Anatomical study and clinical importance of the inferior epigastric artery / Estudio anatómico e importancia clínica de la arteria epigástrica inferior

SUMMARY: The inferior epigastric artery (IEA) is a major blood vessel that supplies the anterior abdominal wall. The aim of the current study was to provide clinicians, surgeons, and obstetricians with sufficient anatomical data on the inferior epigastric artery, such as its origin and branching pattern. The study included 20 embalmed cadavers, these cadavers were dissected, and the inferior epigastric artery and vena comitans/venae comitantes were identified and traced downwards to the external iliac vessels. The origins, caliber, course and pedicle length of both the artery and the vein(s) were studied. The inferior epigastric artery arose independently from the distal external iliac artery deep to the inguinal ligament in 19 (95 %) cadavers. The artery entered the rectus abdominis muscle at its middle third in 13 (65 %) cases and at its lower third in the remaining specimens. In this study, we found that the artery divided into two branches in 18 (90 %) of the cases; in the remaining two cases, it continued as one trunk. The average pedicle length was 7.2 cm. The mean caliber of the IEA was 3.7 mm. In 18 (90 %) dissections, the venous drainage consisted of a pair of venae comitantes that united to form a common vessel at their draining point on the external iliac vein. The average diameter was 3.9 mm. The current study focuses on the anatomical features of the inferior epigastric artery to increase the success rate of abdominal and pelvic operations in clinical practice.

RESUMEN: La arteria epigástrica inferior (AEI) es un vaso sanguíneo principal que irriga la pared abdominal anterior. El objetivo del presente estudio fue proporcionar a los médicos, cirujanos y obstetras suficientes datos anatómicos sobre la arteria epigástrica inferior, como su origen y patrón de ramificación. El estudio incluyó 20 cadáveres embalsamados, los que se disecaron y se identificó la arteria epigástrica inferior y la vena concomitante y se siguieron hasta los vasos ilíacos externos. Se estudiaron los orígenes, calibre, trayecto y longitud del pedículo tanto de la arteria como de la (s) vena (s). La arteria epigástrica inferior surgió independientemente de la arteria ilíaca externa profunda al ligamento inguinal en 19 (95 %) cadáveres. La arteria ingresó al músculo recto del abdomen en su tercio medio en 13 (65 %) casos y en su tercio inferior en las muestras restantes. En este estudio, encontramos que la arteria se dividió en dos ramas en 18 (90 %) de los casos; en los dos casos restantes, continuó como un tronco. La longitud media del pedículo fue de 7,2 cm. El calibre medio del AEI fue de 3,7 mm. En 18 (90 %) disecciones, el drenaje venoso consistió en un par de venas concomitantes las que formaron un vaso común en su punto de drenaje en la vena ilíaca externa. El diámetro medio fue de 3,9 mm. El estudio actual se centra en las características anatómicas de la arteria epigástrica inferior con el propósito de mejorar la tasa de éxito de las cirugías abdominales y pélvicas en la práctica clínica.

A Case of Spontaneous Common Iliac Atery Dissection / 고신대학교의과대학학술지

Spontaneous and isolated dissection of the limb arteries without involvement of the aorta is extremely rare, and has been reported previously in pregnant patients in association with collagen vascular disease, and in cases of high-energy trauma or intensive activity in athletes. There is no consensus yet on indications for medical or surgical therapeutic modality. Due to the rarity of spontaneous dissection of external iliac artery, its natural history has been poorly described. A healthy 50-year-old male with normotension was admitted with an acute onset of left flank pain. Left external iliac artery dissection was diagnosed by abdominal computed tomography.

Variability in the Origin of the Obturator Artery: A Descriptive Cross-Sectional Cadaveric Study.

Background: Surgeons must be conscious of unexpected sources of hemorrhage, such as an aberrant obturator artery or vein, and unexpected iliopubic vessels and take appropriate precautions to avoid injury to these structures. Objective: Evaluating the incidence of normal and aberrant origin of the obturator artery and vein. Materials and Methods: A total of 72 human hemi-pelvises were taken including both the fresh cadavers arrived in mortuary with preserved pelvises in Department of Anatomy at Netaji Subhash Chandra Bose Medical College, Jabalpur. Laparotomy done with midline anterior incision up to the pubic symphysis and dissection carried out in the pelvic and retropubic region to expose the branches of the common iliac artery. Results: Obturator artery common originates from the anterior trunk of the internal iliac artery and less frequently from other branches of internal or external iliac artery. Abnormal communication found in 45.8% of hemi-pelvises which are mostly venous. Conclusion: Obturator artery the most common originates from anterior trunk of internal iliac artery. Abnormal venous communications (venous corona mortis) are a very common and knowledge of abnormal communications of obturator vessels is crucial for the different surgeries at pelvic region.

Unilateral Variant in Origin, Position and Course of Pubic Artery Associated with a Variant Obturator Artery and Vein.

Increased frequencies on variations in the origin, course and branching of retropubic vessels has brought an increased attention to anatomists, surgeons and radiologists. Pubic arterial supply normally originates from branches of; obturator artery before it leaves the pelvic cavity at the obturator foramen, and inferior epigastric artery. Branches from these two vessels usually anastomoses to supply the pubis. We observed a unique variation of pubic artery presenting unilaterally during a routine dissection in an 85-years-old male cadaver. A single unilateral variant left pubic artery was seen arising from a variant left obturator artery that originated from external iliac artery in a common trunk with inferior epigastric artery. On its way to the pubic region it gave a branch that provides arterial supply to the rectus sheath. To date this is a rare entity, thereby important to pelvic surgeons and radiologists undertaking routine procedures involving the retropubic space (space of Bogros).

Alteration of Ankle-Brachial Index after Kidney Transplantation / 대한이식학회지

BACKGROUND: A steno-occlusive disease of the iliac artery can mimic renal vascular hypertension, and is an important cause of renal dysfunction in renal transplant recipients. We assessed the alternation of postanastomotic arterial blood flow of lower extremities by ankle-brachila index (ABI). METHODS: We analyzed 50 patients who underwent kidney transplantation between March, 2010 and November, 2012 at Chonnam National University Hospital. This study was performed prospectively and case selection by renal transplantation patients who got first operation on right iliac fossa. All operational procedures were end to side anastomosis of the external iliac artery to the renal artery. We measured and compared the preoperative and postoperative (1 week, 6 months, 1 year) ABI. We analyzed the diameter of the recipient external iliac artery and renal artery of the transplanted kidney. RESULTS: Among 50 patients, 34 were male (68%) and 16 were female (32%). The mean age of recipients was 44.37+/-11.42 years. The mean preoperative ABI at the right lower extremity was 1.17+/-0.11, postoperative 1 week, 6 months, and 1 year was 1.14+/-0.10, 1.15+/-0.11, 1.17+/-0.15, respectively. Alternation of preoperative ABI and postoperative 1 week, 6 months, and 1 year was P=0.331, P=0.864, and P=0.992, respectively. CONCLUSIONS: Alternation of ABI on the ipsilateral lower extremity was not significant in renal transplanted recipients. We recommend a long-term study with more cases.

Diagnosis and treatment of vascular complications of external iliac arteries after kidney transplantation：a report of 6 cases / 中南大学学报(医学版)

Objective: To explore the characteristics of external iliac artery vascular complications atfer renal transplantation and the diagnosis and treatment. Methods: We reviewed the clinical data of 6 patients with of external iliac artery vascular complications atfer renal transplantation from more than 2000 renal transplantation patients in the Transplantation Center of the Third Xiangya Hospital of Central South University from 2001 to 2013, and analyzed the clinical characteristics, diagnosis and treatment. Results: hTe renal allogratf was removed in 5 of the 6 patients due to repeated external iliac arteryhemorrhage: 2 patients were replaced the external iliac artery with reversed autogenous great saphenous vein, 2 patients underwent the bilateral femoral artery bypass surgery, and 1 was repaired the external iliac artery directly. The other 1 was resected the renal allograft and the involved external iliac arteries due to fungal mass in the external iliac artery. Among the 6 patients, except 1 patient died atfer the surgery of the repair of the external iliac artery, the other 5 are all alive. Conclusion: Vascular replacement and artery bypass are effective methods for patients with external iliac artery vascular complications atfer kidney transplantation.

External iliac artery-related postpartum hemorrhage:report of one case with literature review / 介入放射学杂志

Objective To explore the imaging features of external iliac artery-related postpartum hemorrhage, and to discuss its interventional therapy measures. Methods The clinical data and imaging findings of one patient with external iliac artery-related postpartum hemorrhage was retrospectively analyzed. The patient received interventional therapy at the intervention department of Shanxi provincial people ’s hospital. The relevant academic papers published in medical literature were reviewed. The common features of this condition were summarized, and the imaging features and the interventional therapy measures were discussed. Results A total of 4 patients, including authors’ case, with external iliac artery- related postpartum hemorrhage were reported in China. Of the 4 case , right external iliac artery-related postpartum hemorrhage was seen in 2 and bilateral external iliac artery-related postpartum hemorrhage was seen in other two. Embolization therapy of three abnormal branches of deep circumflex iliac artery that participated in the uterine blood supply was carried out. Immediately after the embolization the bleeding stopped. Conclusion For the treatment of postpartum hemorrhage, uterine arterial embolization should be followed by abdominal aorta angiography so as to check the external iliac artery. When recurrent bleeding occurs after uterine arterial embolization, the possibility that the abnormal branches of external iliac artery participates in the uterine blood supply should be considered. In performing the embolization of abnormal branches of external iliac artery, the catheter should be inserted to the distal end of the target vessel. Under DSA monitoring the embolic agent should be slowly injected into the targeted artery and the patient should be kept under close observation for blood reflux. Usually, the embolization of abnormal branches of external iliac artery will not cause ischemic symptoms of the pelvis and distal limbs.

Unusual branching pattern of external iliac artery: case report / Patrón inusual de ramificación de la arteria ilíaca externa: reporte de caso

During the routine dissection, a rare anomaly was observed in left lower limb of a female cadaver. The external iliac artery continued as femoral artery, branched on lateral side as the lateral circumflex femoral artery and on medial side as profunda femoris artery. On tracing the lateral circumflex femoral artery, the ascending branch towards the spinous anastomosis was very thin and coursed behind the rectus femoris muscle. The transverse and descending branches were not observed, however, the artery coursed along the vastus lateralis towards the knee. The femoral artery had its normal course and continued as popliteal artery. The profunda femoris artery originated from the medial side of the external iliac artery, initially superficial to the femoral vein, coursed downwards and posteriorly, relating posteromedial to femoral artery. The medial circumflex femoral artery originated as thin branch, which further divided into two divisions. The profunda femoris gave origin of 3 perforators and continued as 4th perforator. The unusual branching pattern was observed to be novel and not reported in the literature.

Durante una disección de rutina, se observó una rara anomalía en el miembro inferior izquierdo de un cadáver de sexo femenino. La arteria ilíaca externa dio origen en el lado lateral ala arteria circunfleja femoral lateral y en el lado medial a la arteria femoral profunda. En el recorrido de la arteria circunfleja femoral lateral, la rama ascendente era muy delgada y corría detrás del músculo recto femoral. No se observaron ramas transversales y descendente, sin embargo, la arteria descendió hacia la rodilla a lo largo del músculo vasto lateral. La arteria femoral tuvo su curso normal y continuó como arteria poplítea. La arteria femoral profunda, inicialmente superficial a la vena femoral, se dirigió inferior y posteriormente colocándose posteromedial a la arteria femoral. La arteria circunfleja femoral medial se originó como una rama delgada, que otorgó dos arterias. La arteria femoral profunda dio origen a tres ramas perforantes y continuó como cuarta perforante. Este patrón de ramificación inusual es una descripción nueva no reportada en la literatura.

Variant Origin of Obturator Artery: A Branch of Inferior Epigastric Artery from External Iliac Artery / 체질인류학회지

The obturator artery normally originates from the internal iliac artery. However, variation in the origin of obturator artery has been reported in many countries. Since no such case has been reported in Korea, we examined variations in the origin of obturator artery in cadavers donated to the medical school at the Chungbuk National University. Thirty-six pelvic halves from 18 cadaveric subjects (13 males and 5 females) were studied in this study. Normal origin of the obturator artery from the internal iliac artery was observed in 88.9% (16/18) of cadavers or in 91.7% (33/36) of pelvic halves. A variation in the origin of obturator artery was observed in 11.1% (2/18) of cadavers or in 8.3% (3/36) of pelvic halves. All of the variant obturator arteries originated from external iliac arteries as branches of inferior epigastric arteries. Bilateral presence of variant obturator arteries was observed in 5.6%(1/18) of cadavers. The obturator artery arose from inferior epigastric artery at a distance of 1 to 2.4 cm from origin point of inferior epigastric artery, and then the obturator artery ran inferiorly and medially with the inferior epigastric artery running superiorly and laterally. Presence of variant obturator artery would be important to clinical fields with interest to pelvic anatomy, such as radiology and surgery.

Looped external iliac artery: a case report / Arteria ilíaca externa en bucle ­ reporte de caso

Variations of the external iliac artery are very rare. We found a rare variation in the left external iliac artery. The artery was long and formed a characteristic loop. The loop was found in the lesser pelvis in close relation to the obturator nerve. This loop may compress obturator nerve and vessels. The knowledge of this loop might be important for gynaecologists, orthopaedic surgeons and urologists since it may be involved in surgeries of hip, ovary and prostate...

Las variaciones de la arteria ilíaca externa son raras. Se encontró una variación poco frecuente en la arteria ilíaca externa izquierda. La arteria era larga y formaba un bucle característico. El bucle se encontró en la pelvis menor en estrecha relación con el nervio obturador. Este circuito puede comprimir el nervio obturador y los vasos circundantes. El conocimiento de este circuito podría ser importante para los ginecólogos, cirujanos ortopédicos y urólogos, ya que pueden estar involucrados en las cirugías de cadera, ovario y próstata...

Variability in the origin of the obturator artery

INTRODUCTION: General surgeons dealing with laparoscopic herniorrhaphy should be aware of the aberrant obturator artery that crosses the superior pubic ramus and is susceptible to injuries during dissection of the Bogros space and mesh stapling onto Cooper's ligament. The obturator artery is usually described as a branch of the anterior division of the internal iliac artery, although variations have been reported. MATERIALS AND METHODS: The present study was conducted on 98 pelvic halves of embalmed cadavers, and the origin and course of the obturator artery were traced and noted. RESULTS: In 79 percent of the specimens, the obturator artery was a branch of the internal iliac artery. It branched off at different levels either from the anterior division or posterior division, individually or with other named branches. In 19 percent of the cases, the obturator artery branched off from the external iliac artery as a separate branch or with the inferior epigastric artery. However, in the remaining 2 percent of the specimens, both the internal and the external iliac arteries branched to form an anastomotic structure within the pelvic cavity. CONCLUSION: The data obtained in this study show that it is more common to find an abnormal obturator artery than was reported previously, and this observation has implications for pelvic surgeons and is of academic interest to anatomists. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these variations and their close proximity to the femoral ring.

Abnormal branch of external iliac artery in the iliac fossa / Rama anormal de la arteria ilíaca externa en la fosa ilíaca

An abnormal artery arising from external iliac artery was found during routine dissection class for medical undergraduates. The artery took its origin from the external iliac artery midway between its origin from common iliac and termination as femoral artery. The abnormal artery divided into two branches; an ascending and a descending. The ascending branch supplied iliacus and iliac crest. The descending branch entered the femoral triangle by passing behind the femoral sheath. It supplied the muscles of femoral triangle and anastomosed with medial circumflex femoral artery. The knowledge of this variation may be of use for surgeons doing surgery of femoral hernia.

Una variación arterial proveniente de la arteria ilíaca externa fue encontrada durante una disección de rutina en Medicina de pregrado. La arteria se originaba de la arteria ilíaca externa a mitad de camino entre su origen desde la arteria ilíaca común y su terminación, la arteria femoral. La arteria se dividía en dos ramas: ascendente y descendente. La rama ascendente suministraba la irrigación al músculo ilíaco y a la cresta ilíaca. La rama descendente entraba en el trígono femoral pasando por detrás de la vaina femoral y daba la irrigación a los músculos del trígono femoral, anastomosándose con la arteria circunfleja femoral medial. El conocimiento de esta variación puede ser de utilidad para los cirujanos que realizan cirugía de hernia femoral.

Management of external iliac artery mycotic hemorrhage after kidney transplantation by the use of hypogastric artery autograft (report of one case and review of literature) / 中华泌尿外科杂志

Objective To investigate the management of external iliac artery mycotic hemorrhage after kidney transplantation. Methods A case of external iliac artery mycotic hemorrhage after kidney transplantation managed by the use of hypogastric artery autograft was reported with review of the literature.The massive blooding occurred 3 times after kidney transplantation in a male patient 25 years of age on the 22nd,24th and 38th day after transplantation.The blooding amounted to 800 ml,2500 ml and 3800 ml respectively.The blood loss was replaced and prompt surgical exploration was carried out with the blooding site at the anastomosis sutured up on the 1st and 2nd episode of bleeding.On the 3rd occurrence of bleeding, the diseased external iliac artery segment, about 2cm in length, was resected and the gap was replaced by a 3cm long hypogastric artery autograft. Results The blood flow through the repaired external iliac artery and the blood supply to the lower extremity was adequate.Periodic hemodialysis had been restored and the patient waited for reimplantation. Conclusions External iliac artery mycotic hemorrhage after kidney transplantation is a serious and fatal complication.Simple arterial repair is usually noneffective.Resection of the diseased mycotic segment of the external iliac artery with repairing of the gap with a hypogastric artery autograft is rational,feasible and simple.The procedure is highly recommended.

Clinical study on end-to-side anastomoses of renal artery to external iliac artery in renal trans- plantation / 中华器官移植杂志

This study compared two techniques of artery anastomoses,renal artery to the ex- ternal iliac artery (ESA) and to the internal iliacartery (EEA) in renal transplantation.The operation time and the incidence of anastomotic stenosis was cut down significantely in ESA group.The blood flow in grafts has no difference in two groups with normal renal function.The utilization rate of grafts with multiple arteries was higher (94.4%) in ESA group.Back bench surgery for artery repain,cold ischemia time and renal damage were reduced in ESA group.

The length of the external iliac artery in Thais.

In a dissection of 501 pelvic halves of Thai adult cadavers, the average length of the external iliac artery was 9.7 cm.