Which arteries exit the pelvic cavity?

Arteries That Exit the Pelvic Cavity

The arteries that exit the pelvic cavity include the superior gluteal artery, inferior gluteal artery, internal pudendal artery, and obturator artery. 1, 2

Major Arteries Exiting the Pelvic Cavity

Superior Gluteal Artery

• Originates from the posterior division of the internal iliac artery 2
• Exits the pelvic cavity through the greater sciatic foramen above the piriformis muscle 1
• Supplies the gluteal muscles and surrounding tissues 2

Inferior Gluteal Artery

• Typically arises from the anterior division of the internal iliac artery 2
• Exits the pelvic cavity through the greater sciatic foramen below the piriformis muscle 1
• In some anatomical variations, it may form a common trunk with the internal pudendal artery before exiting the pelvis 1

Internal Pudendal Artery

• Originates from the anterior division of the internal iliac artery 2
• Exits the pelvic cavity through the greater sciatic foramen below the piriformis muscle 1
• Re-enters the perineum through the lesser sciatic foramen 2
• Supplies the external genitalia and perineal region 2

Obturator Artery

• Typically arises from the anterior division of the internal iliac artery but shows significant anatomical variation 3
• Exits the pelvic cavity through the obturator foramen 4
• Supplies the hip adductor muscles and contributes to the cruciate anastomosis around the hip joint 3

Anatomical Variations

Obturator Artery Variations

• In approximately 19% of cases, the obturator artery originates from the external iliac artery rather than the internal iliac artery 3
• In 2% of cases, it may form from anastomoses between branches of both the internal and external iliac arteries 3
• These variations are particularly important during pelvic surgeries and hernia repairs 3

Other Variations

• The superior gluteal, inferior gluteal, and internal pudendal arteries may form a common arterial trunk in some individuals 1
• The branching pattern of the internal iliac artery shows considerable variability, which has significant implications for surgical procedures in the pelvis 2

Clinical Significance

Surgical Considerations

• Understanding these arterial pathways is critical for surgeons performing pelvic procedures to avoid accidental hemorrhage 2
• Variations in the obturator artery origin are particularly relevant during laparoscopic herniorrhaphy and pelvic lymph node dissection 4, 3
• Knowledge of these vessels is essential for successful ligation of the internal iliac artery during acute hemorrhage control 5

Interventional Procedures

• Arterial access for embolization procedures is typically chosen according to accessibility of common femoral arteries 6
• When pelvic injuries are too extensive to allow femoral access, the humeral route may be recommended 6
• Embolization of these vessels may be necessary in cases of severe pelvic trauma 6

Anatomical Relationships

• These exiting arteries have important relationships with surrounding structures, particularly the piriformis muscle which serves as an anatomical landmark separating the paths of the superior and inferior gluteal arteries 1
• The obturator artery's course near the superior pubic ramus makes it susceptible to injury during dissection of the Bogros space and mesh stapling onto Cooper's ligament 3
• The internal pudendal artery's exit and re-entry path through the greater and lesser sciatic foramina creates a unique anatomical course that surgeons must be aware of 2