The superior vesical artery normally originates from the root of the umbilical artery and courses medially and inferiorly to supply the superior aspect of the bladder and distal parts of the ureter. In men, it also may give rise to an artery that supplies the ductus deferens.
The inferior vesical artery occurs in men and supplies branches to the bladder, ureter, seminal vesicle, and prostate. The vaginal artery in women is the equivalent of the inferior vesical artery in men and, descending to the vagina, supplies branches to the vagina and to adjacent parts of the bladder and rectum. The vaginal artery and uterine artery may originate together as a common branch from the anterior trunk, or the vaginal artery may arise independently.
The middle rectal artery courses medially to supply the rectum. The vessel anastomoses with the superior rectal artery, which originates from the inferior mesenteric artery in the abdomen, and the inferior rectal artery, which originates from the internal pudendal artery in the perineum.
The obturator artery courses anteriorly along the pelvic wall and leaves the pelvic cavity via the obturator canal. Together with the obturator nerve, above, and obturator vein, below, it enters and supplies the adductor region of the thigh.
The internal pudendal artery courses inferiorly from its origin in the anterior trunk and leaves the pelvic cavity through the greater sciatic foramen inferior to the piriformis muscle. In association with the pudendal nerve on its medial side, the vessel passes laterally to the ischial spine and then through the lesser sciatic foramen to enter the perineum. The internal pudendal artery is the main artery of the perineum. Among the structures it supplies are the erectile tissues of the clitoris and the penis.
The inferior gluteal artery is a large terminal branch of the anterior trunk of the internal iliac artery. It passes between the anterior rami S1 and S2 or S2 and S3 of the sacral plexus and leaves the pelvic cavity through the greater sciatic foramen inferior to the piriformis muscle. It enters and contributes to the blood supply of the gluteal region and anastomoses with a network of vessels around the hip joint.
The uterine artery in women courses medially and anteriorly in the base of the broad ligament to reach the cervix (Figs. 5.65B and 5.66). Along its course, the vessel crosses the ureter and passes superiorly to the lateral vaginal fornix. Once the vessel reaches the cervix, it ascends along the lateral margin of the uterus to reach the uterine tube, where it curves laterally and anastomoses with the ovarian artery. The uterine artery is the major blood supply to the uterus and enlarges significantly during pregnancy. Through anastomoses with other arteries, the vessel contributes to the blood supply of the ovary and vagina as well.
In women, the gonadal (ovarian) vessels originate from the abdominal aorta and then descend to cross the pelvic inlet and supply the ovaries. They anastomose with terminal parts of the uterine arteries (Fig. 5.66). On each side, the vessels travel in the suspensory ligament of the ovary (the infundibulopelvic ligament) as they cross the pelvic inlet to the ovary. Branches pass through the mesovarium to reach the ovary and through the mesometrium of the broad ligament to anastomose with the uterine artery. The ovarian arteries enlarge significantly during pregnancy to augment the uterine blood supply.