The external iliac artery is invested by both peritoneum and extraperitoneal tissue, the latter (fascia of Abernethy) sending in a septum between the artery and vein. The artery is crossed near Poupart's ligament by the genito-crural nerve, spermatic vessels, and deep circumflex iliac vein. The ovarian vessels in the female cross the middle of the artery. Ligature of the external iliac vessel might be required for trauma or for aneurism, which at this level generally affects also the femoral artery. The ligature may be performed by opening the abdomen, or by making an incision parallel to, and above, Poupart through the abdominal wall, and then shelling the peritoneum upwards. In the abdominal method the Trendelenburg position should be used, and care is necessary to avoid the vein (lying generally behind and to the inner side), the ureter, and the genito-crural nerve. In the extraperitoneal method a curved incision is made, 4 inches long, commencing 1 inch above and internal to the anterior superior spine, and extending downwards and inwards to a point 1½ inches above and external to the centre of Poupart. The superficial structures, muscles, and transversalis fascia are divided, the peritoneum exposed and reflected, until the vessel is exposed on the inner border of the psoas.
The internal iliac is 1½ inches long. Its anterior division gives off (a) in the pelvis ; vesical and middle hemorrhoidal, and in the female, uterine and vaginal ; (b) extrapelvically ; obturator, internal pudic, and sciatic branches. The posterior division gives off ilio-lumbar and lateral sacral branches intrapelvically, and gluteal extrapelvically. The obliterated hypogastric artery constitutes the terminal portion of the internal iliac, which, in the foetus, runs up the abdominal wall to the umbilicus, to pass out with the other structures of the cord.