Surgical anatomy of the posterior division of the internal iliac artery: The important point for internal iliac artery ligation to control pelvic haemorrhage

Abstract

Surgical anatomy of the posterior division of the internal iliac artery: The important point for internal iliac artery ligation to control pelvic haemorrhageLigation of the internal iliac artery is an effective procedure both to control post-partum haemorrhage 1 and to reduce operative blood loss at radical hysterectomy. 2 We performed a post-mortem anatomic dissection study which aimed to determine the location of the posterior division of the internal iliac artery, an important anatomical point for the ligation of anterior division of internal iliac artery for the elective control of pelvic haemorrhage. Anatomical dissection of the internal iliac artery, with anterior and posterior divisions, was performed in 22 fresh female cadavers (aged between 13 and 76 years) that were the subjects of forensic investigation, after institutional ethical approval for the study had been obtained.The following measurements were taken from the right and left sides of the pelvis: the distance from aortic bifurcation to the bifurcation of iliac artery, the distance from bifurcation of the iliac artery to posterior division of the internal iliac artery, the distance from the sacral promontory to the posterior division of the internal iliac artery and the distance from the pelvic midline to the posterior division of the internal iliac artery.The aortic bifurcation to the bifurcation of the iliac artery measurements were 60.9 ± 11.5 mm and 66.2 ± 12.5 mm on the right and left pelvic sides, respectively. The bifurcation of iliac artery to posterior division of the internal iliac artery measurements were 40.2 ± 8.3 mm and 38.4 ± 7.2 mm, on the right and left pelvic sides, respectively. The promontory to the posterior division of the internal iliac artery measurements were 42.01 ± 7.9 mm and 47.6 ± 7 mm, on the right and left pelvic sides, respectively. The distance from the pelvic midline to the posterior division of internal iliac artery was 35.3 ± 6.3 mm and 38.09 ± 4.9 mm, on the right and left pelvic sides, respectively. The values were not significantly different between cadavers under and over the age of 40. When the right and left pelvic sides were compared only the length of sacral promontory to the posterior division of internal iliac artery was significantly shorter on the right side (P = 0.018, Mann-Whitney U-test).The present study suggests that, by measuring a point approximately 4 -4.5 cms from the sacral promontory or common iliac bifurcation, the surgeon can identify the point of origin of the posterior division. The point is also located 3.5 cm away from the pelvic midline. However, in some clinical situations it may be easier or preferable to locate the anterior division by identifying the point of origin of the uterine artery or obliterated umbilical artery, and tying the internal iliac artery just proximal to their origin. There may be variations in the anterior and posterior division of the internal iliac artery. The two important structures, ureter and the internal iliac vein, should be identified by careful late...

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Anatomical Variations of the Blood Vascular System in Veterinary Medicine. The Internal Iliac Artery of the Dog. Part Two

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