The Uterine Artery Passes Through the Parametrium
The uterine artery travels through the parametrium (also called the cardinal ligament or broad ligament), which is the tunnel-like connective tissue space extending from the lateral cervix to the lateral pelvic wall. 1
Anatomical Course Through the Parametrium
The uterine artery follows a specific path after originating from the anterior division of the internal iliac artery:
After arising from the internal iliac artery (in 61.72% of cases), the uterine artery courses medially and anteriorly toward the uterus through the parametrial tissue. 1, 2
Within the parametrium, the artery travels alongside the main uterine lymphatic trunks, which also condense in this same anatomical space. 1, 3
The parametrium serves as the vascular tunnel connecting the lateral pelvic wall to the uterus, housing the uterine artery as it approaches the cervix. 1
Critical Anatomical Landmark
At the level of the uterine-cervical junction, the uterine artery crosses over the ureter while still within the parametrial tunnel—this is the most clinically significant anatomical relationship ("water under the bridge"). 1
After crossing the ureter, the vessel divides into uterine and cervical branches as it ascends along the lateral border of the uterus within the broad ligament. 1
Clinical Relevance
For surgical procedures, the anterior leaf of the broad ligament (parametrium) must be opened to access and ligate the uterine artery lateral to its crossing over the ureter. 4
During uterine artery embolization, catheters are advanced through this parametrial course, with the goal of reaching distal to nontarget branches before embolization. 5
The parametrial pathway is also the route for lymphatic spread in uterine malignancies, as the main uterine lymphatic trunks travel alongside the uterine artery in this space. 3