The blood supply to the body arises from the aorta, the main outflow of the left ventricle of the heart. The abdominal aorta gives rise to two common iliac arteries at its termination, which then further divided into the external and internal iliac arteries. These two arteries supply the abdomen, pelvis and lower limb.
In this article, we will discuss the anatomy and clinical relevance of the common iliac artery. We will also conclude with a summary and some review questions to test the reader’s understanding of the article content.
|Common iliac artery||
Source: abdominal aorta
Branches: internal iliac artery, external iliac artery
|External iliac artery||
Branches: inferior epigastric, deep circumflex iliac and femoral arteries
Supply area: part of the abdominal wall and the lower limb.
|Internal iliac artery||
Branches: obturator, inferior gluteal, umbilical, uterine, vaginal, inferior vesical, middle rectal and internal pudendal arteries (anterior trunk); iliolumbar, lateral sacral and superior gluteal arteries (posterior trunk)
Supply area: sphincters, reproductive organs and pelvic viscera
- Common iliac artery
- External iliac artery
- Internal iliac artery
- Clinical points
- Related diagrams and images
Common iliac artery
The abdominal aorta divides at the level of the L4 vertebral body, and forms the two common iliac arteries. The common iliac arteries run laterally, and divide into the external and internal iliac arteries anterior to the sacroiliac joints.
The internal iliac descends into the pelvis to supply the sphincters, reproductive organs and pelvic viscera. The external iliac will continue to run inferiorly, and pass deep to the inguinal ligament. At this point the artery is renamed as the femoral artery, which goes on to supply the lower limb.
As the common iliac artery descends, it runs along the medial border of the psoas major muscle. They have peritoneum in front, and is crossed near their bifurcation by the ureter and spermatic nerves and vessels. The arteries are accompanied by the common iliac veins along their course which lie posterior. The right common iliac is slightly longer than left, the average length of common iliac arteries is 2.5 inches.
External iliac artery
The external iliac artery arises from the division of the common iliac artery, anterior to the sacroiliac joints. The external iliac artery then continues to pass under the inguinal ligament and is renamed the femoral artery once it emerges. It runs medial to the femoral nerve and lateral to the common iliac vein.
Learn more about the external iliac artery and its branches with our article and video tutorial.
Internal iliac artery
The internal iliac artery arises from the division of the common iliac artery. The vessel runs posterior to the ureter in its upper section, posterior to the internal iliac vein along its entire course, posterior to the lumbosacral trunk as it passes the sacral foramina. It is separated from the psoas major muscle by the internal iliac vein.
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Internal iliac artery bifurcates into the anterior and posterior trunks. The anterior trunk has eight branches that supply the pelvis and perineum. They are the obturator, inferior gluteal, umbilical, uterine, vaginal, inferior vesical, middle rectal and internal pudendal arteries. The branches of the posterior trunk are the iliolumbar, lateral sacral and superior gluteal arteries.
Learn the internal iliac artery anatomy with our article, videos and quizzes.
Common Iliac artery aneurysms- Aneurysms of the common iliac artery do occasionally occur. 10-20% of abdominal aortic aneurysms is associated with aneurysm of the common iliac artery. They are usually asymptomatic but may present with hydronephrosis (due to ureteric blockage), neurological symptoms (sciatic nerve compression). If they rupture then symptoms include shock, and abdominal pain.
Surgical relevance- The ureters run underneath the uterine arteries (hence the saying, ‘water under the bridge’). It can be damaged in operation to the uterus such as hysterectomy.
Severe hemorrhage in the lower limb can be reduced by ligation of the internal iliac artery while the surgical repair takes place. The pelvis also has significant collateral circulation which is able to ensure an adequate blood supply even in the event of vascular compromise.
EVAR (endovascular aneurysm repair)- This is a procedure for the repair of abdominal aortic aneurysm, it involves the insertion of a trouser leg graft into the femoral artery, and the graft will expand and close any leakage in the abdominal aorta. This minimally invasive approach reduces post-procedure morbidity but leads to higher rates of some complications e.g. aortoenteric fistula.