Variability in the Branching Pattern of the Internal Iliac Artery in Indian Population and Its Clinical Importance

Abstract

Internal iliac artery (IIA) is one of the terminal branches of the common iliac artery and is the prime artery of pelvis. The artery has many parietal and visceral branches and hence the variations are frequently noted. The larger branches, namely, the inferior gluteal artery, the superior gluteal artery, and the internal pudendal artery, show sufficient regularity in their patterns of origin to allow typing. The variability of the IIA and its branching pattern were studied by dissecting sixty-eight male pelvic halves (34 right and 34 left) and forty-eight female pelvic halves (24 right and 24 left sides). In significant number of specimens, IIA terminated without dividing into 2 trunks as against the usual description. There was also considerable interchange of branches between the 2 terminal divisions. The patterns of branching noted were grouped as per Adachi's classification. The incidence was noted to be as follows: type Ia in 60.6%, type Ib in 2.6%, type IIa in 15.8%, and type III in 21%. The other types were not observed in this study. Conclusion. Interventions in the pelvic region must take into account the variability of the IIA and its branches that can modify the expected relations and may lead to undesired hemorrhagic or embolic accidents.

Analysis of anatomical variations of intrapelvic vessels for advanced pelvic surgery

“…This study was the first to elucidate these patterns, and our findings have important implications for surgeons. Since Adachi first classified the IIA branching variations into five types [3], several studies have investigated the distributions of branching patterns in different populations [4][5][6]. Although those studies analyzed arterial variations in detail, they only assessed the IIA, independent of other vessels.…”

“…Only a few studies have demonstrated the morphological variability in the courses of the internal iliac artery, vein, or obturator vessels. Moreover, most of those studies were based on a small series or they addressed the variability of an individual artery or vein [3][4][5][6][7][8][9]. During surgery, it is also quite important to understand the inter-relationships between intrapelvic organs, in addition to individual variability, and these issues are rarely studied.…”

Comment on “Variability in the Branching Pattern of the Internal Iliac Artery in Indian Population and Its Clinical Importance”

“…I recently came across an interesting and useful article on “Variability in the Branching Pattern of the Internal Iliac Artery in Indian Population and Its Clinical Importance,” by Sakthivelavan et al [1]. As a practicing obstetrician who has served in several parts of developing countries, I would first like to thank the authors for their commendable desire to contribute to a topic of great clinical significance.…”

“…Conventionally, the IIA is ligated 5 cm distal to the bifurcation of the common iliac artery as it is said to spare the posterior division and avoid gluteal ischemia and necrosis. However, I was quite surprised to see that in as high as 25.9% of the cases this might not be the case due to anatomical variation [1]. It was also interesting to note the anomalous origin of the obturator artery from the posterior division in 6.8% of cases [1], as the parietal branches of the obturator play an important role in collateral circulation.…”

“…However, I was quite surprised to see that in as high as 25.9% of the cases this might not be the case due to anatomical variation [1]. It was also interesting to note the anomalous origin of the obturator artery from the posterior division in 6.8% of cases [1], as the parietal branches of the obturator play an important role in collateral circulation. Knowledge about these anatomical variations is of paramount importance to the operating surgeons, as it would help prevent further blood loss and other potentially severe complications such as ureteral injury, vein laceration, and ligation of the external iliac artery.…”