iliac. [Footnote]

[Footnote: The main artery (Plate 47) has been exposed in the iliac and
femoral regions with the object of showing the relation which its parts
bear to each other and to the whole; all the other dissections have been
made upon the same plan, the practical tendency of which will be
illustrated when considering the subject of arterial anastomosis.]

The external iliac part of the artery, G I, when requiring to be tied,
may be reached in the following way: an incision, commencing above the
anterior iliac spine, B, is to be carried inwards parallel to, and
above, Poupart's ligament, D, as far as the outer margin of the internal
abdominal ring. This incision is the one best calculated for avoiding
the epigastric artery, and for not disturbing the peritonaeum more than
is necessary. The skin and the three abdominal muscles having been
successively incised, the fibrous transversalis fascia is next to be
carefully divided, so as to expose the peritonaeum. This membrane is
then to be gently raised by the fingers, from off the iliacus and psoas
muscles as far inwards as the margin of the true pelvis where the artery
lies. On raising the peritonaeum the spermatic vessels will be found
adhering to it. The iliac artery itself is liable to be displaced by
adhering to the serous membrane, when this is being detached from the
inner side of the psoas muscle. [Footnote] The artery having been
divested of its serous covering as far up as a point midway between I G,
the epigastric and internal iliac branches, the ligature is to be passed
around it in this place, as being equidistant from these two sources of
disturbance. As the vein, K, lies close along the inner side of the
artery, the point of the instrument should first be inserted between
them, and passed from within outwards, in order to avoid wounding the
vein. If an aneurism affect the upper end of the external iliac artery,
it is proposed to tie the common iliac; but this is an operation of so
serious a nature, that it can in this respect be exceeded only by tying
the aorta itself. The common iliac artery is so situated, that it can as
easily be reached from the groin upwards as from the side of the abdomen
inwards, and in both directions the peritonaeum would have to be
disturbed to an equal extent.

[Footnote: The student, in operating upon the dead subject, is often
puzzled to find that the iliac artery does not appear in its usual
situation, unaware at the