Unconventional Obturator Artery Nutrient Branch: Image of an Anatomical Variation

Abstract

Variations in vascular anatomy are of great concern to surgeons, as proper identification of aberrant arteries can reduce the risk of iatrogenic injury and improve patient outcomes. Several studies have highlighted the irregular branching pattern of pelvic arteries, with a recent focus on the obturator artery (OA). The OA has an inconstant origin from the internal iliac artery, external iliac artery, or inferior epigastric artery. Within the pelvis, the OA can give off muscular branches and nutrient vessels to the ilium and pubis. Though occasionally described in text, few resources employ images of human donors that depict branches arising from the OAs. Out of the 34 hemisected pelves studied, we identified 1 individual with a substantial nutrient vessel branching unilaterally from the OA. Herein, we present the first image of this unconventional nutrient artery. This vessel should be highlighted given that its size and course make it particularly vulnerable during intrapelvic surgeries such as pelvic lymph node dissection or in procedures requiring arterial embolization of the OA.

A Bipartite Obturator Artery with Multiple Pelvic Branching—A Gynecologic Approach

“…The OA has been well documented to present significant anatomical variability. The atypical origins of OA variations have been extensively described and correlated to hemorrhagic risks in surgeries involving the pelvis [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. According to a meta-analysis by Sañudo et al, the origin of OA variations could arise from the anterior or posterior trunk of the IIA, the inferior epigastric artery (IEA), the external epigastric artery (EEA), or the femoral artery [ 24 ].…”

“…Anatomical variations in the pelvic blood supply are common [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Thus, a detailed description of these variants has been an advancement promoting minimally invasive gynecologic surgery and surgical quality and safety.…”

Analysis of Variation in the Origin of the Obturator Artery in Midwestern American Donor Bodies

“…Human anatomy studies suggest variations in the origin of the OA are common [1][2][3][4][5][6][7][8][9][10]. An aberrant obturator artery (AOA) is a vessel of an atypical origin and location.…”

“…Specifically, the OA does not originate from the anterior division of the IIA. When AOAs are found, the most common origin is the inferior epigastric artery or the EIA [ 1 , 5 ]. One potentially fatal variation occurs when an anastomosis forms between the OA and the inferior epigastric artery so that the artery courses over the superior pubic ramus [ 11 ].…”