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Internal Iliac Vein

vena iliaca interna

The internal iliac vein drains the pelvic viscera, the pelvic walls, and the perineum, running posterior to the internal iliac artery to join the external iliac vein at the pelvic brim. Its tributaries parallel the internal iliac artery branches and include the superior and inferior gluteal veins, the obturator vein, the lateral sacral veins, the vesical venous plexus, the uterine and vaginal plexuses, and the rectal venous plexus.

Region: Pelvis & Hip

Clinical Relevance

Clinical Notes

The internal iliac vein and its tributaries form the rich pelvic venous plexuses that are the primary source of haemorrhage in pelvic fracture (haemorrhage from the presacral venous plexus and lateral pelvic wall veins), radical hysterectomy, and proctectomy. Preoperative embolisation of internal iliac artery branches (anterior division) reduces pelvic blood loss in major pelvic surgery, but internal iliac vein injury during surgery cannot be addressed by arterial embolisation alone. The venous plexuses communicate with Batson's vertebral venous plexus, explaining the haematogenous spread of prostate cancer to the lumbar spine.

Pathology

Common Injuries & Conditions

Internal Iliac Vein Haemorrhage in Pelvic Fracture

High-energy pelvic fractures tear the internal iliac venous tributaries in the presacral and obturator spaces, producing massive retroperitoneal haemorrhage managed by pelvic ring closure with a binder or external fixator to reduce pelvic volume and tamponade the veins, followed by angiographic embolisation of arterial bleeding sources.