THE EXTERNAL ILIAC ARTERY. 629 



and must be cautiously ,>e panted from it by the finger-nail or handle of the knife, and the aneu- 

 rism needle should be introduced on the inner side, between the artery and the vein. 



I. . iiure of the external iliac artery has recently been performed in three or more cases by 

 a transperitoneal method. An incision four inches in length is made in the semilunar line, com- 

 mencing about an inch below the umbilicus and carried through the abdominal wall into the 

 peritoneal cavity. The intestines are then pushed upward and held out of the way by a broad 

 abdominal retractor, and an incision made through the peritoneum at the margin of the pelvis 

 in the course of the artery, and the vessel secured in any part of its course which may seem 

 desirable to the operator. The advantages of this operation appear to be that if it is found 



ary the common iliac artery can be ligatured instead of the external iliac without extension 

 or modification of the incision : and secondly, that the vessel can be ligatured without in any 

 way interfering with the coverings of the sac. Possibly a disadvantage may exist in the greater 

 risk of hernia after this method. 



Collateral Circulation. The principal anastomoses in carrying on the collateral circulation, 

 after the application of a ligature to the external iliac, are the ilio-lumbar with the circumflex 

 iliac : the gluteal with the external circumflex ; the obturator with the internal circumflex : the 

 sciatic with the superior perforating and circumflex branches of the profunda artery ; and the 

 internal pudic with the external pudic. When the obturator arises from the epigastric, it is 

 supplied with blood by branches, either from the internal iliac, the lateral sacral, or the inter- 

 nal pudic. The epigastric receives its supply from the internal mammary and inferior 

 intercostal arteries, and from the internal iliac by the anastomoses of its branches with the 

 obturator. 



In the dissection of a limb eighteen years after the successful ligature of the external iliac 

 artery by Sir A. Cooper, which is to be found in Guys Hospital Reports, vol. i. p. 50. the 

 anastomosing branches are described in three sets: An anterior set. 1. a very large branch 

 from the ilio-lumbar artery to the circumflex iliac : '2. another branch from the ilio-lumbar, 

 joined by one from the obturator, and breaking up into numerous tortuous branches to anastomose 

 with the external circumflex : 3. two other branches from the obturator, which passed over the 

 brim of the pelvis, communicated with the epigastric, and then broke up into a plexus to anas- 

 tomose with the internal circumflex. An internal set. Branches given off from the obturator, 

 after quitting the pelvis, which ramified among the adductor muscles on the inner side of the 

 hip-joint, and joined most freely with branches of the internal circumflex. A posterior set. 

 1. three large branches from the gluteal to the external circumflex: 2. several branches from the 

 sciatic around the great sciatic notch to the internal and external circumflex, and the perforating 

 branches of the profunda. 



Branches. Besides several small branches to the Psoas muscle and the neigh- 

 boring lymphatic glands, the external iliac gives off two branches of considerable 

 size the 



Deep Epigastric and Deep Circumflex Iliac. 



The Deep Epigastric Artery arises from the external iliac a few lines above 

 Poupart's ligament. It at first descends to reach this ligament, and then ascends 

 obliquely along the inner margin of the internal abdominal ring, lying between 

 the trans versalis fascia and peritoneum, and, continuing its course upward, it 

 pierces the transversalis fascia, and, passing over the semilunar fold of Douglas, 

 enters the sheath of the Rectus muscle. It then ascends on the posterior surface 

 of the muscle, and finally divides into numerous branches, which anastomose, 

 above the umbilicus, with the terminal branches of the internal mammary and 

 inferior intercostal arteries. The deep epigastric artery bears a very important 

 relation to the internal abdominal ring as it passes obliquely upward and inward 

 from its origin from the external iliac. In this part of its course it lies along the 

 lower and inner margin of the ring and beneath the commencement of the sper- 

 matic cord. As it winds round the internal abdominal ring it is crossed by the vas 

 deferens in the male and the round ligament in the female. 



Branches. The branches of this vessel are the following : The ere waster ic\ 

 which accompanies the spermatic cord, and supplies the Cremaster muscle and 

 other coverings of the cord, anastomosing with the spermatic artery : a pubic 

 branch, which runs along Poupart's ligament, and then descends behind the pubes 

 to the inner side of the femoral ring, and anastomoses with offsets from the 

 obturator artery : HI titular // me of which are distributed to the abdominal 



muscles and peritoneum, anastomosing with the lumbar and circumflex iliac arteries : 

 others perforate the tendon of the External oblique, and supply the integument, 

 anastomosing with branches of the superficial epigastric. 



