Inferior epigastric artery arising from the obturator artery as a terminal branch of the internal iliac artery and consideration of its rare occurrence
Obturator artery is frequently a branch of anterior division of the internal iliac artery. It has drawn attention of pelvic surgeons, anatomists and radiologists because of the high frequency of variations in its course and origin. The obturator vein is usually described as a tributary of the internal iliac vein. During routine dissection classes to undergraduate medical students we have observed obturator artery arising from external iliac artery, obturator vein draining into external iliac vein, communicating vein between obturator vein and external iliac vein and inferior epigastric artery arising from the obturator artery. The anomalous obturator vessels and inferior epigastric artery in the present case may be in a dangerous situation in pelvic surgeries that require dissection or suturing along the pelvic rim. Developmental reasons and clinical significances of the variations are discussed.
Abstract
Background
Ipsilateral branches of the deep femoral artery (DFA) are qualitatively identified as collateral arteries based on angiography after internal iliac artery (IIA) interruption. The purpose of this study was to quantitatively identify the major collateral pathway after unilateral IIA interruption during endovascular aortoiliac aneurysm repair to preserve the pelvic circulation and reduce the risk of ischemic complications.
Methods
The study population included 28 patients (mean age 76.3 years) with aortoiliac aneurysm who underwent endovascular aneurysm repair with unilateral IIA interruption from August 2012 to January 2020. The diameters of the bilateral preoperative and postoperative DFA, lateral femoral circumflex artery (LFCA), medial femoral circumflex artery (MFCA) and obturator artery (ObA) were measured on contrast-enhanced computed tomography using a 3-dimensional image analysis system. The measured values were evaluated and analyzed with a repeated measures two-way analysis of variance and Dunnett’s test.
Results
The postoperative diameters of the MFCA (P = 0.051) and ObA (P = 0.016) were observed to be larger than the preoperative diameters. Such increases in the MFCA (P < 0.001) and ObA (P < 0.001) diameters were only found to be significant on the unilateral side of the IIA interruption, and the diameter of the ipsilateral LFCA (P < 0.001) was also found to have significantly increased in size. However, no significant arterial extension was found on the contralateral side.
Conclusions
The ipsilateral MFCA-ObA pathway might therefore be a major collateral pathway arising from the DFA to preserve pelvic circulation after unilateral IIA interruption.
AbstractMost commonly, the Obturator artery arises from the anterior trunk of internal iliac artery. However, origin of the Obturator artery from external iliac artery was reported at 25% by Missankov et al. [3], 1.1% by Bergman et al. [1], 1.3% by Jakubowicz and Czerniawska- Grzesinska [2].Due to its high frequency of variations in course and origin, Obturator artery had drawn the attention of anatomists, surgeons and radiologists. In this case report, we are presenting an anomalous origin of right Obturator artery from right external iliac artery. The knowledge of this variation is important anatomically, radiologically and surgically.
Purpose: To describe the anatomical variations of the corona mortis, a vascular anomaly that may lead to dangerous hemorrhage and possible death. Case Report: A 46-year-old male cyclist was involved in a collision with a car, during which he sustained fractures to the left ribs and pelvic ring. Abdominal ultrasound imaging demonstrated a large (12×6×7 cm) nonhomogeneous mass ventral to the bladder, suggestive of a hematoma, which was confirmed on computed tomography. During angiography, 2 branches of the internal iliac artery were identified as sources of the bleeding; these were successfully embolized with microcoils, but the bleeding continued. Examination of the external iliac system found a lacerated aberrant obturator artery arising from the inferior epigastric branch of the external iliac artery, a condition known as the corona mortis. Additional embolization quelled the hemorrhage. Conclusions: Coil embolization of the internal iliac artery branches is very effective in managing hemorrhage due to pelvic fractures, but variations in the origin of the obturator artery from the internal or external iliac artery may be additional sources of bleeding.
Variaciones en el patrón de ramificación de la arteria ilíaca interna son ocasionalmente encontradas en las disecciones cadavéricas y las cirugías. Algunas de las variaciones son de importancia quirúrgica y clínica e ignorarlas podría derivar en alarmantes sangrados durante las prácticas quirúrgicas. Evaluamos las variantes en el patrón de la arteria ilíaca interna en un cadáver masculino. La división de la arteria ilíaca interna dio origen a las arterias rectal media y obturatriz. La arteria vesical superior tenía su origen en la arteria obturatriz. La división posterior de la arteria ilíaca interna dio lugar a las arterias iliolumbar, sacra lateral, glútea superior y pudenda interna. La arteria glútea inferior estaba ausente. Variations in the branching pattern of the internal iliac artery are occasionally encountered during cadaveric dissections and surgeries. Some of the variations are of surgical and clinical importance and ignoring them might result in alarming bleeding during surgical procedures. We report variant branching pattern of the right internal iliac artery in a male cadaveric specimen. The anterior division of the internal iliac artery gave origin to obturator and middle rectal arteries. Superior vesical artery took its origin from the obturator artery. The posterior division of the internal iliac artery gave iliolumbar, lateral sacral, superior gluteal and internal pudendal arteries. The inferior gluteal artery was absent.
Abstract
Background And Aims: Variations in the origin of the parietal branches of internal iliac artery are of great surgical and radiological importance. Very few studies regarding the variations in the origin of the branches of internal iliac artery have been reported from South India. The present study was carried out to investigate the sites of origin of the large parietal branches of the internal iliac artery in a sample Indian population from two Southern states. Materials And Methods: 50 pelvic halves of embalmed cadavers were dissected and observed for variations in the origins of superior gluteal, inferior gluteal, internal pudenda! and obturator arteries. Results: Among the 50 pelvic halves studied, the origins of superior gluteal, inferior gluteal and internal pudenda! arteries confirmed to a Type I arrangement on the Adachi scale in 30 cases (60%), a Type III pattern being found in 15 cases (30%) and a Type II pattern was seen in 4 cases (8%). Type IV was less frequent and was seen in only one case (2%). The obturator artery arose directly from the anterior division of internal iliac artery in 40% of cases; in the rest of specimens, it arose as a branch from either the inferior gluteal-internal pudenda! trunk or internal pudenda! or superior gluteal or iliolumbar arteries. Conclusions: The data obtained from this study show that the branching pattern of internal iliac artery is subject to great variation, especially with regard to its four large parietal branches. These observations are important in diagnostic & interventional radiological procedures of this major artery as well as in pelvic surgery to minimize intra-operative blood loss.
Abstract The obturator artery is a branch of the internal iliac artery, although there are reports documenting variations, with origin from neighboring vessels such as the common iliac and external iliac arteries or from any branch of the internal iliac artery. It normally runs anteroinferiorly along the lateral wall of the pelvis to the upper part of the obturator foramen where it exits the pelvis by passing through said foramen. Along its course, the artery is accompanied by the obturator nerve and one obturator vein. It supplies the muscles of the medial compartment of the thigh and anastomoses with branches of the femoral artery on the hip joint. We report a rare arterial variation in a Brazilian cadaver in which the obturator artery arose from the external iliac artery, passing beyond the external iliac vein toward the obturator foramen, and was accompanied by two obturator veins with distinct paths. We also discuss its clinical significance.
The inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery