The inferior epigastric artery is the primary blood supply to the lower rectus abdominis and the vascular pedicle for the TRAM and DIEP flaps used in breast reconstruction. It anastomoses with the superior epigastric (from the internal thoracic) to form the deep epigastric system that supplies the rectus through a series of perforators. The corona mortis (crown of death) is an aberrant obturator artery that crosses the superior pubic ramus and can cause fatal haemorrhage if inadvertently cut during pelvic surgery.
| Origin | External iliac artery just above the inguinal ligament |
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The inferior epigastric artery and its perforators are the basis of the DIEP (deep inferior epigastric perforator) flap — the current gold standard for autologous breast reconstruction, using the lower abdominal skin and fat without sacrificing the rectus abdominis muscle. Laparoscopic trocar insertion medial to the rectus lateral border can injure the inferior epigastric vessels, producing trocar site haemorrhage requiring clip ligation. The corona mortis anomalous vessel crosses the superior pubic ramus in 10 to 30 percent of people and can cause catastrophic haemorrhage during pelvic ring surgery.
Inadvertent division of the corona mortis (aberrant obturator artery crossing the superior pubic ramus) during pelvic surgery producing massive bleeding requiring urgent vascular control.
