Anatomical Study on the Variations in the Branching Pattern of Internal Iliac Artery

Abstract

The internal iliac artery (IIA) arises from the common iliac artery at the level of the sacroiliac joint. It descends as trunk, divides into anterior and posterior divisions. From the anterior division it gives superior vesical, obturator, middle rectal, inferior vesical, inferior gluteal, and internal pudendal arteries. In females, inferior vesical artery is replaced by vaginal artery and gives an additional branch, uterine artery. The branches from the posterior division are ilio lumbar, lateral sacral, and superior gluteal arteries. An accidental hemorrhage and neurovascular injuries are common due to erroneous interpretation of variant arteries during surgical procedures. Hence the present study has been undertaken with reference to highlight its clinical and surgical significances. The study included 50 human bisected pelvises irrespective of their side and sex. Formalin-fixed specimens were selected and the branching patterns of IIA were studied. The level of origin, length, and the branching pattern of the IIA were examined and tabulated. The present study highlighted the variation seen in the origin, division branches of the IIA. The detailed knowledge of morphology is essential for successful ligation of the IIA during acute hemorrhage. This will guide the interventional radiologist in intra-arterial procedures during arterial embolization for hemorrhage, control of pelvic fractures, during selective catheterization of the intraarterial chemotherapy, and embolization of the pelvic tumors.

Variations of anterior and posterior division of internal iliac artery: A systematic review and clinical implications

“…Hence, understanding anatomical variation of IIA is essential for surgeons to apply the IIA ligature to prevent hemorrhages following by pelvic surgeries, hysterectomies and orthopedic surgeries related to hip joint. Previous studies show that the level of origin of IIA is variable and dependent on the length of the common iliac artery and the level of division of IIA 5 . Typically, the origin of the IIA is between L5 and the upper border of S1 1,2 .…”

A Missing Posterior Division of the Internal Iliac Artery

“…Mamatha et al. 2 investigated 50 formalin fixed bisected pelvises irrespective of side and sex. While the origin of the ILA from the main trunk of the IIA was reported as a rare variation (6%), the additional origins of the LSA and SGA from the trunk were not observed in that study.…”

Ligation of Internal Iliac Artery: Educational Video with Basic Steps and Key Points

“…Nevertheless, superior gluteal artery and other branches of the posterior division arise from the same trunk in a majority of the patients (62%), bearing an average length of 2.7 cm from the point of bifurcation of the common iliac artery (ranging between 2-3.5 cm). 3,4 This cadaveric dissection study found the distance between the bifurcation of the common iliac artery and the origin of the superior gluteal artery to be 3.1 cm. For most patients, the ligation of the internal iliac artery 3 cm away from the bifurcation of the common iliac artery is a safe idea.…”