Deep Inferior Epigastric Artery

arteria epigastrica inferior profunda

The deep inferior epigastric artery (DIEA) arises from the external iliac artery just above the inguinal ligament and ascends medially in the extraperitoneal plane to enter the posterior rectus sheath. It supplies the rectus abdominis and the overlying abdominal skin through musculocutaneous and fasciocutaneous perforators. The medial and lateral rows of DIEA perforators (DIEAPs) through the rectus muscle are the basis of the DIEP free flap for breast reconstruction.

Region: Abdomen

Clinical Relevance

Clinical Notes

The DIEA and its perforators are the foundation of modern autologous breast reconstruction: the DIEP flap (based on DIEA perforators only, preserving the rectus muscle) has become the gold standard because it provides adequate skin and fat volume with minimal abdominal wall morbidity. The DIEA is the anatomical basis for hernia anatomy: it defines the lateral border of the Hesselbach triangle (direct inguinal hernia space) — hernias lateral to the DIEA are indirect; medial are direct. The artery is ligated in laparoscopic transabdominal preperitoneal (TAPP) hernia repair to avoid interference with mesh fixation.

Pathology

Common Injuries & Conditions

DIEP Flap Based on Deep Inferior Epigastric Perforators

The DIEP flap harvests abdominal skin and fat supplied by perforators of the deep inferior epigastric artery traced through the rectus abdominis without sacrificing the muscle, providing vascularised breast reconstruction with primary vessel diameter of 2-3 mm suitable for microsurgical anastomosis to the thoracodorsal or internal mammary vessels.