THE PELVIS. 



437 



Collateral Circulation (Fig. 444). When the external iliac artery is ligated the 

 following anastomoses occur : 



Iliolumbar with deep circumflex iliac 



Gluteal . with external circumflex 



Obturator with internal circumflex 



Sciatic with superior perforating 



Internal pudic .' with deep external pudic 



Internal mammary, intercostals, and lumbars . . with deep epigastric 



IHolumbar artery 



Gluteal artery 



Deep circumflex 

 iliac artery 



Common femoral artery 



Profunda artery 



External circum- 

 flex artery 



Aorta 



Common iliac artery 



Middle sacral artery 

 External iliac artery 

 Internal iliac artery 

 Deep epigastric artery 



Sciatic artery 

 Obturator artery 



Internal pudic artery 



Deep external 

 pudic artery 



Internal circum- 

 flex artery 



Superior, middle, and in- 

 ferior perforating arteries 



FIG. 444. Collateral circulation after ligation of the external iliac artery. 



Ligation of the iliac arteries by a transperitoneal instead of subperitoneal route 

 has been advocated by Dennis (Medical News, Phila. , 1886). This lessens the 

 danger of wounding the deep circumflex iliac and deep epigastric arteries, the vas 

 deferens, the ureter, puncturing the veins and loosening up the subperitoneal tissue. 

 Treves has used a median incision from the umbilicus to the pubes. 



