scholarly journals Importance of Both Internal and External Iliac Artery Interrogation in Pelvic Trauma as Evidenced by Hemorrhage from Bilateral Corona Mortis with Unilateral Aberrant Origin off the External Iliac Artery

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Michael Herskowitz ◽  
James Walsh ◽  
Meghan Lilly ◽  
Kimberly McFarland
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Hemodynamic Instability ◽  
Pelvic Trauma ◽  
Obturator Artery ◽  
Iliac Arteries ◽  
Corona Mortis ◽  
Internal Iliac ◽  
Blunt Pelvic Trauma ◽  
Internal Iliac Arteries

Transcatheter angiography and embolization has long been recognized as the gold standard for patients with hemodynamic instability secondary to blunt pelvic trauma. While often the bleeding source can be readily localized based on the distribution of extravasation on preprocedural Computed Tomographic Angiography, one should be cautious in assessment for aberrant anatomy. A variant obturator artery originating from the inferior epigastric branch of the external iliac artery is commonly referred to as the corona mortis. We present a case of blunt pelvic trauma in which a patient demonstrated extravasation in the anterior distributions of both internal iliac arteries. Following embolization of bilateral internal iliac arteries, identification and embolization of bilateral corona mortis branches was crucial to achieving hemodynamic stability in this patient.

Hemorrhage Secondary to Pelvic Fracture: Coil Embolization of an Aberrant Obturator Artery

2003 ◽  
Vol 10 (3) ◽  
pp. 676-680 ◽  
Author(s):  
Bernd Daeubler ◽  
Suzanne E. Anderson ◽  
Michael Leunig ◽  
Jürgen Triller
Keyword(s):  
Iliac Artery ◽  
Coil Embolization ◽  
Internal Iliac Artery ◽  
Pelvic Ring ◽  
External Iliac Artery ◽  
Vascular Anomaly ◽  
Abdominal Ultrasound ◽  
Obturator Artery ◽  
Corona Mortis ◽  
Internal Iliac

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.

scholarly journals Rare origin of the obturator artery from the external iliac artery with two obturator veins

2016 ◽  
Vol 15 (3) ◽  
pp. 250-253 ◽  
Author(s):  
Kiyoshi Goke ◽  
Lucas Alves Sarmento Pires ◽  
Tulio Fabiano de Oliveira Leite ◽  
Carlos Alberto Araujo Chagas
Keyword(s):  
Iliac Artery ◽  
Internal Iliac Artery ◽  
External Iliac Artery ◽  
Lateral Wall ◽  
Iliac Vein ◽  
Obturator Foramen ◽  
Obturator Artery ◽  
Iliac Arteries ◽  
Internal Iliac ◽  
The Common

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.

scholarly journals Anatomical variation of obturator vessels and its practical risk: a case report from an anatomic study

2008 ◽  
Vol 7 (3) ◽  
pp. 275-277 ◽  
Author(s):  
Somayaji Nagabhooshana ◽  
Venkata Ramana Vollala ◽  
Vincent Rodrigues ◽  
Seetharama Bhat ◽  
Narendra Pamidi ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Anatomical Variation ◽  
External Iliac Artery ◽  
Iliac Vein ◽  
Inferior Epigastric Artery ◽  
Undergraduate Medical Students ◽  
Obturator Artery ◽  
External Iliac Vein ◽  
Epigastric Artery ◽  
Internal Iliac

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.

scholarly journals Role of bilateral internal iliac artery ligation in severe obstetric and gynaecological hemorrhage

2018 ◽  
Vol 7 (3) ◽  
pp. 1090 ◽  
Author(s):  
Shashi Lata Kabra Maheshwari ◽  
Nisha Kumari ◽  
Syed N. Ahmad
Keyword(s):  
Success Rate ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Care Hospital ◽  
Artery Ligation ◽  
Iliac Arteries ◽  
Internal Iliac Artery Ligation ◽  
Internal Iliac ◽  
Internal Iliac Arteries

Background: Massive pelvic haemorrhage is a potentially lethal complication while undergoing obstetric and gynaecological surgery. The objective of this study was to study of role of bilateral internal iliac artery ligation in severe obstetric and gynaecological haemorrhage. It was a prospective interventional study carried out in a multi-speciality tertiary care hospital in New Delhi.Methods: Thirty-five patients (31 obstetric and 4 gynaecological) fulfilling the inclusion criteria over a period of 2 years were included in the study cohort after informed consent. After laparotomy, internal iliac arteries were exposed by incising the peritoneal fold between the infundibulo-pelvic and round ligaments. A number 1 silk suture and right-angled artery forceps were used to tie the internal iliac arteries approximately 1 inch below their origin. The success and complications of the procedure were analysed.Results: In the present study 31 out of 35 cases underwent BIIAL for obstetrical cause of haemorrhage and rest 4 for gynaecological cause. In 19 out of 31 patients, hysterectomy preceded or followed BILAL depending upon the clinical situation making a uterine salvation rate of 38.7%. The success rate of BIIAL was 67.7% in 31 obstetric cases. In the 4 gynaecological cases BILAL was done to arrest post-hysterectomy haemorrhage and success rate was 100%. Among 35 patients one patient died of haemorrhagic shock and 4 other died of full blown sepsis and MODS in surgical ICU. No significant procedure related complications were encountered.Conclusions: BILAL is a very effective procedure to control PPH and pelvic haemorrhage due to other causes and helps save the much precious lives and uteri. This procedure can always be tried where procedures like embolization are unavailable.

scholarly journals Variation in the origin of right obturator artery - A case report

2015 ◽  
Vol 05 (03) ◽  
pp. 105-106
Author(s):  
Rani Nallathamby ◽  
Ramakrishna Avadhani ◽  
Sivarama C. H. ◽  
Meril Ann Soman ◽  
Meera Jacob
Keyword(s):  
Case Report ◽  
Iliac Artery ◽  
High Frequency ◽  
Internal Iliac Artery ◽  
External Iliac Artery ◽  
Anomalous Origin ◽  
Obturator Artery ◽  
Anterior Trunk ◽  
Internal Iliac

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.

scholarly journals Morphological considerations on the origin and morphometry of the internal iliac arteries

2014 ◽  
Vol 20 (4) ◽  
pp. 219-227
Author(s):  
Oana Popa ◽  
P. Bordei ◽  
D. Iliescu ◽  
C. Ionescu
Keyword(s):  
Intervertebral Disc ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Single Case ◽  
Front Face ◽  
Iliac Arteries ◽  
Internal Iliac ◽  
The Right ◽  
Different Levels ◽  
Internal Iliac Arteries

Abstract The origin of the internal iliac artery, right and left, was studied in 76 cases, 58 cases of male (76.32% of all cases) and 18 female cases (23.68% of all cases). The origin of the internal iliac arteries was considered in relation to the spine (lumbar-sacral). The right internal iliac artery males originates in a range from the upper edge of L4 vertebra - the lower part of fin sacral. It is found that in males, in most cases, 43 cases (74.14% of male cases), right internal iliac artery originates at different levels of sacral fin. We considered that the right iliac artery low origin only the cases in the lower part of the fin sacral, 10 cases (17.24% of male cases). Cases of high origin of the artery, above the fin sacral we found it in 15 cases (25.86% of male cases). From high origins, in the upper edge of the L4 vertebra and intervertebral disc at L4-L5, I met only one single case. Right internal iliac artery in females originated in a range between the upper edges of L5 - the lower part of sacral fin. In females, the right internal iliac artery origin, is located within narrower than in men, but in women, most frequently, 14 cases (77.78% of female the cases) was the origin of the internal iliac located at different levels of sacral fin. The females have not met internal iliac origin above the L5 vertebra or intervertebral disc level L4-L5. High origin was met it in 4 cases (22.22% of female the cases) and low origin in 6 cases (33.33% of female the cases). The level of the left internal iliac artery origin we studied 78 cases, finding it in the same range as in males, i.e., the upper edge of L4 vertebra - the front of the sacrum. In males, on a number of 57 cases (73.08% of all cases) the origin of the left internal iliac artery was made between the upper edge of the vertebra L4 - the front face of the sacrum, most commonly, in 44 cases (77 19% of male the cases) located in the sacral fin. The artery high origin I found it in 9 cases (15.79% of male the cases) and low origin in 18 cases (31.58% of male the cases). I have not met artery origin at L5-S1 intervertebral disc. In terms of low origin, only in males, the left internal iliac artery originated from the anterior to the sacrum, something not found the right internal iliac artery. In females, the 18 cases followed, had their origins in the range lower half of the L5 - middle sacral fin, 17 cases (94.44% of female the cases), terminating at the sacral fin. It is found that in women the origin of the left internal iliac artery is within narrower than the other cases described so far, showing the highest level of origin, this artery in females do not possess low origin. The high origin is present in a small percentage, only 5.56% of cases, encountering any case the origin of the left internal iliac artery is located at the L4 vertebra or the intervertebral discs at L4-L5 or L5-S1. Internal iliac artery diameter was followed on 90 cases, 44 cases for the right internal iliac artery and 46 cases for left internal iliac artery. In males, the right internal iliac artery I found a caliber between 3 to 9.8 mm. In women the right internal iliac artery caliber found between 3.9 to 6.9 mm.

Pseudostenosis of the External Iliac Artery in a Patient With Blunt Pelvic Trauma

2009 ◽  
Vol 66 (2) ◽  
pp. 586
Author(s):  
Shigeki Kushimoto ◽  
Yasuhiro Yamamoto ◽  
Masato Miyauchi ◽  
Hiroyuki Tajima
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Pelvic Trauma ◽  
Blunt Pelvic Trauma

Abstract P225: Calcification of the Splenic, Internal and External Iliac, and Breast Arteries and Risk of All-cause Mortality

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Eva J Hendriks ◽  
Pim A de Jong ◽  
Joline W Beulens ◽  
Yvonne T van der Schouw ◽  
Michael H Criqui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iliac Artery ◽  
Proportional Hazards ◽  
External Iliac Artery ◽  
Cox Proportional Hazards ◽  
Whole Body ◽  
Cvd Risk ◽  
Iliac Arteries ◽  
Internal Iliac ◽  
Multivariable Models

Introduction: Prognostic consequences of and risk factors for coronary and aortic calcification are well known. Less is known about the consequences of and risk factors for calcification in other arteries. Hypothesis: We hypothesize that calcifications in the splenic, internal and external iliac, and breast arteries (in females) have different risk factor profiles, and that calcification in these beds is associated with mortality. Methods: We conducted a case cohort study from 5196 individuals who self-referred for whole body computed tomography (CT). We selected a random sub-cohort of 395 individuals. Our cases were 298 individuals who died during a median follow-up of 9.4 years. CT scans were scored for splenic, internal and external iliac, and, in females, breast artery calcification. The associations between risk factors and presence or absence of calcification in each vascular bed in the random sub-cohort was evaluated using logistic regression. Using both the sub-cohort and death cases, we used Prentice-weighted Cox proportional hazards models to assess associations of calcification in each bed with mortality. Results: Within the random sub-cohort, prevalence of calcification was 11.6% (46 of 395) in the splenic, 47.9% (187 of 390) in the internal iliac and 9.5% (37 of 390) in the external iliac arteries. Among the 163 women, 3.7% had breast artery calcification. In multivariable models, age (OR 1.62 [95%CI 1.04-2.54] per 10 years), diabetes (OR 5.80 [95%CI 1.37-24.61]), log-transformed abdominal aortic calcium (AAC) (OR 1.36 [95%CI 1.09-1.70]) and log-transformed CAC score (OR 1.38 [95%CI 1.13-1.68]) were independently associated with splenic artery calcification. Age (OR 1.60 [95%CI 1.09-2.33], male gender (OR 3.86 [95%CI 2.09-7.15]), AAC (OR 1.44 [95%CI 1.28-1.62]) and CAC score (OR 1.23 [95%CI 1.08-1.39]) were associated with internal iliac artery calcium. Smoking (current vs. never OR 9.87 [95%CI 2.24-43.61]) and AAC (OR 1.96 [95%CI 1.24-3.11]) were associated with external iliac artery calcium. For the breast arteries, numbers were too small to fit these multivariable models. Although calcification in the splenic, internal, and external iliac arteries were significantly associated with mortality in unadjusted models, these associations were attenuated and no longer statistically significant after adjusting for cardiovascular risk factors. Among women, breast artery calcification was associated with mortality independent of traditional CVD risk factors and a 0-5 score of the number of calcified vascular beds out of the carotids, coronaries, abdominal and thoracic aorta and common iliacs (HR 5.67 [95%CI 1.50-21.41]). Conclusions: Calcification in the splenic, internal and external iliac arteries was strongly associated with calcification in the abdominal aorta. In females, breast artery calcification was strongly and independently associated with mortality.

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