Ligation Of The Iliac Arteries

The iliac arteries can be reached for ligation through an incision 2 cm. above and parallel to Poupart's ligament, reaching from the inner side of the external iliac artery to above the anterior superior spine if necessary. If the external iliac only is to be ligated this can be done through a comparatively small incision, but if it is desired to reach the internal or common iliac then the incision must be quite large. When the peritoneum is reached it is lifted up from the iliac fascia beneath and the external iliac artery followed up as far as desired. When the peritoneum is raised the ureter is usually lifted with it; it will be encountered crossing the point of bifurcation of the common iliac into the external and internal iliacs. The relation of the veins to the iliac artery on the two sides is to be borne in mind when passing the needle (Fig. 443).

Collateral Circulation (Fig. 444). - When the external iliac artery is ligated the following anastomoses occur:

Fig. 444. - Collateral circulation after ligation of the external iliac artery.

Ligation of the iliac arteries by a transperitoneal instead of subperitoneal route has been advocated by Dennis {Medical News, Phila., 1886). This lessens the danger of wounding the deep circumflex iliac and deep epigastric arteries, the vas deferens, the ureter, puncturing the veins and loosening up the subperitoneal tissue. Treves has used a median incision from the umbilicus to the pubes.