Variability in morphology and branching of the internal iliac artery: Implications for pelvic surgery

Abstract

Purpose: The internal iliac artery displays variations that may predispose it to inadvertent injury during pelvic surgeries. This study aimed to describe variations of the internal iliac artery among Kenyans. Basic procedures: Fifty-seven pairs of right and left-sided hemi-pelvises, 48 from males and 9 from females, were used in this study. We collected data on the internal iliac artery origin, relations, termination, branching, length and course of parietal branches. Data were then coded and entered into SPSS (version 21, Chicago, IL), where we performed descriptive statistics and analyses. Findings: In all cases, the internal iliac artery originated singly from the common iliac artery. The IIA originated above the vertebral level of the L5/S1 disk (pelvic brim) in 30/57 (52.6%) cases, with the highest observed at L4. In most cases (32/57 [56.8%]), the IIA terminated at S1 vertebral level. The internal iliac artery lay medial, anterior and lateral to the sacroiliac joint in 37/57 (64.9%), 18/57 (30.6%) and 2/57 (5%) cases, respectively. Regarding parietal branching, 39/57 (64.8%) cases had a type 1 pattern as per the Adachi classification. The mean diameter and length of the internal iliac artery were 7.32 ± 1.69 mm and 36.97 ± 14.12 mm, respectively. The differences in dimensions of the IIA between the left and the right sides were not significant. Principal conclusions: A considerable proportion of the Kenyan population demonstrates an origin of the internal iliac artery above the pelvic brim. Unique termination via trifurcation and ramification may also be observed in the Kenyan population. Surgeons and radiologists performing vascular interventions in the pelvis should be mindful of these variations.

Keywords

• Iliac
• Artery
• Pelvis
• Surgery
• Variation