Anatomy of the Internal Iliac Vein: Implications for Uterine Transplant

Abstract

Study objective: Uterine transplantation has proven feasible since the first live birth reported in 2014. To enable attachment of the uterus in the recipient, long vascular pedicles of the uterine and internal iliac vessels were obtained during donor hysterectomy, which required a prolonged laparotomy to the living donors. To assist further attempts at uterine transplantation, our video serves to review literature reports of internal iliac vein anatomy and demonstrate a laparoscopic dissection of cadaver pelvic vascular anatomy.

Design: Observational (Canadian Task Force Classification III).

Setting: Academic anatomic laboratory. Institutional Review Board ruled that approval was not required for this study.

Intervention: Literature review and laparoscopic dissection of cadaveric pelvic vasculature, focusing on the internal iliac vein.

Measurements and main results: Although the internal iliac artery tends to have minimal anatomic variation, its counterpart, the internal iliac vein, shows much variation in published studies [1,2]. Relative to the internal iliac artery, the vein can lie medially or laterally. Normal anatomy is defined as some by meeting 2 criteria: bilateral common iliac vein formed by ipsilateral external and internal iliac vein at a low position and bilateral common iliac vein joining to form a right-sided inferior vena cava [2]. Reports show 79.1% of people have normal internal iliac vein anatomy by these criteria [2]. The cadaver dissection revealed internal iliac vein anatomy meeting criteria for normal anatomy.

Conclusion: Understanding the complexity and variations of internal iliac vein anatomy can assist future trials of uterine transplantation.

Keywords: Anatomy; Internal iliac vein; Pelvic vasculature; Uterine transplant.