VENOUS AND LYMPHATIC DRAINAGE OF PELVIS S-IV RM33
At the end of lecture the student will know:
• Main veins of the pelvis and their tributaries.
• Area of drainage of these veins.
• Different groups of lymph nodes.
• Afferent and efferent of different groups.
• Role of lymphatics and common route of spread
of malignancies of pelvis.
Lecture outline
The common iliac vein
• It is composed by the junction of the external and internal iliac veins in front of
sacroiliac joint, and collects the blood from the pelvis and the lower limbs
Veins of the Pelvis
Common iliac veins: Formed by the union of external and internal iliac veins in front of
sacroiliac joint.
• Common iliac veins ends upon L4~L5 by uniting each other to form inferior vena cava.
1-External iliac vein accompany the artery of the same name.
2-Internal iliac veins:
• These are the veins draining the pelvis.
• These veins converge near the greater sciatic foramen to form the internal iliac vein.
It has
1. Parietal tributaries: which accompany with arteries of pelvic wall.
2. Visceral tributaries: From the pelvic visceras
1-Parietal Tributaries.
– The gluteal,
– internal pudendal, and
– obturator veins, which have their origins outside the pelvis.
(a) The lateral sacral veins, which lie in front of the sacrum.
The Superior Gluteal Veins
These are venæ comitantes of the superior gluteal artery;
• They receive tributaries from the buttock corresponding with the branches of the artery,
and enter the pelvis through the greater sciatic foramen, above the Piriformis,
• They frequently unite before ending in the hypogastric vein
The Inferior Gluteal Veins
•
Venæ comitantes of the inferior gluteal artery, begin on the upper part of the back
of the thigh, where they anastomose with the medial femoral circumflex and first
perforating veins.
• They enter the pelvis through the lower part of the greater sciatic foramen and join to
form a single stem which opens into the lower part of the hypogastric vein
. Visceral Tributries
Middle rectal (hemorrhoidal)
• Prostatic
• vesical,
• uterine,
• vaginal veins,
• All these veins originate in the venous plexuses connected with the pelvic viscera.
Clinical Anatomy
Blockage of the veins of lower limb will result in the alternate path of the venous blood
through the pelvic veins.
• Surgical interference of these veins e.g during hysterectomy may compromise venous
drainage and may precipitate the edema of one or both legs.
• Veins of the rectal plexus may become varicose and may result in internal or external
hemorrhoids.
Lymphatic Drainage of Pelvis
Internal iliac lymph node
• Surround internal iliac vessels
• Receive afferents from pelvic viscera, perineum, buttock and back of thigh
External iliac lymph nodes
• Lie along external iliac artery
• Receive afferents from lower limb and some parts of pelvic viscera
Sacral lymph node
Common iliac lymph node
• Lie along common iliac artery
• Receive afferents from all the above nodes
• Efferents pass to lumbar lymph node
Main Groups of Pelvic Lymph Nodes
Most of the lymphatic vessels from the pelvis drain into groups of nodes associated with
the iliac arteries and their branches.
1-External iliac lymph nodes receive vessels from the inguinal nodes, external genitalia,
lower vagina, and cervix; they drain into the common iliac nodes.
2- Internal Iliac Lymph Nodes
• Surround internal iliac vessels.
• Internal iliac and sacral lymph nodes receive afferents from all the pelvic viscera (e.g.,
cervix, prostate, and rectum) and from the perineum, buttock, and thigh they drain into
the common iliac nodes.
• Common iliac lymph nodes send their efferent to the lumbar group of aortic nodes,
which also receives the afferents of the testis and ovary.
• The lower part of the anal canal, as also the external genitalia, drains into the inguinal
nodes.