190 SURGICAL ANATOMY OF THE 



vessels of the right and left side differ somewhat in 

 length, the right being slightly the longer, and lies 

 rather more obliquely across the body of the fifth lum- 

 bar vertebra. Their length is about two inches, more 

 or less, and passing downwards and outwards, at the 

 sacro-iliac synchondrosis divide into external and inter- 

 nal iliacs ; the vena cava inferior lying to the right side, 

 and being formed by the union of the two common iliac 

 veins, the right common iliac artery crosses their junc- 

 tion, rendering the relation of the vessels on the right 

 side more intimate, the vein projecting externally to the 

 artery above, and being internal to it below, whilst on 

 the left side the vein lies below and internal to its artery. 

 Both are crossed at their bifurcation by the ureter. 



The relations of the common iliac of the right side : In 

 front of it, the peritoneum, ilium, sympathetic plexus, 

 and ureter; externally ', the cava, right common iliac 

 vein, psoas magnus ; behind, junction of common iliac 

 veins, obturator nerve. On the left side it has, in front, 

 peritoneum, sympathetic, rectum, inferior meseuteric 

 artery, ureter ; externally, psoas magnus ; internally, left 

 common iliac vein ; behind, left common iliac vein, ob- 

 turator nerve. 



Ligature of Common Iliac Artery. In order to reach 

 this vessel a curved incision is recommended, commenc- 

 ing from just above the middle of Poupart's ligament to 

 a point an inch or so above and to the inner side of the 

 anterior superior spine, or, commencing from a point 

 close to the anterior superior spine, towards the edge of 

 the rectus. The first incision divides the integuments ; 

 next the external oblique, the internal oblique, and the 

 transversal is are to be divided in succession and to an 

 equal extent. Beneath this latter is the transversal is 



