ILIAC ARTERIES. 



837 



frequently, are covered not only by the skin 

 and subcutaneous cellular structure, but also 

 by a dense filamentary expansion, or fascia, 

 which invests the penis beneath them, and they 

 give branches to those structures as also to the 

 fibrous membrane of the corpus cavernosum, 

 and finally to the prepuce. The dorsal artery 

 is at times furnished by the obturator, or the 

 external pudic artery. 



Beside the varieties of origin which have 

 been mentioned, the pudic presents some im- 

 portant varieties in its course. It has been 

 found by Burns in four instances, "instead 

 of passing out of the pelvis between the 

 sacro-sciatic ligaments to attach itself to the 

 lateral and inferior part of the bladder, and to 

 traverse the upper segment of the prostate 

 gland in its course to the ramus of theischium." 

 Another variety is described by Harrison, in 

 which the proper trunk of the pudic is found 

 unusually small, and the dorsal artery of the 

 penis arises originally and separately from the 

 internal iliac, runs along the side of the bladder 

 and prostate gland, and escapes from the 

 pelvis along with the dorsal vein of the penis 

 beneath the arch of the pubis. The latter dis- 

 position, mutatis mutandis, has been found by 

 Tiedemann in the female as well as in the 

 male, and is figured in his thirtieth plate. It is 

 described by Wmslow as the normal arrange- 

 ment, only thataccording to him the vessel, which 

 takes this unusual course, arises sometimes 

 from the common pudic, at others from the 

 iliac. Haller questions the occurrence of this 

 disposition, but describes another, in which 

 the inferior vesical artery arising from the 

 middle hemorrhoidal is" continued on the 

 dorsum of the prostate into the dorsal artery of 

 the penis, given, as in ordinary, from the pudic. 



Among the varieties of the arterial system 

 few possess greater interest than these, inas- 

 much as no foresight or skill can guard against 

 the untoward accidents which attend their 

 presence in lithotomy ; their possibility forbids 

 a section of the prostate upward; but for- 

 tunately they are rare. 



The situation of the pudic artery upon the 

 exterior of the pelvis admits the possibility of 

 tying the vessel in the living subject; the 

 plan of operation necessary for the purpose 

 is similar to that to be adopted with the gluteal 

 artery, only it must be performed lower down ; 

 it is the same with that for the ischiatic artery ; 

 for determining the situation of which or the 

 pudic the following directions are given by 

 Harrison :* " Place the individual on his face 

 with the lower extremity extended and the toes 

 turned inwards : feel for the summit of the 

 great trochanter, and for the base or articulated 

 end of the coccyx ; these two points are on a 

 level ; then draw a line from one to the other, 

 and we may be certain that the pudic artery 

 and the spine of the ischium are opposite the 

 junction of the middle and internal thirds of 

 this line." The ischiatic artery may be 

 reached as easily, or even more so, than the 



* Vol. ii. p. 103. 



gluteal ; but the difficulty which must attend 

 the seeking for the pudic must be extreme. 



THE EXTERNAL ILIAC ARTERY, (arterid 

 iliaca externa, Lat. ; artcre iliaque externe, 

 Fr. ; portion iliaque de la crurale, Chauss. ; 

 Aussere Huft-pulsader, Ger.) is the vessel 

 destined for the supply of the lower extremity, 

 of which the portion contained within the 

 abdomen, in the iliac region, is denominated the 

 " external " iliac, in contradistinction to the 

 artery of the pelvis, the " internal." 



It commences at the division of the primi- 

 tive iliac artery, at a point intermediate to the 

 body of the last lumbar vertebra, or the sacro- 

 vertebral prominence, and the sacro-iliac articu- 

 lation, and it terminates at the crural arch, at 

 a point midway between the superior anterior 

 spinous process of the ilium and the spinous 

 process of the pubis,* or at the outer side of 

 the ilio-pectineal eminence of the os innomina- 

 tum. The point at which the vessel com- 

 mences is not uniform either in all subjects or 

 on the two sides of the same; depending upon 

 the point at which the primitive iliac divides, 

 which is variable, it will be higher or lower, 

 nearer to the vertebra or to the articulation, 

 according to the situation of the bifurcation of 

 that vessel : on the right side of the body the 

 artery commences for the most part nearer to 

 the body of the vertebra than on the left, on 

 which it is of course nearer to the articulation ; 

 hence the artery arising higher upon the former 

 is longer upon that side than upon the latter, 

 the difference in length varying from a quarter 

 to half an inch. The external iliac terminates 

 in the femoral or crural artery, strictly so 

 called ; but the distinction between the two is 

 one only of convenience, inasmuch as they are 

 but different stages of the same vessel ; there 

 appears therefore much propriety in the 



* The situation of the artery at its termination is 

 differently stated by different writers ; Boyer states 

 it to be midway between the spinous process of the 

 ilium and the symphysis pubis ; Cloquet, midway 

 between the spine of the ilium and the spinous pro- 

 cess of the pubis ; Harrison, about half an inch to 

 the pubic side of the centre of the crural arch. The 

 relation of the vessel to the points between which 

 it is placed, is probably not the same in all cases ; 

 but that assigned to it by Cloquet seems most 

 generally applicable. According to Cooper, with 

 whom Cloquet concurs, there are, in the male, 

 3 inches from the symphysis pubis to the 

 middle of the artery, and in the female 3|, 

 while the distance to the superior anterior spinous 

 process of the ilium is in the former 53., and in 

 the latter six inches ; the artery must therefore be 

 external to the mid-point, being for the most part 

 concave forward and inward above, and convex 

 forward below ; but in this particular it is not uni- 

 form, being sometimes nearly straight ; the degree 

 of its tortuosity also appears to depend upon the 

 age of the subject and the plenitude of the vessel. 

 The direction of the artery is oblique, and as the 

 primitive iliac and it are continuous in the adult, the 

 course of both the vessels maybe defined, during 

 life, by a line extending from the umbilicus, or 

 from half an inch below it, at its left side, to a point 

 midway between the superior anterior spinous pro- 

 cess of the ilium and the spinous process of the 

 pnbis, the upper extremity of the line varying 

 according to the situation at which the aorta divides. 



