Female Pelvis Blood Supply
Overview
The pelvic organs of women are supplied primarily by the Internal Iliac Artery (anterior division) and the Ovarian Arteries (direct aortic branches at L2). Understanding these relationships is essential for interpreting pelvic MRI, planning UAE, and preventing iatrogenic injury.
Key Arteries
- Uterine Artery (from anterior division of internal iliac): Crosses superiorly over the ureter ('water runs under the bridge') about 1-2 cm lateral to the cervix at the level of the internal os.
- Ovarian Artery (directly from aorta at L2): Travels in the infundibulopelvic ligament. Anastomoses richly with the uterine artery, enabling bilateral UAE without uterine necrosis.
- Vaginal Artery (from internal iliac): Supplies the vagina and the base of the bladder.
- Superior Vesical Artery: Supplies the dome of the bladder; continues as the obliterated umbilical artery.
Venous Drainage Asymmetry
Crucially, the right ovarian vein drains directly into the IVC, while the left ovarian vein drains into the left renal vein. This anatomical asymmetry makes left pelvic congestion syndrome and left-sided ovarian vein thrombosis more common.
WarningUreteral Injury Risk in Hysterectomy
The ureter is at highest risk where the uterine artery crosses above it ('water under the bridge'). During total hysterectomy, the ureter must always be identified before clamping and cutting the uterine vasculature.
High Yield Facts
LightbulbFRCR / MD Prep Pearl
In UAE for fibroids: the uterine artery characteristically shows a 'corkscrew' or 'helical' appearance on DSA when hypertrophied. After successful embolisation, the fibroid undergoes avascular coagulative necrosis and shrinks. The dominant ovarian arterial supply must be checked to avoid non-target embolisation causing premature ovarian failure.