The Surgical Importance of the Inferior Epigastric Vessels

Abstract

The inferior epigastric artery arises just above the inguinal ligament from the medial side of the external iliac artery and then runs upwards and medially along the medial side of the deep inguinal ring to the deep surface of the rectus abdominis. In its course, it raises a peritoneal fold, when viewed from inside, called the lateral umbilical fold, which should not be confused with the medial umbilical fold raised by the obliterated continuation of the umbilical artery after the takeoff of the superior vesical artery. The inferior epigastric artery pierces the transversalis fascia in the attenuated part of the posterior rectus sheath and ascends between the muscle and the posterior lamina of its sheath, supplying the muscle and anastomosing behind the middle of the length of the rectus with the superior epigastric artery (the terminal branch of the internal mammary) and lower posterior intercostal arteries. At the deep inguinal ring, the ductus deferens in the male or the round ligament of the uterus in the female lies lateral to and hooks around the inferior epigastric artery. Muscular and cutaneous branches from the inferior epigastric arteries, such as the cremasteric artery in the male or the artery of the round ligament of the uterus in the female, supply the anterior abdominal wall near the origin of this artery. A pubic branch descends from either the lateral or the medial side of the femoral ring, to anastomose with the pubic branch of the obturator artery. The deep iliac circumflex artery, a separate branch of the external iliac artery, arises a little below the inferior epigastric, immediately above the inguinal ligament from the lateral aspect of the external iliac artery. It turns to the anterior superior iliac spine, lying just above the inguinal ligament within a fascial canal formed by the iliac and transversalis fasciae. The inferior epigastric vein, a tributary to the external iliac vein on its medial side just above the level of the inguinal ligament, collects the venous blood from the inferior half of the ipsilateral rectus abdominis muscle. The pubic vein links the obturator vein and the posteromedial side of the external iliac vein. The external iliac vein receives the deep circumflex iliac vein on its lateral side, just above the level of the inguinal ligament. The inferior epigastric vessels are important in a wide range of procedures in the lower abdomen, as discussed below.