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Inferior vesical artery

The inferior vesical artery is a branch of the anterior division of the internal iliac artery. It supplies the lower part of the urinary bladder, seminal vesicles, prostate, and terminal ureter. It is present in males, while in females its role is often replaced by branches of the vaginal artery. This artery is clinically significant in pelvic surgery, interventional radiology, and in conditions such as bladder tumors and prostate disease.

Synonyms

  • Vesical artery (inferior)

  • Lower vesical branch of internal iliac artery

  • Male inferior vesical artery

Origin, Course, and Distribution

  • Origin:

    • Arises from the anterior division of the internal iliac artery (often close to the origin of the middle rectal artery)

  • Course:

    • Runs medially and inferiorly across the pelvic floor toward the bladder base

    • Passes anterior to the ureter and in proximity to the seminal vesicles and prostate

  • Distribution (Branches):

    • Bladder branches: Supply the fundus and base of the urinary bladder

    • Prostatic branches: Supply the prostate gland

    • Seminal vesicle branches: Supply the seminal vesicles

    • Ureteral branch: Small branch to the terminal ureter

Relations

  • Anteriorly: Bladder base

  • Posteriorly: Rectum and seminal vesicles

  • Medially: Prostate gland (in males)

  • Laterally: Internal iliac vein and obturator vessels

Function

  • Provides arterial supply to the base and fundus of the urinary bladder

  • Supplies blood to prostate gland, seminal vesicles, and distal ureter

  • Maintains pelvic organ vascular integrity and contributes to collateral circulation in pelvic surgery

Clinical Significance

  • Important in prostatectomy and cystectomy, where it must be preserved or controlled

  • Frequently targeted in prostatic artery embolization for benign prostatic hyperplasia (BPH) treatment

  • Source of bleeding in pelvic trauma and bladder/prostate surgery

  • May serve as a route of tumor vascular supply in bladder or prostate carcinoma

  • In females, it is often replaced by branches of the vaginal artery

MRI Appearance

T1-weighted images:

  • Vessel lumen appears as a flow void (dark signal)

  • Surrounding pelvic fat appears bright, providing contrast

T2-weighted images:

  • Vessel shows flow void signal (dark)

  • Perivascular edema or tumor infiltration may appear bright

STIR (Short Tau Inversion Recovery):

  • Vessel lumen remains dark

  • Surrounding fat is suppressed, highlighting edema, inflammation, or tumor spread as bright signal

T1 Fat-Sat Post-Contrast (MR Angiography):

  • Vessel enhances strongly and uniformly after gadolinium administration

  • Helps visualize branches supplying bladder, prostate, and seminal vesicles

  • Pathology such as tumor neovascularity or vascular malformations shows abnormal enhancement

CT Appearance

Non-Contrast CT:

  • Vessel appears as a tubular soft tissue density, difficult to delineate without contrast

  • May be inferred by location near bladder base and prostate

Post-Contrast CT (CT Angiography):

  • Vessel enhances brightly and is well visualized

  • Useful for mapping in prostate artery embolization or pelvic tumor surgery

  • Pathology: active bleeding shows contrast extravasation; tumors may demonstrate hypertrophied feeding branches

MRI image

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MRI image

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CT image

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