A cadaveric study of variations of external iliac artery and its implication in trauma and radiology

The surgical treatment of gynecological malignancies is, except for tumors diagnosed at the earliest stages and patients’ desire for fertility preservation, not limited to only the affected organ. In cases of metastatic iliac lymph nodes, gynecological tumors or recurrences located near the pelvic sidewall, oncogynecologists should dissect tissues in that region. Moreover, surgery of deep infiltrating endometriosis, e.g., within the sacral plexus, or oncological procedures, such as a laterally extended endoplevic resection or a laterally extended parametrectomy, often require a dissection of the pelvic sidewall. Dissection should be meticulous, and detailed knowledge of anatomy is mandatory. There are many controversies among authors regarding the terminology in the pelvic sidewall. In particular, several imprecise or confusing definitions exist in regard to the region located medially to the psoas major muscle. Therefore, after discussing the anatomy of the pelvic sidewall and the commonly used terminology, we define a new term and boundaries of a potential avascular space, the medial psoas space. Contrary to the variety of earlier definitions, the proposed boundaries relate to a truly avascular space and could help surgeons to avoid complications resulting from misleading anatomical descriptions. Additionally, describing the clear boundaries of and possible anatomical variations in the medial psoas space may urge oncogynecologists to consider different approaches during surgery. The purpose of the present study is to describe the anatomy of the pelvic sidewall and the applications of the medial psoas space in gynecologic oncology.

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“…In rare cases, an additional muscular branch from the external iliac artery descending laterally to the artery could be observed [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Pelvic Sidewall Anatomy in Gynecologic Oncology—New Insights into a Potential Avascular Space

et al. 2022

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“…Common abnormal conditions of the external iliac arteries include congenital malformation, occlusion, traumatic and iatrogenic rupture and even disconnection. The relationship between the pelvic and peritoneal arteries and veins of the human body is not invariable, especially the relationship among the total iliac system and the internal and external iliac arteries and veins, which are very diverse [ 1 , 2 ]. Such differences include changes in the relative position of or differences in the origins or branches of the blood vessels and a missing or larger trunk; external iliac artery injuries caused by trauma are more common in pelvic fractures and other blunt injuries, which usually start abruptly and quickly lead to hemorrhagic shock [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

An extremely rare disconnection of the external iliac artery and novel collateral remodeling in an endometrial stromal sarcoma woman

Wang

Zhou

et al. 2022

BMC Women's Health

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Background Injury to the external iliac artery can have serious consequences and can be extremely challenging for surgeons. Here, we report a patient with bizarre disconnection of the external iliac artery during a laparoscopic operation. Case presentation On May 27, 2020, during a laparoscopic pelvic lymphadenectomy operation to treat endometrial stromal sarcoma, we encountered an unusual anatomy: abnormal disconnection of the left external iliac artery in a 26-year-old female patient. The proximal and distal ends of the left external iliac artery demonstrated old narrowing without active bleeding, and the distance between the two disconnected ends was more than 3 cm. The scenario was surprising to all the staff in the operating theater. After a comprehensive assessment of skin temperature, arterial pulsation and arterial blood flow, a multidisciplinary team determined that collateral circulation of the left lower limb had been established and could meet the blood supply of the lower limbs, which was also confirmed three times by computed tomography angiography and Doppler ultrasound of the blood vessels in the abdomen and lower limbs. Sixteen months after the operation, the patient had no obvious abnormality, and the daily activities of the left lower limb were not affected. Follow-up after treatment for the patient is still in progress. Conclusions We describe the details of the whole case of disconnection of the external iliac artery. We hope to summarize the experience and lessons learned through this case and a relevant literature review to improve the safety and orderliness of our future clinical work.

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Quantification of Iliac Arterial Blood Velocity in Stenotic Phantom and Porcine Models Using Quantitative Digital Subtraction Angiography

Meram,

Hoffman,

Periyasamy

et al. 2024

Journal of Vascular and Interventional Radiology

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A cadaveric study of variations of external iliac artery and its implication in trauma and radiology

Cited by 4 publications

References 24 publications

Pelvic Sidewall Anatomy in Gynecologic Oncology—New Insights into a Potential Avascular Space

Pelvic Sidewall Anatomy in Gynecologic Oncology—New Insights into a Potential Avascular Space

An extremely rare disconnection of the external iliac artery and novel collateral remodeling in an endometrial stromal sarcoma woman

Quantification of Iliac Arterial Blood Velocity in Stenotic Phantom and Porcine Models Using Quantitative Digital Subtraction Angiography

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