Common Iliac Artery 369 



side of the internal abdominal ring to the tip of the last rib, the con- 

 falling in front of the iliac crest. The external oblique (aponeur- 

 otic and fleshy) and the fleshy internal oblique and transversalis are 

 divided to the extent of the skin-wound ; between the last two muscles 

 a branch of the deep circumflex iliac artery, which runs in a little loose 

 connective tissue, may require attention. The transversalis fascia is 

 divided on a director and the peritoneum is gently dragged up by the 

 out-spread fingers, and with it, probably, the ureter and the spermatic 



s. The external iliac artery is then made out, pulsating near 

 the pubes, and is followed upwards until the internal trunk is felt 

 descending into the pelvis ; the ligature is applied a little higher up. 

 During the operation the finger would be brought in contact with the 

 brim of the pelvis at the sacro-iliac articulation. 



For the left artery the aneurysm-needle should be passed from 

 within outwards, but on the right side it must be passed from without 

 inwards. The veins are the important relations of the common iliac 

 arteries, and the ligature is passed always from the chief venous (the 



-ide. As with the innominate artery (p. 185), the venous relations 

 of the right common iliac are of paramount importance. 



The curved incision affords more room for the surgeon's fingers ; it 

 should not come further inwards than the middle of Poupart's ligament, 

 or the deep epigastric artery might be wounded ; it should not run too 

 close along the ligament and the iliac crest, or the deep circumflex artery 

 may be cut ; and it should not be too high above the ligament and crest, 

 or else the bag of the peritoneum is not so easily dragged up. A cleanly 



Dr need not hesitate to tie the artery across the peritoneal 



Collateral circulation would be established by those branches of 



ernal and internal iliacs all of them are empty which ramify in 



the neighbourhood of well-filled vessels. Thus, of the external iliac, the 



deep epigastric would bring in blood from its fellow of the opposite 



from the lumbar, lower intercostals, and the internal mammary 



whilst the deep circumflex would help by its anastomosis with the 



lombai arteries. 



The serviceable anastomoses of the internal iliac are, from the 

 anterior division, the middle haaaotihoidal with those of the opposite 

 side and with the inferior mesenteric ; vesical branches with those on 

 the other side of the bladder ; the artery of the vas deferens with the 

 spermatic ; vaginal with their fellows, uterine with their fellows and with 

 blanches of the aortic ovarian ; obturator with its fellow through the 

 pubic branch (0.306) ; internal pudic with its fellow through the inferior 

 haemorrhoidal, and perhaps with branches in the perineum and penis. 



From die posterior division of the internal iliac there will be the 

 lumbar branch of the ilio-lumbar anastomosing with the lumbars of 

 the aorta, and the lateral sacral with their fellows of die opposite 

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