Complete Survey of the Uterine Arterial System

Description

Arising from the anterior division of each internal iliac artery, the uterine artery courses medially along the pelvic sidewall within the base of the broad ligament toward the cervix, then ascends tortuously along the lateral uterus to the fundus. Near the cervix, it crosses superior to the ureter beneath the uterine artery, the classic water under the bridge relationship. Along its uterine course, cervical and vaginal branches descend toward the upper vagina, while superior branches anastomose with the ovarian artery near the uterine tube and cornua, completing a collateral arcade around the uterine body. This survey view matters for operative planning in the female pelvis because uterine perfusion depends on both the internal iliac origin and the utero-ovarian anastomosis, a point that determines bleeding risk and tissue viability. Ligation or thermal injury near the uterine artery at the level of the cervix is a common mechanism for ureteric compromise during hysterectomy, and the artery’s variable branching pattern influences where surgeons skeletonize the vessel. Interventional radiologists also rely on this map when selecting and embolizing uterine arteries for symptomatic leiomyomas or postpartum hemorrhage, where spasm, accessory uterine arteries, and cross-pelvic collaterals can lead to persistent flow. Use this artwork in pelvic anatomy teaching for OB-GYN and surgical trainees, in atlases and review articles on uterine artery embolization, or as a figure for counseling materials that explain uterine blood supply in fertility-sparing procedures. It also fits operative technique manuals covering hysterectomy, myomectomy, and management of placenta accreta spectrum where pelvic devascularization strategies are discussed. Anatomical accuracy verified by SciePro's Medical Advisory Board.