Translational Research in Anatomy (Mar 2023)
Anatomical variations of obturator artery and its clinical significances: A systematic review and meta-analysis
Abstract
Introduction: Vascular anatomy of the pelvis has gained a great deal of clinical interest. The obturator artery (OA) is one of the pelvic artery with great variations reaching the medial thigh including the head of the femur. However, there is no summative evidence indicating its variation from different origins and clinical significances. This systematic review and meta-analysis is conducted to estimate the pooled prevalence of OA variations and its clinical significances. Methods: Searching strategies and protocols were registered in prospero (CRD42022383777) based on preferred reporting items for systematic review and meta-analysis. Then we searched PubMed, Web of Science, Scopus, CINAHL and Google Scholar until 10 December 2022 to retrieve pertinent peer-reviewed articles. “MeSH terms,” “keywords” and “Boolean operators” were used in separation and combination for searching the articles. The Cochrane's Q statistics and inverse variance (I2) were used to assess heterogeneity of the studies. The random-effects meta-analysis model was applied to estimate the pooled effects of DerSimonian and Laird. Funnel plot, Egger and Begg's tests were also used to assess publication biases. Results: A total of 25 peer-reviewed articles with 3453 observations (1386 males and 2067 females) were identified for final analysis. The pooled prevalence of OA arose from ADIIA was 66.66% (95% CI: 55.19–78.11). However the pooled estimate of variant origin of OA other than ADIIA was 31.41% (95%CI: 20.49–42.32). Independently the OA arose from CIA (6.40%, 95% CI; −2.42-15.21), IIABD (10.91%, 95% CI; −1.92-23.73), EIA (11.71%, 95% CI; 6.88–16.55), IEA (15.82%, 95% CI; 10.59–21.06), PDIIA (10.85%, 95% CI; 6.12–15,58), FA (2.53%, 95% CI; 0.75–4.31), SGA (9.43%, 95% CI; 6.04–12.79), IGA (7.79%, 95% CI: 2.84–12.74), ILA (2.20%, 95% CI: 0.58–3.82) and IPA (7.07%,95% CI: -1.49-15.63). About 35.35% (95% CI: 18.14–52.56) of pelvises with VOA were males (I2 = 98.7%, P = 0.000); and 15.60% (95% CI: 9.64–21.56) of pelvises with VOA were females (I2 = 94.2%, P = 0.000). Being a right hemi-pelvis accounted 23.80% (95% CI: 14.00–33.59) of OA variations (I2 = 95%, P = 0.000) and left hemi-pelvis took 19.14% (95% CI: 9.51–28.77) of VOA (I2 = 95.2%, P = 0.00). The continental VOA analysis showed 27.50% (95% CI: 21.75–33.26) from Asia, 57.51% (95% CI: 15.12–99.91) from North America, 24.47% (95% CI: 5.77–43.18) from Europe, 50.58% (95% CI: 38.28–62.88) from South America and 22.45% (95% CI: 14.46–31.65) from Africa. Conclusions: About one third of the cases had VOA. The most common origin of VOA was the IEA followed by EIA. The variation of OA in males were almost two times that of females. The right hemi-pelvis had more VOA as compared to the left hemi-pelvis. Therefore anatomists, radiologists and pelvic surgeons should be vigilance enough about OA and its variant origin before any pelvic procedures.
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