1014 SURGICAL ANATOMY OF THE ARTERIES. 



the operation, and to determine as to the propriety of tying the one vessel or 

 the other, for the iliac arteries are under his view almost as fully as if 

 dissected. Arteries in other parts of the body are, on the contrary, only 

 seen at the point at which it has been beforehand determined to place the 

 ligature. 



SURGICAL ANATOMY OF THE INTERNAL ILIAC ARTERY. 



This artery has been tied for aneurism affecting one of its large branches 

 on the back of the pelvis the gluteal or sciatic (p. 420). It is arrived at 

 by dividing the abdominal muscles before the iliac fossa to a greater extent 

 than is required for exposing the external iliac in the manner of the 

 operation first mentioned for the common iliac artery. The vein, a large 

 one, is, it will be borne in mind, behind the artery and in contact with it 

 [plate 55]; it is occasionally double [plate 58, fig. 6]. 



There is some difference in the degree of difficulty that would be ex- 

 perienced in securing the internal iliac artery in different cases. This is 

 owing to the fact that, when short, (and, as stated before, it often is so,) 

 ths artery is placed deeply in the pelvis ; whereas, when the leugth is more 

 considerable, it is accessible above that cavity. 



Again, when the artery is very short, [as represented, for instance, in 

 plate 58, fig. l], it would probably be more safe to tie the common iliac, or 

 both the external and the internal iliacs at their origin, than to place a ligature 

 on the latter only, close to a strong current of blood. 



SURGICAL ANATOMY OF THE EXTERNAL ILIAC ARTERY. 



The external iliac artery (p. 431) admits of being tied in a surgical opera- 

 tion at any part except near its upper and lower end ; the near neighbour- 

 hood of the upper end being excepted on account of the circulation through 

 the internal iliac, and the lower end on account of the common position of the 

 branches (epigastric and circumflex iliac). Occasional deductions from this 

 statement occur in consequence of a branch or branches taking origin near or 

 at the middle of the artery ; and, as the operator may see such a branch, he 

 will avoid placing a ligature very near it. 



The incision through the muscles to reach the artery, commencing a 

 little above the middle of Poupart's ligament, may be directed parallel with 

 the ligament upwards and outwards as far as its outer end, where the 

 incision may be curved with advantage for a short space (about an inch) up- 

 wards. 



This and the other iliac arteries might be operated on by means of straight 

 incisions in a line from the umbilicus to the middle of Poupart's ligament, 

 or a little to the outer side of this line. But the division of the muscles on 

 the fore part of the abdomen is liable to the objection that the peritoneum 

 must be disturbed in front as well as behind ; and, moreover, a curved inci- 

 sion has the advantage of giving more room laterally than one which is merely 

 straight. 



The muscles and the fascia transversalis being divided, and the peri- 

 toneum (to which the spermatic vessels adhere) being raised, the artery is 

 found where the finger of the surgeon, introduced into the wound, 

 begins to descend into the true pelvis, along the border of the psoas 

 muscle. 



In contact with the artery will be seen the following structures, each 

 occupying the position already mentioned, viz., lymphatic glands, the cir- 

 cumflex iliac vein, and the external iliac vein [plate 55]. 



