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

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.

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

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703921 ◽

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.

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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

Case Reports in Radiology ◽

10.1155/2019/6734816 ◽

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.

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

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.005116 ◽

2016 ◽

Vol 15 (3) ◽

pp. 250-253 ◽

Cited By ~ 2

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.

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Secondary Angio-Embolization After Emergent Pelvic Stabilization and Pelvic Packing Is a Safe Option for Patients With Persistent Hemorrhage From Unstable Pelvic Ring Injuries

Frontiers in Surgery ◽

10.3389/fsurg.2020.601140 ◽

2020 ◽

Vol 7 ◽

Author(s):

Thomas Lustenberger ◽

Philipp Störmann ◽

Kathrin Eichler ◽

Christoph Nau ◽

Maren Janko ◽

...

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

Pelvic Ring ◽

Pelvic Packing ◽

Superior Gluteal Artery ◽

Obturator Artery ◽

Pelvic Ring Injuries ◽

Internal Iliac ◽

Pelvic Stabilization ◽

Mean Time

Introduction: In patients with severe pelvic ring injuries, exsanguination still is the leading cause of death in the early post-injury phase. While mechanical pelvic ring stabilization and pre-peritoneal pelvic packing are mainly addressing venous bleeding, angio-embolization aims to control arterial bleeding. The goal of the present study was to evaluate the rate of postoperative angio-embolization after mechanical pelvic ring injury stabilization and pre-peritoneal pelvic packing. Bleeding sources detected in the angiography and the patient's outcome were investigated.Patients and Methods: Retrospective observational cohort study at a single academic level I trauma center, reviewing all patients with pelvic ring injuries admitted from 01/2010 to 12/2019. Patients with emergent mechanical pelvic ring stabilization (supraacetabular external fixator and/or pelvic C-clamp) and direct pre-peritoneal pelvic packing were further analyzed. Patients that underwent postoperative angio-embolization were compared with those that did not. All postoperative angio-embolizations were evaluated with regards to bleeding sources and type of embolization.Results: During the study period, a total of 39 patients required immediate mechanical pelvic stabilization and direct pre-peritoneal pelvic packing. Of these, 12 patients (30.8%) underwent a postoperative angio-embolization. The following vessels were identified as bleeding sources: superior gluteal artery (n = 6), obturator artery (n = 2), internal pudendal artery (n = 2), unnamed branches of the internal iliac artery (n = 3). A selective embolization was successful in 11 patients; in 1 patient, an unilateral complete occlusion of the internal iliac artery was performed to control the bleeding. Mean time from hospital admission to the surgical procedure was 52.8 ± 14.7 min and the mean time from admission to angio-embolization was 189.1 ± 55.5 min. The in-hospital mortality rate of patients with angio-embolization was 25.0% (n = 3). Of these, 2 patients died due to multiple organ failure and 1 patient due to severe head injury.Conclusion: Secondary angio-embolization after external pelvic fixation and pre-peritoneal pelvic packing was effective in controlling ongoing bleeding. The most frequently detected bleeding vessel was the superior gluteal artery, which is difficult to surgically address, further highlighting the importance of angio-embolization in the management algorithm.

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

Jornal Vascular Brasileiro ◽

10.1590/s1677-54492008000300015 ◽

2008 ◽

Vol 7 (3) ◽

pp. 275-277 ◽

Cited By ~ 2

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.

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An original external iliac artery reconstruction with internal iliac artery translocation in a blunt injury of the pelvic vessels in a 4-year-old child: A 12-year follow-up study

Journal of Vascular Surgery Cases and Innovative Techniques ◽

10.1016/j.jvscit.2019.09.003 ◽

2019 ◽

Vol 5 (4) ◽

pp. 492-496 ◽

Cited By ~ 1

Author(s):

David Chayen ◽

Leonel Copeliovitch ◽

Zalman Itzhakov ◽

Michael Zaretsky ◽

Igor Rabin

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

External Iliac Artery ◽

Blunt Injury ◽

Follow Up Study ◽

Internal Iliac ◽

Artery Reconstruction

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Rupture of a Right Internal Iliac Artery Aneurysm after Coil Embolization and an Exclusion Operation

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.41.178 ◽

2012 ◽

Vol 41 (4) ◽

pp. 178-181

Author(s):

Toshio Baba ◽

Kiyofumi Morishita ◽

Shunsuke Oohori ◽

Kousuke Ujihira

Keyword(s):

Iliac Artery ◽

Coil Embolization ◽

Internal Iliac Artery ◽

Artery Aneurysm ◽

Iliac Artery Aneurysm ◽

Internal Iliac Artery Aneurysm ◽

Internal Iliac

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Pelvic collateral pathway during endovascular aortoiliac aneurysm repair with internal iliac artery interruption: a retrospective observational study

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01764-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Satoshi Nishi ◽

Shogo Hayashi ◽

Takuya Omotehara ◽

Shinichi Kawata ◽

Yoshihiro Suematsu ◽

...

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

Image Analysis System ◽

Circumflex Artery ◽

Obturator Artery ◽

Collateral Arteries ◽

Aortoiliac Aneurysm ◽

Internal Iliac ◽

Collateral Pathway ◽

Aneurysm Repair

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.

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