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Superior vesical artery

The superior vesical artery is a branch of the anterior division of the internal iliac artery. It provides the principal arterial supply to the superior portion of the urinary bladder and gives small branches to adjacent pelvic structures. In some cases, it arises from the patent portion of the umbilical artery. It is an important vessel in pelvic surgery, urology, and radiology, especially during procedures involving the bladder, prostate, and pelvic lymph nodes.

Synonyms

  • Arteria vesicalis superior

  • Upper vesical artery

  • Superior branch of the umbilical artery

Origin, Course, and Distribution

  • Origin: Typically arises from the patent proximal part of the umbilical artery, which itself is a branch of the anterior division of the internal iliac artery.

  • Course:

    • Runs anteroinferiorly within the pelvis, along the lateral pelvic wall

    • Travels toward the superior aspect of the urinary bladder, coursing in close relation to the peritoneum

    • Often multiple superior vesical arteries arise rather than a single trunk

  • Distribution:

    • Urinary bladder (superior portion and dome)

    • Distal ureter (in some cases)

    • In males, small branches to the ductus deferens and seminal vesicles

Relations

  • Anteriorly: Peritoneum of the pelvic side wall

  • Posteriorly: Obturator nerve and pelvic fascia

  • Medially: Bladder dome and ureter

  • Laterally: Umbilical artery (patent and obliterated portions)

Branches

  • Multiple small branches to the superior and anterior bladder wall

  • Branches to the distal ureter

  • In males: artery to the ductus deferens (deferential artery) may arise from it

Function

  • Provides oxygenated blood to the superior portion of the urinary bladder

  • Contributes to collateral circulation in the pelvis

  • In males, assists in the vascular supply of the ductus deferens and seminal vesicles

Clinical Significance

  • Important landmark and vessel during pelvic and urological surgeries (e.g., prostatectomy, cystectomy)

  • May serve as a bleeding source in bladder or pelvic trauma

  • Target vessel in pelvic embolization procedures for bladder hemorrhage

  • Variations in origin and number are common, important for interventional radiology and surgical planning

MRI Appearance

T1-weighted images:

  • Appears as a flow void (dark linear or branching structure) along the pelvic side wall and near the bladder dome

  • Surrounding pelvic fat appears bright

T2-weighted images:

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

  • May show hyperintense signal if slow flow or thrombus present

STIR (Short Tau Inversion Recovery):

  • Vessel itself remains dark due to flow void

  • Surrounding fat suppressed, improving visibility of vascular course

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

  • Superior vesical artery enhances brightly after contrast

  • Outlines clearly in MR angiographic sequences supplying the bladder dome

CT Appearance

Non-Contrast CT:

  • Usually not visible unless calcified; appears as soft tissue density following pelvic vessels

  • Surrounding pelvic fat provides contrast for vessel identification

Post-Contrast CT (CT Angiography):

  • Enhances brightly in the arterial phase, showing its course from the umbilical artery to the bladder dome

  • Demonstrates branching pattern and variations

  • Pathology (aneurysm, thrombosis, tumor invasion) may alter its appearance

MRI image

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MRI image

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CT image

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