SUEGICAL ANATOMY OF THE ILIAC ARTERIES. 453 



into a single vessel, which crosses the external iliac artery about an 

 inch above Poupart's ligament, and enters the external iliac vein. 



Branch.- — The muscular brancli is given off near the iliac crest, and ascends on 

 the fore-part of the abdomen between the transversalis and internal oblique 

 muscles : having supplied those muscles, it anastomoses with the lumbar and 

 epigastric arteries. This branch varies much in size, and is occasionally replaced 

 by several smaller muscular offsets. 



Varieties. — Si:e. — The external iliac artery is much diminished in those rare 

 cases in which the principal blood-vessel of the lower limb is continued from the 

 sciatic branch of the internal iliac, and ends in the muscles of the front of the 

 thigh, talving the place of the profunda. 



Uninvhcs. — The usual number of two principal branches of the external iliac 

 artery may be increased by the separation of the circumflex iliac into two branches. 

 or by the addition of a branch usually derived from another source, such as the 

 internal circumflex artery of the thigh or the obturator artery. 



The dtrj) (jjit/agfric artery occasionally arises higher than usual, as at an inch 

 and a half, or even two inches and a half, above Poupart's ligament ; and it has 

 been seen to arise below that ligament from the femoral, or from the deep 

 femoral artery. The epigastric frequently fimiishes the obtui'ator artery as 

 already described ; and two examples are recorded in which the ejjigastric artery 

 arose from an obturator furnished by the internal Uiac artery. (Monro, " Morbid 

 Anatomy of the Human Gullet," &c., p. 427. A. K. Hesselbach, '• Die sicherste 

 Art des Bruchschnittes," &c.) In a siagle instance the epigastric artery was 

 represented by two branches, one arising from the external iliac, and the other 

 from the internal iliac artery. (Lauth, in *' Velpeau's Medecine Operatoire," v. ii., 

 p. 4.52.) Some combinations of the epigastric with the internal cu-cumfiex, or 

 with the circumflex iliac, or with both those vessels, have been noticed. 



The dcej) circumflex iliac artery sometimes deviates from its ordinaiy position, 

 — arising at a distance not exceeding an inch above Poupart's ligament. Devia- 

 tions in the opi^osite direction are more rarely met with ; it has in a few cases 

 been observed to arise below the ligament, from the femoral artery. 



SUEaiCAIi ANATOMY OP THE ILIAC ARTERIES. 



The external iliac artery is usually tied about midway between the origins of 

 the internal iliac and of the deep epigastric arteries. It is reached by a ciuwed 

 incision about three and a lialf inches long, made through the abdominal muscles 

 an inch above and parallel to Poupart's ligament. After dividing the transver- 

 salis fascia, the peritoneum (to which the spermatic vessels adliere) is raised, 

 and the artery is found at the margin of the pelvis, running along the inner 

 border of the jisoas muscle. The vein is close to the artery, but on its inner 

 and iiosterior asi:)ect. In order to pass the ligature, it is necessary to divide the 

 thin subserous membrane which binds the vessel down to the fascia iliaca. 



The infernal iliac artery is reached by a similar but somewhat longer incision. 

 The steps of the operation are the same, but owing to the shortness of the vessel, 

 and the greater depth at which it is placed, the operation itself is more difficult. 



FEMORAL ARTERY. 



The femoral artery is that portion of the artery of the lower limb 

 ■which lies in the upper two-thirds of the thigh, — its limits being 

 marked above by Poupart's ligament, and below by the opening in the 

 great adductor muscle, after passing through which, the artery receives 

 the name of popliteal. 



A general indication of the direction of the femoral artery over the 

 fore-part nnd inner side of the thigh is given by a line reaching from a 

 point midway between the anterior superior iliac spine and the sym- 

 physis of the pubes above to the inner side of the internal condyle of 

 the femur below. At the upper part of the thigh, it lies along the 

 middle of a depression between the muscles covering the femur on the 



