The external iliac artery admits of being tied in a surgical operation at any part except near its upper and lower end ; the near neighbourhood of the upper end being excepted on account of the circulation through the internal iliac, and the lower end on account of the common position of the branches (epigastric and circumflex iliac). Occasional deductions from this statement occur in consequence of a branch or branches taking origin near or at the middle of the artery; and as the operator may see such a branch he will avoid placing a ligature very near it.
The incision through the muscles to reach the artery, commencing a little above the middle of Poupart's ligament, may be directed parallel with the ligament upwards and outwards as far as its outer end, where the incision may be with advantage curved for a short space (about an inch) upwards.
This and the other iliac arteries might be operated on by means of straight incisions in a line from the umbilicus to the middle of Poupart's ligament, or a little to the outer side of this line. But the division of the muscles on the fore part of the abdomen is liable to the objection that the peritoneum must be disturbed in front as well as behind ; and, moreover, a curved incision has the advantage of giving more room laterally than one which is merely straight.
The muscles and the fascia transversalis being divided, and the peritoneum (to which the spermatic vessels adhere) being raised, the artery is found where the finger of the surgeon, introduced into the wound, begins to descend into the true pelvis, along the border of the psoas muscle.
In contact with the artery will be seen the following structures, each occupying the position already mentioned, viz., lymphatic glands, the circumflex iliac vein, and the external iliac vein.
In order to pass the ligature, it is necessary to divide a thin and sometimes resistant membrane, which binds the vessels down to the fascia iliaca.
From Quain's anatomy.