Internal Iliac Artery Blood Supply
The internal iliac artery (also called the hypogastric artery) supplies blood to the pelvic organs, pelvic musculoskeletal structures, gluteal region, perineum, and medial thigh.
Primary Structures Supplied
The internal iliac artery is the major vascular supply of the pelvis 1, 2, 1, 2, 1, 2. It divides into anterior and posterior divisions, each with distinct territories:
Anterior Division Supplies:
- Pelvic visceral organs (bladder, rectum, reproductive organs)
- Perineum
- Gluteal region (via branches that exit the pelvis)
- Medial thigh region
The most prevalent branch is the internal pudendal artery (present in 90.5% of cases), which supplies the perineum and external genitalia 3.
Posterior Division Supplies:
- Pelvic parietal structures (musculoskeletal framework)
- Gluteal region (primarily via superior gluteal artery, present in 77% of cases) 4, 5
Critical Clinical Importance
Preservation of at least one internal iliac artery is strongly recommended during aortoiliac aneurysm repair to prevent devastating pelvic ischemia 1, 2, 1, 2, 1, 2. This is a Class I, Level B-NR recommendation from the 2022 ACC/AHA guidelines.
Consequences of Internal Iliac Artery Sacrifice:
When the internal iliac artery is excluded or ligated, significant ischemic complications occur:
- Buttock claudication: 27% with unilateral exclusion, 36% with bilateral exclusion 1, 2, 1, 2, 1, 2
- Erectile dysfunction: 10% in men 1, 2, 1, 2, 1, 2
- Bowel ischemia: <1% but potentially catastrophic 1, 2, 1, 2, 1, 2
- Spinal cord ischemia: <1% 1, 2, 1, 2, 1, 2
- Gluteal muscle necrosis: <1% 1, 2, 1, 2, 1, 2
Anatomical Considerations
The internal iliac artery originates from the common iliac artery at the sacroiliac joint level, typically between L5-S1 vertebrae 6. The mean diameter is approximately 6.86 mm, and the mean length is approximately 40 mm 6. However, anatomical variations are extremely common (61% of cases), with the anterior division showing more variability (48%) than the posterior division (20%) 7.