Obturator artery

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Obturator artery
Gray547.png
The relations of the femoral and abdominal inguinal rings, seen from within the abdomen. Right side. (Obturator artery is visible at bottom.)
Internal iliac branches.PNG
Internal iliac artery and some branches.
Details
Source Internal iliac artery
Branches Anterior branch and posterior branch
Vein Obturator veins
Supplies Obturator externus muscle, medial compartment of thigh, femur
Identifiers
Latin arteria obturatoria
TA98 A12.2.15.008
TA2 4323
FMA 18865
Anatomical terminology

The obturator artery is a branch of the internal iliac artery that passes antero-inferiorly (forwards and downwards) on the lateral wall of the pelvis, to the upper part of the obturator foramen, and, escaping from the pelvic cavity through the obturator canal, it divides into an anterior branch and a posterior branch.

Contents

Structure

In the pelvic cavity this vessel is in relation, laterally, with the obturator fascia; medially, with the ureter, ductus deferens, and peritoneum; while a little below it is the obturator nerve.

The obturator artery usually arises from the internal iliac artery. [1] [2] Inside the pelvis the obturator artery gives off iliac branches to the iliac fossa, which supply the bone and the Iliacus, and anastomose with the ilio-lumbar artery; a vesical branch, which runs backward to supply the bladder; and a pubic branch, which is given off from the vessel just before it leaves the pelvic cavity.

The pubic branch ascends upon the back of the pubis, communicating with the corresponding vessel of the opposite side, and with the inferior epigastric artery.

After passing through the obturator canal and outside of the pelvis, the obturator artery divides at the upper margin of the obturator foramen, into an anterior branch and a posterior branch of the obturator artery which encircle the foramen under cover of the obturator externus.

Anterior branch

The anterior branch of the obturator artery is a small artery in the thigh and runs forward on the outer surface of the obturator membrane and then curves downward along the anterior margin of the obturator foramen.

It distributes branches to the obturator externus, pectineus, adductors, and gracilis muscle, and anastomoses with the posterior branch and with the medial femoral circumflex artery.

Posterior branch

The posterior branch of the obturator artery is a small artery in the thigh and follows the posterior margin of the foramen and turns forward on the inferior ramus of the ischium, where it anastomoses with the anterior branch.

It gives twigs to the muscles attached to the ischial tuberosity and anastomoses with the inferior gluteal artery. It also supplies an articular branch which enters the hip-joint through the acetabular notch, ramifies in the fat at the bottom of the acetabulum and sends a twig along the ligament of head of femur (ligamentum teres) to the head of the femur.

The blood supply to the femoral head and neck is enhanced by the artery of the ligamentum teres derived from the obturator artery. In adults, this is small and doesn't have much importance, but in children whose epiphyseal line is still made of cartilage (which doesn't allow blood supply through it), it helps to supply the head and neck of the femur on its own.

The articular branch is usually patent until roughly 15 years of age. In adults it does not provide enough blood supply to prevent avascular necrosis in upper femur fractures.

Variation

Inferior epigastric origin of the obturator artery, a normal variant. (A) shows a course abutting the external iliac vein, clear of the femoral ring. (B) shows the corona mortis variant, where artery courses within the lacunar ligament before diving through fascia inferiorly. Gray541.png
Inferior epigastric origin of the obturator artery, a normal variant. (A) shows a course abutting the external iliac vein, clear of the femoral ring. (B) shows the corona mortis variant, where artery courses within the lacunar ligament before diving through fascia inferiorly.

The obturator artery usually arises from the main stem or from the anterior trunk of the internal iliac artery. [1] [2] It may arise from the superior gluteal artery, and occasionally it arises from the external iliac.

In about two out of every seven cases it arises from the inferior epigastric and descends almost vertically to the upper part of the obturator foramen. In studies, it has been found that corona mortis is in half of all hemipelvis with a prevalence of 46%. [3] In other studies, it is found to be 33.33% in both hemipelves of the individuals. [4] The variation has also been found to be more common in patients from Europe than in Asia where studies have been conducted. In comparative studies, it was found that European patients had a 10% higher chance of having the arterial variation when compared to Asian population. [5] The artery in this course usually lies in contact with the external iliac vein, and on the lateral side of the femoral ring (Figure A on diagram). It can also pass medial to the femoral ring along the margin of the lacunar ligament (Figure B). In either case it would be at risk of injury during the operation to repair a femoral hernia, whether the hernia is reducible, incarcerated or strangulated. When the obturator artery travels along the lacunar ligament, it nearly encircles the femoral ring and can be lacerated during a femoral hernia repair. Most femoral hernias are repaired through a small (1/2 to 3/4 inch) incision in the groin area, rather than through the abdomen, so if a laceration were to occur, bleeding may not be immediately recognized and result in significant blood loss into the peritoneal cavity. Because of this danger, the anatomic variant in Figure B is sometimes referred to as the "crown of death" (corona mortis). [6] [7]

Additional images

Related Research Articles

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The piriformis muscle is a flat, pyramidally-shaped muscle in the gluteal region of the lower limbs. It is one of the six muscles in the lateral rotator group.

<span class="mw-page-title-main">Pectineus muscle</span> Adductor of the thigh

The pectineus muscle is a flat, quadrangular muscle, situated at the anterior (front) part of the upper and medial (inner) aspect of the thigh. The pectineus muscle is the most anterior adductor of the hip. The muscle's primary action is hip flexion; it also produces adduction and internal rotation of the hip.

<span class="mw-page-title-main">Hip</span> Anatomical region between the torso and the legs, holding the buttocks and genital region

In vertebrate anatomy, the hip, or coxa in medical terminology, refers to either an anatomical region or a joint on the outer (lateral) side of the pelvis.

<span class="mw-page-title-main">Adductor brevis muscle</span> Muscle in the thigh situated immediately behind the pectineus and adductor longus

The adductor brevis is a muscle in the thigh situated immediately deep to the pectineus and adductor longus. It belongs to the adductor muscle group. The main function of the adductor brevis is to pull the thigh medially. The adductor brevis and the rest of the adductor muscle group is also used to stabilize left to right movements of the trunk, when standing on both feet, or to balance when standing on a moving surface. The adductor muscle group is used pressing the thighs together to ride a horse, and kicking with the inside of the foot in soccer or swimming. Last, they contribute to flexion of the thigh when running or against resistance.

<span class="mw-page-title-main">Adductor longus muscle</span> Skeletal muscle located in the thigh

In the human body, the adductor longus is a skeletal muscle located in the thigh. One of the adductor muscles of the hip, its main function is to adduct the thigh and it is innervated by the obturator nerve. It forms the medial wall of the femoral triangle.

<span class="mw-page-title-main">Obturator foramen</span> Opening in the pelvis

The obturator foramen is the large, bilaterally paired opening of the bony pelvis. It is formed by the pubis and ischium. It is mostly closed by the obturator membrane except for a small opening, the obturator canal, through which the obturator nerve and vessels pass.

<span class="mw-page-title-main">Internal iliac artery</span> Main artery of the pelvis

The internal iliac artery is the main artery of the pelvis.

<span class="mw-page-title-main">Inferior epigastric artery</span> Blood vessel

In human anatomy, the inferior epigastric artery is an artery that arises from the external iliac artery. It is accompanied by the inferior epigastric vein; inferiorly, these two inferior epigastric vessels together travel within the lateral umbilical fold The inferior epigastric artery then traverses the arcuate line of rectus sheath to enter the rectus sheath, then anastomoses with the superior epigastric artery within the rectus sheath.

<span class="mw-page-title-main">Obturator nerve</span> Nerve in human anatomy

The obturator nerve in human anatomy arises from the ventral divisions of the second, third, and fourth lumbar nerves in the lumbar plexus; the branch from the third is the largest, while that from the second is often very small.

<span class="mw-page-title-main">Superior gluteal artery</span>

The superior gluteal artery is the terminal branch of the posterior division of the internal iliac artery. It exits the pelvis through the greater sciatic foramen before splitting into a superficial branch and a deep branch.

<span class="mw-page-title-main">Lateral sacral artery</span> Artery in the pelvis

The lateral sacral arteries is an artery in the pelvis that arises from the posterior division of the internal iliac artery. It later splits into two smaller branches, a superior and an inferior.

<span class="mw-page-title-main">Inferior gluteal artery</span>

The inferior gluteal artery is a terminal branch of the anterior trunk of the internal iliac artery. It exits the pelvis through the greater sciatic foramen. It is distributed chiefly to the buttock and the back of the thigh.

<span class="mw-page-title-main">Inferior gluteal veins</span>

The inferior gluteal veins are venae comitantes of the inferior gluteal artery. They commence in the superior/proximal posterior thigh. They enter the pelvis through the lower part of the greater sciatic foramen. They converge to form a single vessel before emptying into the distal portion of the internal iliac vein.

<span class="mw-page-title-main">Lateral circumflex femoral artery</span>

The lateral circumflex femoral artery is an artery in the upper thigh. It is usually a branch of the profunda femoris artery, and produces three branches. It is mostly distributed to the muscles of the lateral thigh, supplying arterial blood to muscles of the knee extensor group.

<span class="mw-page-title-main">Internal iliac vein</span> Large blood vessel of the pelvis

The internal iliac vein begins near the upper part of the greater sciatic foramen, passes upward behind and slightly medial to the internal iliac artery and, at the brim of the pelvis, joins with the external iliac vein to form the common iliac vein.

<span class="mw-page-title-main">Greater sciatic notch</span>

The greater sciatic notch is a notch in the ilium, one of the bones that make up the human pelvis. It lies between the posterior inferior iliac spine (above), and the ischial spine (below). The sacrospinous ligament changes this notch into an opening, the greater sciatic foramen.

<span class="mw-page-title-main">Deep circumflex iliac artery</span> Artery in the pelvis

The deep circumflex iliac artery is an artery in the pelvis that travels along the iliac crest of the pelvic bone.

<span class="mw-page-title-main">Outline of human anatomy</span> Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

<span class="mw-page-title-main">Hip bone</span> Bone of the pelvis

The hip bone is a large flat bone, constricted in the center and expanded above and below. In some vertebrates it is composed of three parts: the ilium, ischium, and the pubis.

<span class="mw-page-title-main">Pelvis</span> Lower torso of the human body

The pelvis is the lower part of an anatomical trunk, between the abdomen and the thighs, together with its embedded skeleton.

References

PD-icon.svgThis article incorporates text in the public domain from page 616 of the 20th edition of Gray's Anatomy (1918)

  1. 1 2 Kumari, Savita; Trinesh Gowda, M. S. (2016-08-01). "A study of variations of origin of obturator artery: Review in south Indian population". Journal of the Anatomical Society of India. 65: S1–S4. doi:10.1016/j.jasi.2016.05.001. ISSN   0003-2778.
  2. 1 2 Biswas, Sharmishta; Bandopadhyay, Manimay; Adhikari, Anjan; Kundu, Panchanan; Roy, Rita (2010-12-01). "Variation of Origin of Obturator Artery in Eastern Indian Population - A Study". Journal of Anatomical Society of India. 59 (2): 168–172. doi:10.1016/S0003-2778(10)80019-X. ISSN   0003-2778.
  3. ↑ Noussios, George; Galanis, Nikiforos; Chatzis, Iosif; Konstantinidis, Sergios; Filo, Eva; Karavasilis, George; Katsourakis, Anastasios (2020). "The Anatomical Characteristics of Corona Mortis: A Systematic Review of the Literature and Its Clinical Importance in Hernia Repair". Journal of Clinical Medicine Research. 12 (2): 108–114. doi:10.14740/jocmr4062. ISSN   1918-3003. PMC   7011932 . PMID   32095180.
  4. ↑ Heichinger, René; Pretterklieber, Michael L.; Hammer, Niels; Pretterklieber, Bettina (January 2023). "The Corona mortis is similar in size to the regular obturator artery, but is highly variable at the level of origin: an anatomical study". Anatomical Science International. 98 (1): 43–53. doi:10.1007/s12565-022-00671-w. ISSN   1447-6959. PMC   9845159 . PMID   35653059.
  5. ↑ Noussios, George; Galanis, Nikiforos; Chatzis, Iosif; Konstantinidis, Sergios; Filo, Eva; Karavasilis, George; Katsourakis, Anastasios (2020). "The Anatomical Characteristics of Corona Mortis: A Systematic Review of the Literature and Its Clinical Importance in Hernia Repair". Journal of Clinical Medicine Research. 12 (2): 108–114. doi:10.14740/jocmr4062. ISSN   1918-3003. PMC   7011932 . PMID   32095180.
  6. ↑ "Corona Mortis". Medical Terminology Daily. Clinical Anatomy Associates, Inc. 4 December 2012. Retrieved 6 October 2013.
  7. ↑ Rusu, Mugurel Constantin; Cergan, Romica; Motoc, Andrei Gheorghe Marius; Folescu, Roxana; Pop, Elena (28 July 2009). "Anatomical considerations on the corona mortis". Surgical and Radiologic Anatomy. 32 (1): 17–24. doi:10.1007/s00276-009-0534-7. PMID   19636491. S2CID   25637954.
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