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 |
|---|---|
| Course | Curves forward around the medial side of the deep inguinal ring, ascends obliquely along the transversalis fascia, pierces it to enter the rectus sheath near the arcuate line, runs on the deep surface of rectus abdominis and anastomoses with the superior epigastric artery from the internal thoracic artery |
| Branches |
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The inferior (deep inferior) epigastric artery and its perforators are the basis of the DIEP flap, the standard autologous breast reconstruction, which uses lower abdominal skin and fat without sacrificing rectus abdominis. The artery forms the lateral border of the inguinal (Hesselbach) triangle: indirect inguinal hernias leave the abdomen lateral to it through the deep ring, and direct hernias push through medial to it, a key landmark in laparoscopic hernia repair. Laparoscopic ports placed near the lateral edge of rectus can injure it and cause abdominal wall bleeding. A pubic branch joining the obturator artery (corona mortis) crosses the superior pubic ramus in many people and can bleed heavily in pelvic 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.
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