As the uterine artery courses cephalad, it gives rise to Sampson artery of the round ligament. Just before the main uterine artery vessel reaches the fallopian rube, it divides into three terminal branches. The ovarian branch of the uterine artery forms an anastomosis with the terminal branch of the ovarian artery;
Internal iliac a.
the rubal branch makes its way through the mesosalpinx and supplies part of the fallopian tube; and the fundal branch penetrates the uppermost uterus.
In addition to the uterine artery, the uterus receives blood supply from the ovarian artery (see Fig. 2-10). This artery is a direct branch of the aorta and enters the broad ligament through the infundibulopelvic ligament. At the ovarian hilum, it divides into smaller branches that enter the ovary. As the ovarian artery runs along the hilum, it also sends several branches through the mesosalpinx to supply the fallopian rubes. Its main stem, however, traverses the entire length of the broad ligament toward the uterine cornu. Here, it forms an anastomosis with the ovarian branch of the uterine artery. This dual uterine blood supply creates a vascular reserve to prevent uterine ischemia if ligation of the uterine or internal iliac artery is performed to control postpartum hemorrhage.
Uterine veins accompany their respective arteries. As such, the arcuate veins unite to form the uterine vein, which empties into the internal iliac vein and then the common iliac vein. Some of the blood from the upper uterus, the ovary, and the upper part of the broad ligament is collected by several veins. Within the broad ligament, these veins form the large pampiniform plexus that terminates in the ovarian vein. From here, the right ovarian vein empties into the vena cava, whereas the left ovarian vein empties into the left renal vein.
Ureter Inferior mesenteric a.
Ovarian a.
External iliaca.
Iliolumbar a.
Obturatora.
Accessory obturator a.
Superior rectal a.
Inferior epigastric a.
Round ligament (cut) Lateralsacral a.
Medial umbilical ligament Superior gluteal a.
Superior vesical aa.
Inferior gluteal a.
Inferior vesical a.
Vaginal a.
Internal pudendala.
Uterine a. (ascending branch)
Sampson a.toround ligament Uterus
FIGURE 2-12 Pelvic arteries. (Reproduced with permission from Corton MM: Anatomy. In Hoffman BL, Schorge JO, Bradshaw KD, et al (eds):
Williams Gynecology, 3rd ed. New York, McGraw-Hili Education, 2016.)
Blood supply to the pelvis is predominantly provided by branches of the internal iliac artery (Fig. 2-12). These branches are organized into anterior and posterior divisions, and subsequent branches are highly variable between individuals. The anterior division provides blood supply to the pelvic organs and perineum and includes the inferior gluteal, internal pudendal, middle rectal, vaginal, uterine, and obturator arteries, as well as the umbilical artery and its continuation as the superior vesical artery. The posterior division branches extend to the buttock and thigh and include the superior gluteal, lateral sacral, and iliolumbar arteries. For this reason, during internal iliac artery ligation, many advocate ligation distal to the posterior division to avoid compromised blood low to the areas supplied by this division (Bleich, 2007).