Abnormal obturator artery with ipsilateral inferior epigastric artery passed behind the femoral vein / Arteria obturatriz anómala con arteria epigástrica inferior ipsilateral que cruza posterior a la vena femoral

SUMMARY: Clear awareness of the vascular variations is critical in surgeries, which may cause massive hemorrhage during surgical procedures. During educational dissection of a male cadaver, we encountered a combined variation of the left obturator artery and ipsilateral aberrant inferior epigastric artery. The left obturator artery originated from the external iliac artery, then coursed inward, adherent to the superior pubic ramus. The left inferior epigastric artery originated from the femoral artery, and coursed behind the femoral vein. These anatomical variations shown in one person were extremely rare. This is particularly true with regard to these variations while performing pelvic and inguinal region surgeries.

El conocimiento claro de las variaciones vasculares es fundamental en las cirugías, ya que pueden causar una hemorragia masiva durante los procedimientos quirúrgicos. Durante la disección educativa de un cadáver de sexo masculino, encontramos una variación combinada de la arteria obturatriz izquierda y la arteria epigástrica inferior ipsilateral aberrante. La arteria obturatriz izquierda se originaba en la arteria ilíaca externa, luego discurrió hacia medial, adhiriéndose a la rama púbica superior. La arteria epigástrica inferior izquierda se originaba en la arteria femoral y discurría por detrás de la vena femoral. Estas variaciones anatómicas mostradas en una sola persona son extremadamente raras. Esto es importante de conocer estas variaciones cuando se realizan cirugías de las regiones pélvica e inguinal.

Rare origin of the obturator artery from the external iliac artery with two obturator veins / Origem rara de artéria obturatória a partir da artéria ilíaca externa acompanhada por duas veias obturatórias

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.

Resumo A artéria obturatória é um ramo da artéria ilíaca interna, embora haja grande variabilidade a respeito de sua origem, pois tal vaso pode surgir de diversas artérias vizinhas, como a artéria ilíaca comum e a artéria ilíaca externa, assim de como qualquer ramo da artéria ilíaca interna. Normalmente, a artéria obturatória corre anteroinferiormente pela parede lateral da pelve até a porção superior do forame obturatório, ponto em que sai da pelve. No seu trajeto, a artéria é acompanhada pelo nervo e veia obturatórios. Ela supre os músculos do compartimento medial da coxa e possui anastomoses com ramos da artéria femoral na articulação do quadril e coxa. Este trabalho visa relatar e discutir os aspectos clínicos de uma variação incomum na artéria obturatória, na qual ela se origina da artéria ilíaca externa acompanhada de duas veias obturatórias com trajetos distintos.

Symmetric bilateral aberrant obturator artery: a case report / Arteria obturatriz aberrante simétrica bilateral: reporte de un caso

Aberrant obturator artery (AOA) is an anatomical variation in the origin and course of the obturator artery, which is clinically important because of their vulnerability during surgical procedures performed in the pelvis. This article describes the case of a symmetrical AOA found in both hemipelvises of a male cadaver. Morphological and morphometric characteristics are presented, while their clinical significance is discussed.

La arteria obturatriz aberrante (AOA) es una variación anatómica del origen y trayecto de la arteria obturatriz que tiene importancia clínica debido a su vulnerabilidad durante los procedimientos quirúrgicos realizados en la pelvis. En este artículo se describe el caso de una AOA simétrica encontrada en ambas hemipelvis de un cadáver masculino. Se presentan sus características morfológicas y morfométricas, y se discute su importancia clínica.

Clinical importance of a star shaped branch of internal iliac artery and unusual branches of an abnormal obturator artery: rare vascular variations / Importância clínica de um ramo estrelado de artéria ilíaca interna e de ramos incomuns de artéria obturatória anormal: variações vasculares raras

The internal iliac artery (IIA) is one of the branches of the common iliac artery and supplies the pelvic viscera, the musculoskeletal part of the pelvis, the gluteal region, the medial thigh region and the perineum. During routine cadaveric dissection of a male cadaver for undergraduate Medical students, we observed variation in the course and branching pattern of the left IIA. The artery gave rise to two common trunks and then to the middle rectal artery, inferior vesicle artery and superior vesicle artery. The first, slightly larger, common trunk gave rise to an unnamed artery, the lateral sacral artery and the superior gluteal artery. The second, smaller, common trunk entered the gluteal region through the greater sciatic foramen, below the piriformis muscle and presented a stellate branching pattern deep to the gluteus maximus muscle. Two of the arteries forming the stellate pattern were the internal pudendal artery and the inferior gluteal artery. The other two were muscular branches.

A artéria ilíaca interna (AII) é um dos ramos da artéria ilíaca comum e supre as vísceras da pelve, a parte musculoesquelética da pelve, a região glútea, a região medial da coxa e o períneo. Durante a dissecção de rotina realizada em um cadáver do sexo masculino para estudantes de Medicina, observamos uma variação no curso e padrão de ramificação da AII esquerda. A artéria deu origem a dois troncos comuns e então à artéria retal média, artéria vesical inferior e artéria vesical superior. O primeiro tronco comum, ligeiramente maior, deu origem a uma artéria sem nome, à artéria sacral lateral e à artéria glútea superior. O segundo tronco comum, menor, adentrou a região glútea através do forame ciático maior, abaixo do músculo piriforme, e apresentou um padrão estrelado de ramificação na parte profunda do músculo glúteo máximo. Duas das artérias que formaram o padrão estrelado foram a artéria pudenda interna e a artéria glútea inferior. Os outros dois ramos eram musculares.

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.

Variability of Origin of Obturator Artery and its Clinical Significance.

Background: Obturator artery is a branch of anterior division of internal iliac artery. It normally runs anteroinferiorly on the lateral wall of pelvis to the upper part of the obturator foramen and leaves the pelvis by passing through the obturator canal. On its course, the artery is accompanied by the obturator nerve and vein. It supplies the muscles of the medial compartment of the thigh. A severe and potentially lethal complication in pelvic injuries is arterial bleeding commonly involving the branches of the internal iliac artery, namely the lateral sacral, iliolumbar, obturator, vesical and inferior gluteal arteries. A sound knowledge of retro-pubic pelvic vascular anatomy is pivotal for successful performance of endoscopic procedures such as total extraperitoneal inguinal hernioplasty or laparoscopic herniorraphy. The context and purpose of the study: This study is an attempt to analyse the origin, course, distribution of obturator artery in pelvis and their clinical implication. Result: out of 60 formalin fixed pelvic halves 36.6% of the specimens, (26.67% in males and 10% in females) the origin of obturator artery was found to be normal from anterior division of internal iliac artery. About 63.63% from various other sources. Conclusion: This knowledge of variation in the origin of obturator artery is important while doing pelvic and groin surgeries requiring appropriate ligation. Such aberrant origins may be a significant source for persistent bleeding in the setting of acute trauma. Knowledge regarding the variations of obturator artery is useful during surgeries of fracture and direct or indirect inguinal, femoral and obturator hernias.

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).

Study of Variations In Anterior Division of Internal Iliac Artery.

Background: The internal iliac artery is the chief pelvic artery. It supplies to the all pelvic viscera, musculoskeletal part of the pelvis. The branches of the anterior trunk of the internal iliac artery are the superior and inferior vesical, middle rectal, vaginal, obturator, uterine, internal pudendal and inferior gluteal. Knowledge of internal iliac artery is very helpful in pelvic surgery practice. Methods: 50 adult human pelvic halves were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Results: Middle rectal artery took origin from anterior division in 42 specimens (84%), most frequently with internal pudendal artery in 32 specimens (64%) and was found to be absent in 8 specimens (16%). The obturator artery took origin most frequently from the anterior division of Internal iliac artery in 36 specimens (72%), from posterior division in 9 specimens (18%), from external iliac artery in 1 specimen (2%) and from inferior epigastric artery in 3 specimens (6%). The superior vesical artery, inferior vesical artery, uterine artery, vaginal artery and superior gluteal artery were found to be constant in their origin and course. Conclusions : The branches anterior division of internal iliac artery shows multiple variations, knowledge about these variation are helpful in pelvic surgeries.

Morphological Study of Internal Iliac Artery.

Background: The internal iliac artery is the “artery of the pelvis”. It supplies most of the blood to the pelvic viscera, gluteal region, medial thigh region and perineum. A severe and potentially lethal complication in pelvic surgeries is arterial bleeding commonly involving the branches of internal iliac artery. While operating on pelvic organs, the knowledge of internal iliac artery and its variations is important for surgeons. The present study was conducted to study of morphology of internal iliac artery. Methods: 50 adult human pelvic halves were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Results: The classification of branching pattern of internal iliac artery was based on modified Adachi classification. Out of the 50 specimens studied, Type Ia arrangement was found in 52% of the specimens, Type III in 34%, Type IIa and type V was found in 2% each, Type IV was not found in any of the specimens and 10% of the specimens could not be classified because of the absence of inferior gluteal artery in them. Adachi Type Ia arrangement was the most frequent finding. The obturator artery took origin most frequently from the anterior division of internal iliac artery. Middle rectal artery was not constant. Conclusion: The internal iliac artery morphology shows multiple variation the knowledge is very helpful during pelvic surgeries.

Morphological Study of Obturator Artery.

Background: The obturator artery normally arises from the anterior trunk of internal iliac artery. High frequency of variations in its origin and course has drawn attention of pelvic surgeons, anatomists and radiologists. Normally, artery inclines anteroinferiorly on the lateral pelvic wall to the upper part of obturator foramen. The obturator artery may origin individually or with the iliolumbar or the superior gluteal branch of the posterior division of the internal iliac artery. However, the literature contains many articles that report variable origins. Interesting variations in the origin and course of the principal arteries have long attracted the attention of anatomists and surgeons. Methods: 50 adult human pelvic halves were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Results: The obturator artery presents considerable variation in its origin. It took origin most frequently from the anterior division of internal iliac artery in 36 specimens (72%). Out of which, directly from anterior division in 20 specimens (40%), with ilio-lumbar artery in 5 specimens (10%), with inferior gluteal artery in 3 specimens (6%), with inferior vesical artery in 2 specimens (4%), with middle rectal artery in 1 specimen (2%), with internal pudendal artery in 4 specimens (8%) and with uterine artery in 1 specimen (2%). The obturator artery took origin from the posterior division of internal iliac artery in 9 specimens (18%), from external iliac artery in 1 specimen (2%), from inferior epigastric artery in 3 specimens (6%) and was found to be absent in 1 specimen (2%).

An anomalous origin of obturator artery and its clinical importance in humans.

Background: Obturator artery is one of the medium sized parietal branches of the anterior division of internal iliac artery and it supplies the medial side of the thigh. It is the most variable vessel among the branches of the internal iliac artery. Materials and Methods: The present study was conducted on a total of 45 pelvic halves had been studied. The material consisted of adult subjects between the ages of forty and eighty five, from the dissection hall of department of anatomy of Alluri Sitarama Raju Academy of Medical Sciences, Eluru, and Andhra Pradesh. The findings were observed and recorded. Results: Origin of obturator artery was most frequently a direct branch of the anterior division of the internal iliac artery, in 16 specimens (35.55%). It was arising from the inferior epigastric artery in 12 specimens (26.66%). It arose from the common trunk of inferior gluteal and internal pudendal artery in 6 specimens (13.33%) etc. Conclusion: The variations in obturator artery may lead to surgical complications during pelvic surgeries requiring suturing along the pelvic brim. The anomalies affecting the arterial patterns of the limbs are based on unusual selection of channels from primary capillaries. The most appropriate channel enlarges, whilst the others retract and disappear, thereby establishing the final arterial pattern and resulting in variations in the origin. Prior knowledge of the anatomical variations may be beneficial for vascular surgeons ligating the internal iliac artery or its branches and the radiologists interpreting angiograms of the pelvic region.

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.

The inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery / 대한해부학회지

We report a rare case of a left inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery in an 84-year-old female cadaver. A common trunk for the inferior epigastric and obturator arteries firstly originated from the left internal iliac artery, at 3.0 mm below the bifurcation of the left common iliac artery. This trunk ran straight between the left external iliac artery and left external iliac vein, and was finally divided into the left inferior epigastric and left obturator arteries just superior to the inguinal ligament.

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.

Anomalous Origin of Obturator Artery from the Internal Iliac Artery / Origen Anómalo de la Arteria Obturatriz de la Arteria Iliaca Interna

Obturator arteryis frequently a branch of anterior division of internal iliac artery or one of the parietal branches of internal iliac artery. But it has attracted attention of pelvic surgeons and anatomists and radiologists because of the high frequency of the variation in its course and origin. The present report demonstrates obturator artery to be arising from the posterior division of internal iliac artery out of 316 pelvises, a rare observation in Indian population. The variation is correlated developmentally and its clinical implications are also discussed.

La arteria obturatriz es frecuentemente una rama de la división anterior de la arteria iliaca interna o uno de los ramos parietales de la arteria iliaca interna. Sin embargo, ella atrae la atención de cirujanos pélvicos, anatomistas y radiologistas por la alta frecuencia de variaciones, tanto en su origen como en su trayecto. Este reporte muestra un caso en que la arteria obturatriz se origina de la parte posterior de la arteria iliaca interna en 316 pelvis examinadas, una rara observación en la población de la India. Esta variación es conelacionada con el desanollo y se discuten sus implicancias clínicas.

Variation in origin of the obturator artery and corona mortis in Thai

Objective: To determine the variation in origin of the obturator artery and incidences of arterial and venous corona mortis among Northeast Thais. Methods: Dissection of 204 cadaveric Northeast Thai pelvic halves between 20 and 95 years-old at decease. Chi-square test was used for statistical analysis. Results: The respective origin of the obturator artery was the internal iliac (77.5%) and inferior epigastric arteries (22.5%), while double origins (from both arteries) in one pelvic half and bilateral abnormal origins (from the inferior epigastric arteries) were 5.4 and 9.6 percent, respectively. Sex and side made no significant difference (P>0.05). The occurrence of the arterial corona mortis, venous corona mortis and both structures was 22.5, 70.6 and 17.2 percent, respectively. The arterial corona mortis while crossing over the iliopubic ramus was frequently found anterior to the venous corona mortis. Conclusion: The incidence of an anomalous obturator artery forming the arterial corona mortis among Northeast Thais was 22.5% although a venous corona mortis (70.6%) was more frequent. Seventeen percent had both arterial and venous corona mortis. Nevertheless, both their courses, crossing over the iliopubic rami, would be at risk of damage during an ilioinguinal approach or operation of the anterior ring of the pelvis.