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The 2 principal venous tributaries in the pelvis are the internal and external iliac veins, while the gastric veins dominate the abdomen. The union of the internal and external iliac veins creates the common iliac vein, while the inferior epigastric vein drains into the external iliac vein and anastomoses with the superior epigastric vein. The primary function of these veins is to drain deoxygenated blood and return this blood to the heart. Lymphatic nodes are dispersed throughout the pelvic vasculature. The internal, external, and common iliac nodes drain the pelvis and its contents, while the inferior epigastric vein empties into the external iliac vein. For example, the contents of the pelvic viscera are drained by the internal iliac nodes while being surrounded by branches of the internal iliac vessels. Furthermore, complex pelvic surgeries are complicated by anatomical variants of the iliac veins. Treatment outcomes can improve by accurately recognizing anatomical variants.