaves the pelvic
5:04
cavity through the space above the
5:06
pediatric muscle
5:08
the suprapudiform furamen we call it
5:11
and then it goes upwards as you see here
5:13
and this archery will supply
5:15
musculus gluteus minimus gluteus medius
5:18
a tensor fasciae latae and articulator
5:22
coxa or the hipster hip
5:23
joints sometimes also called the
5:26
acetobilofemoral joints
5:28
so that’s this one next since we have a
Inferior Gluteal Artery (a. glutea inferior)
5:32
superior gluteal artery
5:33
we also have the inferior gluteal artery
5:37
it leaves the pelvic cavity through the
5:39
space below the piriform muscle
5:41
and then goes towards the lower part of
5:43
the hip joint as you see here
5:45
to supply all the muscles shown here and
5:48
these are the
5:49
internal obturator muscle
5:54
as well as the gluteus maximus and the
5:56
levator on the muscle
5:58
so that’s it for the inferior gluteal
6:01
artery
Internal Pudendal Artery (a. pudenda interna)
6:02
the last artery that leaves the pelvic
6:04
cavity completely
6:06
is the internal potential artery this
6:09
artery will also leave the pelvis
6:11
in the space below the peripheral muscle
6:13
as you see here
6:15
and if we follow the artery looking from
6:17
this perspective
6:18
you will see that the artery winds
6:20
around the
6:22
spina chiatica and then it continues
6:25
into
6:26
the space between the perineal muscles
6:28
and the muscle of the pelvic diaphragm
6:31
to to then go continue towards the
6:34
anterior side
6:35
as you see here where it terminates and
6:37
in male
6:38
it terminates as two arteries the deep
6:41
and dorsal arteries of the penis while
6:44
in female
6:45
it terminates as the deep and dorsal
6:48
arteries of the clitoris
6:50
so that’s the course of the internal
6:53
pudendal artery
6:54
let’s now look from the posterior view
6:57
to cover the side branches of the
6:59
internal pudendal the first one is the
7:02
inferior rectal artery
7:04
which supplies the lower third of the
7:06
rectum there’s the perineal artery which
7:08
supplies the muscles of the perineum
7:11
and also give off branches to the
7:13
external genitals
7:14
and these branches are the posterior
7:17
scrotal artery supplying the posterior
7:20
surface of the scrotum in male
7:22
and the posterior labial artery which
7:24
supply the posterior parts of the labia
7:27
miura
7:28
another branch of the internal potential
7:29
artery is the urethral branch
7:32
supplying the urethra then there’s the
7:34
artery of the bulb of the penis
7:37
which supplies the bulbous penis in male
7:39
or the artery of the
7:41
bulb of the vestibule for the buildbus
7:43
vestibule
7:44
so that’s all for the internal potential
7:48
now we’ve covered the two arteries going
7:51
to the back body wall
7:53
and the four arteries leaving the pelvis
7:55
completely
4 Branches Supplying Structures Within the Pelvis
7:56
next let’s do the four arteries
7:57
supplying structures within the pelvis
8:00
for the pelvic viscera so let’s add the
Umbilical Artery (a. umbilicalis)
8:02
urinary bladder and continue with the
8:04
first artery
8:05
which is the umbilical artery now the
8:08
umbilical artery is
8:09
actually an artery found during the
8:11
fetal life
8:13
but then regresses after birth and a
8:15
portion
8:16
obliterates to become the medial
8:18
umbilical ligament
8:19
as you see here in the anterior
8:21
abdominal wall
8:22
the peritoneum is going to form this
8:25
fold
8:26
what remains of this artery are the
8:28
superior
8:30
vesicle artery which ascends along the
8:32
urinary bladder
8:33
to supply the body and the apex of the
8:37
urinary bladder
8:38
another artery that remains is the
8:40
artery of the ductus difference
8:42
which goes together with the ductus
8:43
difference it supplies the dictus
8:46
difference and also supplies the vesica
8:48
seminalis
8:49
and then on its way the artery gives off
8:51
small
8:52
branches called the small urethral
8:54
branches to supply the lower third of
8:56
the ureter
8:58
so that’s this artery the next artery is
Inferior Vesical Artery (Aa. vesicales inferiores)
9:01
the inferior vesicle artery in male
9:03
which supplies the fundus of the urinary
9:05
bladder
9:06
and the prostate and the seminal vesicle
9:09
and then in female this artery is called
9:12
the vaginal artery
9:13
which supplies the anterior wall of the
9:15
vagina
9:16
i made this scheme showing the different
Uterine Artery (a. uterina)
9:18
arteries
9:19
so here you see the internal pudendal
9:21
artery going
9:23
down to supply the clitoris through the
9:25
deep and dorsal arteries of the clitoris
9:28
as well as the side branches of the
9:30
internal potential as mentioned earlier
9:32
the posterior labial artery which
9:34
supplies the posterior part of the labia
9:36
miura
9:37
now let’s continue with the scheme
9:39
because the next artery
9:40
is called the uterine artery which is
9:43
you know
9:44
only in female and we will add the
9:47
ureter
9:48
and the cardinal ligament as as a
9:50
landmark because the uterine artery
9:52
will run upwards and pass the cardinal
9:55
ligament of the uterus to the cervix
9:57
before it ascends along the lateral side
10:00
of the uterus as you see here
10:02
where it divides into two branches tubal
10:05
branch
10:06
which supplies the tuba uttarina and the
10:08
mesosol beans
10:09
and the ovarian branch which supplies
10:12
the ovaries
10:13
there are many variations of this as
10:16
mentioned earlier
10:17
but mainly both of these arteries
10:19
anesthetize with the ovarian artery
10:22
of the abdominal aorta another thing
10:24
with the uterine artery
10:26
is that it also supplies the anterior
10:29
and the posterior wall of the uterus
10:31
occasionally
10:32
you may find the uterine artery also
10:34
giving off urethral branches for the
10:36
lower third of the urethra
10:38
and the vaginal artery for the vagina so
10:41
that’s the uterine artery
Middle Rectal Artery (a. rectalis media)
10:43
now the last artery is an artery for the
10:46
rectum
10:46
called the middle rectal artery which
10:49
goes behind
10:50
the vaginal canal now let’s do the full
10:53
blood supply of the rectum so that you
10:55
get the whole idea
10:56
the internal iliac artery descends and
10:59
give off the internal pudendal artery
11:02
which then branch off giving the
11:04
inferior rectal artery
11:06
now tell me where does the superior
11:08
rectal artery come from
11:11
it comes from the inferior mesenteric
11:13
artery good job if you remember this one
11:16
from the abdominal auto then there’s the
11:18
middle rectal artery which comes
11:20
directly from the internal ilic artery
11:23
completing the whole blood supply to the
11:25
rectum so
11:27
that’s all i had for the internal ilic
11:29
artery
11:30
i really hope this video helped you to
11:32
understand the internal iliac artery
11:34
until next time