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.

Clinical importance of a star shaped branch of internal iliac artery and unusual branches of an abnormal obturator artery: rare vascular variations.

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.

Rare origin of the obturator artery from the external iliac artery with two obturator veins.

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.

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.

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% 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% 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% 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.

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.