The iliopectineal arch (iliopectineal ligament) is a thickened band of iliac fascia running from the back of the inguinal ligament to the iliopubic (iliopectineal) eminence. It divides the space beneath the inguinal ligament into two compartments: the lateral lacuna musculorum, which transmits the iliopsoas muscle and femoral nerve, and the medial lacuna vasorum, which transmits the femoral vessels and the femoral canal. This division explains why the femoral nerve lies outside the femoral sheath.
| Origin | Inguinal ligament (midpoint) |
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| Insertion | Iliopubic (iliopectineal) eminence of the hip bone |
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Separates the space beneath the inguinal ligament into the lacuna musculorum laterally and the lacuna vasorum medially.
The iliopectineal arch separates the femoral nerve (lateral, in the muscular lacuna) from the femoral artery and vein (medial, in the vascular lacuna), a key relation for femoral nerve block and femoral vascular access. The femoral ring (femoral hernia entry point) lies in the vascular lacuna and is bounded anteriorly by the inguinal ligament, medially by the lacunar ligament, laterally by the femoral vein, and posteriorly by the pectineal ligament. Femoral hernias are more common in women (wider pelvis) and have the highest risk of strangulation of any groin hernia.
Bowel herniation through the femoral ring medial to the femoral vein managed with urgent mesh repair given the high strangulation risk.
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