Internal Iliac Artery Ligation in Obstetrics and Gynecology: Surgical Anatomy and Surgical Considerations

Abstract

The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe obstetrical or gynecologic hemorrhage, IIA ligation can be a lifesaving procedure. Regrettably, IIA ligation has not gained widespread popularity, primarily due to limited surgical training and concerns regarding possible complications, including buttock claudication, impotence, and urinary bladder and rectum necroses. Nowadays, selective arterial embolization or temporary balloon occlusion are increasingly utilized alternatives, which can be applied preoperatively or intraoperatively for threatening severe genital or pelvic bleeding. However, IIA ligation retains its relevance, as the previously described procedures are not always available and have limitations. This article provides a step-by-step guide to the IIA ligation procedure and its possible complications. It also includes a detailed description of the anatomy of the IIA and pelvic arterial anastomoses. This review highlights the importance of a thorough understanding of pelvic anatomy as a prerequisite for safe IIA ligation and posits that training in this procedure should be an integral part of obstetrics and gynecology curricula.

Effects of Internal Iliac Artery Ligation on Stress and Urge Incontinence: A Retrospective Evaluation

“…There are studies emphasizing the necessity of a comprehensive understanding of pelvic anatomy and advocating for its inclusion as a core part of medical curricula. These studies assert that BIIAL has a minimal effect on fertility while arguing for its crucial role in obstetrics and gynecology training programs [ 16 ]. However, the association of BIIAL with complications such as necrosis of the leg, gluteal muscle, bladder, and rectum, particularly in settings with limited surgical training, has heightened concerns about this technique [ 17 ].…”