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 intra-arterial chemotherapy, and embolization of the pelvic tumors.

Keywords: Accidental hemorrhage; Arterial ligations; Embolization; Internal iliac artery.

Fig. 1

Obturator artery branching from the posterior division of internal iliac artery. IIA internal iliac artery, PD posterior division, AD anterior division, SGA superior gluteal artery, OA obturator artery

Fig. 2

Abnormal obturator artery branching from inferior epigastric artery. CIA common iliac artery, EIA external iliac artery, IIA internal iliac artery, AOA accessory obturator artery, IEA inferior epigastric artery

Fig. 3

Ilio lumbar artery, direct branch from the trunk of internal iliac artery. IIA internal iliac artery, ILA ilio lumbar artery, SGA superior gluteal artery, IPA internal pudendal artery, IGA inferior gluteal artery, MRA middle rectal artery, SVA superior vesicular artery, OA obturator artery, IVA inferior vesicular artery

Fig. 4

Obturator artery branching from the posterior division of internal iliac artery. IIA internal iliac artery, SGA superior gluteal artery, SVA superior vesicular artery, MRA middle rectal artery, IVA inferior vesicular artery, IPA internal pudendal artery, IGA inferior gluteal artery, OA obturator artery

Fig. 5

Obturator artery branching with inferior vesical artery as a common trunk from anterior division of IIA. IIA internal iliac artery, ILA ilio lumbar artery, LSA lateral sacral artery, SGA superior gluteal artery, SVA superior vesicular artery, OA obturator artery, IVA inferior vesicular artery, IGA inferior gluteal artery, IPA internal pudendal artery