Original Article
STUDY OF POSTERIOR DIVISION OF INTERNAL ILIAC ARTERY
Pavan P Havaldar *
1, Sameen Taz
2, Angadi A.V
3, Shaik Hussain Saheb
4.
ABSTRACT
Address for Correspondence: Dr. Pavan P Havaldar, Assist ant Professor of Anat omy, JJM M edical College, Davangere -577004. India.
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* 1,4 Assist ant Professors Depart m ent of Anat omy, JJM M edical College, Davangere, Karnat aka, India.
2
Assist ant Professors Depart m ent of Anat omy, Sri Devaraj Urs M edical College, Kolar, Karnat aka, India.
3 Professor & Head, Depart m ent of Anat omy, SSIM S & RC, Davangere, Karnat aka, India.
Background: The int ernal iliac art ery originat es from t he com m on i liac art er y at t he level of sacroiliac joint . The int ernal iliac art ery descends post er ior t o t he great er sciat ic foram en t hereby dividing int o ant erior and post erior divisions. The post erior division of t he int ernal iliac art ery is know n t o give rise t o t hree m ain branches i.e. iliolum bar art ery, lat eral sacral ar t ery. Accidental haem orr hage is com m on during er roneous int erpretat ion of anom alous blood vessels. The know ledge of t he nor m al and t he abnorm al anat omy of t he branches of t he int ernal iliac ar t ery is essent ial for obst et r ic surgeons.
M et hods: 50 adult hum an pelvic halves w ere procured from em balm ed cadavers of J.J.M . M edical College and S.S.I.M .S & R.C, Davangere, Kar nataka, India for t he st udy.
Results: Out of 50 specim ens, i lio-lum bar art ery t ook origin from post erior division, direct ly in 22 specim ens (44%), w it h obt urat or art er y in 5 specim ens (10%) and w it h superior glut eal art er y in 2 specim ens (4%). From ant erior division, w it h obt urat or art ery in 6 specim ens (12%) and w it h infer ior glut eal ar t ery in 1 specim en (2%). From com m on t runk, as direct branch in 10 specim ens (20%), w it h lat eral sacral art ery in 1 specim en (2%), w it h vert ebral branch in 1 specim en (2%), w it h superior glut eal art ery in 1 specim en (2%) and w as found t o be absent in 1 specim en (2%). Post erior division of int ernal i liac art er y given origin direct ly t o super ior glut eal art er y in 44 specim ens (88%), w it h ilio-lum bar art ery in 1 specim en (2%), w it h obt urat or art ery in 2 specim ens (4%). Lat eral sacral art ery f rom post er ior division w as observed in 38 specim ens (76%) and unpaired origin w as observed in 7 specim ens (14%).
Conclusion: Int ernal iliac ar t ery supplies t he pelvic viscera and m usculat ure t he know ledge of it s branches helpful in pelvis surgeries.
KEYW ORDS: Int ernal iliac ar t ery , Superior Glut eal art er y, Lat eral sacral art er y, Ilio lum bar art ery.
INTRODUCTION
Int ernat ional Journal of Ana tomy and Research,
Int J Anat Res 2014, Vol 2(2):375-79. ISSN 2321- 4287
Received: 17 April 2014
Peer Review : 17 April 2014 Published (O):31 M ay 2014 Accept ed: 12 M ay 2014 Published (P):30 June 2014 Int ernat ional Journal of Anat omy and Research
ISSN 2321-4287 w w w.ijm hr.org/ ijar.ht m
In general, art eries pursue t he short est and t he m ost direct course in order t o reach t heir o bj ect i v e an d t h at t h is cou r se i s p ar t l y det erm ined by m echanical convenience. The angle at w hich branches leave a m ain art erial st em cert ainly depends t o a considerable ext ent on haem odynam ic fact ors. The int ernal iliac artery is t he artery of t he pelvis. It supplies most of t he blood t o t he pelvic viscera.
Bi lat eral int er nal i liac ar t er y ligat ion i s an ef f ect i v e l i f e savi n g m et ho d t o co n t r o l obst et rical and gynaecological haem orrhage and avoids a hyst erect omy[1].
Int J Anat Res 2014, 2(2):375-79. ISSN 2321-4287
sciat ic foram en w here it divides int o an ant erior t runk, w hich cont inues in t he sam e line t owards t he ischial spine and a post erior t runk, w hich passes back t o t he great er sciat ic foram en. The branches of t he post erior t runk of t he int ernal iliac art ery are t he iliolum bar, lat eral sacral and superior glut eal art eries.
Bergm an (1988) has report ed t hat , int ernal iliac art ery m ay be longer or short er t han usual. The branches m ay arise w it hout t he art ery dividing int o ant erior and post erior division. Branches of t he ant er io r an d po st er i o r d i vi si on s m ay exchange origins. Variat ions of branches of t he post erior division as follow s:
Ilio-lum bar art ery : This art ery m ay be absent , or part ially replaced by one of t he lum bars. It occasionally, gives rise t o a lat eral superior sacral art ery.
Lat eral sacral art ery : The vessels from bot h sides m ay arise in com m on. Superior branches are som et im es absent and m ay be replaced by branches from t he com m on iliac, int ernal iliac, ilio-lum bar or sciat ic art eries. When inferior branches are absent , t hey are replaced by branches from t he m iddle rect al, glut eal and sciat ic art eries.
Superior glut eal art ery : M ay arise from int ernal iliac art ery sharing a com m on t runk w it h inferior glut eal art er y and som et im es w it h int er nal pudendal art ery[2].
Occasionally, t he int ernal iliac art ery is ligat ed t o cont rol pelvic haem orrhage. Ligat ion does not st op blood flow but reduces blood pressure, allow ing haem ost asis (ar rest of bleeding t o occur). Because of t hree art erial anast om oses (lum bar t o ilio-lum bar, m edian sacral t o lat eral sacral and superior rect al t o m iddle rect al), blood f low in t he ar t er y is m aint ained alt hough reversed. This m aint ains t he blood supply t o t he pelvic viscera, glut eal region and genit al organs. Chen et al, present ed a paper on t he anat omy and clinical applicat ions of iliac crest flap pedicled on t he ilio-lumbar artery. The art ery w as const ant , but w it h a few variat ions. It s lengt h was 7.0±3.9 cm and t he out er diam et er 2.0±0.4 m m at t he lat eral edge of t he psoas m ajor m uscle. The iliac crest flap pedicled on t he ilio-lum bar art er y is a reliable bone flap for clinical usage[3].
The st udy t o charact erize t he anat om y of t he int ernal iliac art ery and it s post erior division branches and t o correlat e t hese f indings t o int ernal iliac art ery ligat ion was conduct ed on 54 fem ale cadavers. Average lengt h of int ernal iliac ar t er y w as 27.0 m m (range 0-52 m m ). Post erior division art eries arose from a com m on t runk in 62.3% (66 of 106) of pelvic halves. In t h e rem ai ni ng sp ecim ens, branches aro se independent ly from t he int ernal iliac artery, w it h t he iliolum bar not ed as t he first branch in 28.3%, lateral sacral in 5.7% and superior glut eal in 3.8%. The average w idt h of t he first branch was 5 (range 2-12) m m . In all dissect ions, post erior division branches arose from t he dorsal and lat eral aspect of int ernal iliac art ery. In t he adult m ale cadaver, on t he right side, t he absence of i nf er io r gl u t eal ar t er y w as o bser ved , com pensat ed by a branch com ing from superior glut eal art ery. The origin of superior glut eal art ery was from t he ant erior division of int ernal iliac art ery in t he sam e specim en, w hich passed t h ro u gh t h e gr eat er sci at i c f o r am en an d ap pear ed i n t h e gl ut eal regi on abo ve t he piriform is m uscle. In t his case, t he axial art ery has persist ed as t he proxim al port ion of t he superior glut eal art ery. In t he cases like t he present one, if t he superior glut eal art ery is com pressed, t he blood supply t o t he glut eus m axim us m uscle w ill be dim inished since t he inferior glut eal art ery is absent [4].
M ATERIALS AND M ETHODS
should occur at sim ilar frequencies. How ever, in our research, t he incidence of t he form er was 10.5%, w hile t hat of t he lat t er was a very low 0.4%. During norm al developm ent , infer ior epigast ric art ery is established at an earlier stage t han obt urat or art ery as a channel for blood supply. The difference of blood flow result ing from t his t im e lag is one of t he reasons w hy t he inferior epigast ric art ery from t he obt urat or art ery is very rare in com parison t o t he obt urat or art ery from t he inferior epigast ric art ery[5]. The superior glut eal art ery perforat or flap can be t ransferred pedicled t o t reat sacral pressure sores or t o be t ransferred freely for t he breast reconst ruct ion[6].
RESULTS
50 formalin fixed adult human pelvic halves w ere procured from t he Depart m ent of Anat om y, J.J.M . M edical College and S.S.Inst it ut e of M edi-cal Sciences and Research Cent re, Davangere. Specim ens w ere collect ed during rout ine dissec-t ion pracdissec-t icals conducdissec-t ed by dissec-t he Depardissec-t m endissec-t of Anat omy, J.J.M . M edical College and S.S.Inst it ute of M ed ical Sci ences an d Resear ch Cent r e, Davangere. A horizont al sect ion t hrough t he abdom en at t he fourt h lum bar vert ebral level was t aken. The pelvic specim en t hus obt ained was divided int o t w o equal halves by cut t ing t hrough t he pubic sym physis, t he sacrum and coccyx. The level of origin of int ernal iliac art ery was not ed. The individual branches (pariet al, vis-ceral) arising from t he ant erior and post erior di-visions w ere dissect ed upt o t heir t erm inat ions inside t he pelvis.
Out of 50 specim ens, ilio-lum bar art ery t ook origin from t hree sources. Post erior division, ant erior division and com m on t runk of int ernal iliac art ery. From post erior division, direct ly in 22 specim ens (44%), w it h obt urat or art ery in 5 specim ens (10%) and w it h super ior glut eal art er y in 2 specim ens (4%). From ant er ior division, w it h obt urat or art ery in 6 specim ens (12%) and w it h inferior glut eal art ery in 1 speci-m en (2%). Frospeci-m cospeci-m speci-m on t runk, as direct branch in 10 specim ens (20%), w it h lat eral sacral art ery in 1 specim en (2%), w it h vert ebral branch in 1 specim en (2%), w it h superior glut eal art ery in 1 specim en (2%) and was found t o be absent in
1 specim en (2%)(Table no 1).
Table No. 1:Vario us sources of origin of ilio-lum bar art ery as o bser ved in 50 specim ens.
Division Origin Specimen Percentage
w ith OBA 5 10
W ith SGA 2 4
w ith OBA 6 12
w ith IGA 1 2
Direct 10 20
w ith LSA 1 2
w it h VA 1 2
W ith SGA 1 2
Absent 1 2
Total 50 100
+/ N 22 44
PD
AD
CT
Superior glut eal art ery t ook origin from bot h post er io r an d ant er ior div ision s. Po st er ior division gave origin direct ly t o superior glut eal art ery in 44 specim ens (88%), w it h ilio-lum bar art ery in 1 specim en (2%), w it h obt urat or art ery in 2 specim ens (4%) and double superior glut eal art ery was found in 1 specim en (2%) and from ant erior division in 2 specim ens (4%). It m ade it s exit from t he pelvis t hrough t he great er sci at ic fo r am en ab o ve t h e p y r if o r m i s m uscle(Table no 2).
Lateral sacral artery t ook origin from post erior division, ant erior division and from com m on t runk of int ernal iliac art ery. These vessels vary in caliber, num ber and dist ribut ion. Paired origin of lat eral sacral art ery from post erior division w as ob ser v ed i n 38 speci m ens (76%) and unpaired origin w as observed in 7 specim ens (14%). From anterior division wit h inferior glut eal art ery in 2 specim ens (4%) and as a direct branch from com m on t runk in 3 specim ens (6%)(Table no 3).
Table No. 2:Various sources of o rigin o f superior glut eal art er y. Division Origin Specimen Percentage
+/ N 44 88 with ILA 1 2 W ith OBA 2 4 Double 1 2 AD Direct 2 4 Total 50 100 PD
Table No. 3: Various Sources of origin of lat eral sacral ar t er y.
Division Origin Specimen Percentage
Paired 38 76
Unpaired 7 14
AD with IGA 2 4
CT Direct 3 6
Total 50 100
PD
Int J Anat Res 2014, 2(2):375-79. ISSN 2321-4287
Fig. 1: Post erior division of int ernal iliac art ery. Fig. 2: Post erior division of int er nal i liac art ery.
Left
Sex Side Origin
7) Inferior glut eal art ery ABSENT
2) Superior vesical artery Present – nor mal
3) Obturat or artery Present – nor mal
4) Inferior vesical artery Present - two branches
Present - two fr om posteri or di vi si on and one from i nter nal pudendal ar ter y from anteri or division.
VARIATIONS : Length i s shor t. Internal pudendal arter y gi ves infer i or vesi cal arter y and one l ater al sacr al artery. M iddle rectal ar tery i s absent. Infer ior gl uteal arter y is absent.
3) Lat eral sacral art ery II) POSTERIOR DIVISION
1) Ilio-lumbar artery Present – nor mal
2) Superior glut eal artery Present – nor mal
Between L5 & S1
Length of the IIA
1cm above gr eater sci ati c
foramen
Level Of division
Present gi ves infer ior vesi cal arter y and one l ater al sacr al artery
5) M iddle rect al art ery ABSENT
6) Int ernal pudendal artery
3 cm
BRAN CHES FROM THE COMM ON TRUNK : NIL
BRAN CHES FROM DIVISION S :
I) ANTERIOR DIVISION
1) Obliterated umbilical artery Present – nor mal
M ale
2.5cm
BRAN CHES FROM DIVISIONS : I) AN TERIOR DIVISION
Sex Side Origin
M al e Right
1) Oblit erat ed umbilical art ery Pr esent - nor mal
2) Superior vesical art ery Pr esent - nor mal
3) Obturator art ery Pr esent gi ves i nfer i or vesi cal ar ter y.
4) Inferior vesical art ery Pr esent
5) M iddle rectal art ery Pr esent
6) Int ernal pudendal art ery Pr esent gi ves middl e r ectal ar tery
VARIATIONS : Length is shor t. Common tr unk gi ves i l i o-l umbar and upper lateral sacr al arter y. Obturator ar ter y gi ves i nfer i or vesi cal ar ter y. Inter nal pudendal and inferi or gluteal ar ter y- common tr unk fr om anter i or di vi si on. Inter nal pudendal ar ter y gi ves mi ddle r ectal ar ter y,and i nfer ior gl uteal arter y gi ves l ower l ater al sacral ar ter y.
Pr esent - two br anches,upper fr om common tr unk, l ower fr om i nfer i or gluteal ar ter y.
Level Of division Lengt h of t he
IIA
2.5cm above gr eater sci ati c
for amen Between L5 & S1
BRAN CHES FROM THE COM M ON TRUNK : Il i o-l umbar ar tery and upper l ater al sacral Arter y
2) Superior glut eal artery Pr esent - nor mal
3) Lat eral sacral art ery
7) Inferior gluteal art ery Pr esent gi ves l ower l ateral sacr al arter y
II) POSTERIOR DIVISION
1) Ilio-lumbar art ery Pr esent fr om common trunk Table. 1: Analysis of Figure 1.
DISCUSSION
Table. 2: Analysis of Figure 2.
Art eries are essent ially conduct ing channels t hrough w hich blood is conveyed from t he heart t o t he capillary bed. In t he present st udy, t he ilio-lum bar artery arose from post erior divisionin 29 specim ens (58%), from ant erior division in 7 specim ens (14%) and from com m on t runk in 13 specim ens (26%) and was found t o be absent in 1 specimen (2%). Bergman st at es t hat , t he ilio-lu m b ar ar t er y m ay be absent , r ed uced or part ially replaced by one of t he lum bars. It occasionally gives rise t o a lateral sacral artery[2].
In t he present st udy, lat eral sacral art ery t ook origin from post erior division, paired origin in 38
specim ens (76%) and unpaired in 7 specim ens (14%). Lat eral sacral art ery t ook origin from ant erior division w it h inferior glut eal art ery in 2 specim ens (4%) and f rom com m on t runk of i n t er n al i li ac ar t er y in 3 sp eci m ens (6%). Bergm an st at es t hat , lat eral sacral vessels from bot h sides m ay arise in com m on. The lat eral sacrals m ay provide t he inferior vesical and m iddle rect al art eries[2].
CONCLUSION
How to cite this article
:
Pavan P Havaldar, Sam een Taz, Angadi A.V, Shaik Hussain Saheb.
STUDY OF POSTERIOR DIVISION OF INTERNAL ILIAC ARTERY. Int J Anat Res 2014;2(2):375-79.
Conflicts of Interests: None
REFERENCES
t runk in 13 specim ens (26%). Lat eral sacral art ery t ook paired origin from post erior division in 38 specim ens (76%) and unpaired origin from post erior division in 7 specim ens (14%), from ant erior division in 2 specim ens (4%) and from com m on t runk in 3 specim ens (6%). Superior glut eal art ery w ere found t o be const ant in t heir origin and course.
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