Anatomy of Internal Iliac Artery and Its Ligation to Control Pelvic Hemorrhage

Abstract

Pelvic hemorrhage is a major cause of maternal morbidity and mortality in developing countries. A sound clinical judgment, adequate assessment, and preparation of the patient are the best preoperative means to avoid its occurrence. Bilateral internal iliac artery ligation is a life-saving procedure to control massive obstetric and gynecological hemorrhage when other measures fail. This procedure significantly reduces the pulse pressure and rate of blood flow abolishing the‘triphammer effect’ of arterial pulsation and subsequently resulting in sluggish blood flow allowing effective thrombosis within the small bleeding vessels. This has helped to save many lives and uteruses for more than a century. No tissue necrosis occurs due to ample collateral circulation in the pelvis from the major pelvic anastomoses. An increased understanding of retroperitoneal anatomy and regional variations of the internal iliac artery is needed to reduce the risk of intraoperative andpostoperative complications.

Uterine Artery Embolisation: A Saviour for Central Placenta Previa

“…A minimally invasive medical therapy of selective UAE by PVA particles selectively embolises the uterine artery, giving the desired effect. This also prevents the complications of bilateral internal iliac artery ligation [8].…”

Postpartum hemorrhage with associated placenta previa in a kidney transplant recipient: A case report

“…In patients who have undergone kidney transplantation, performing REBOA requires an increased awareness of atypical pelvic blood flow dynamics. When the internal iliac artery is ligated, blood flow within the uterine artery is sustained through collateral channels originating from the external iliac and ovarian arteries [ 14 , 15 ]. Hence, even when the internal iliac artery is treated due to kidney transplantation, REBOA blocks the blood flow within the external iliac artery, potentially aiding blood flow control.…”

A Bipartite Obturator Artery with Multiple Pelvic Branching—A Gynecologic Approach

“…Proper identification of these vascular abnormalities can decrease the risk of intraoperative complications such as hemorrhage. Bilateral internal iliac artery (IIA) ligation is a life-saving procedure which significantly reduces the pulse pressure and rate of blow flow caused by a hemorrhage, subsequently allowing effective thrombosis within small bleeding vessels, such as the OA [ 37 ]. After ligation, the pubic branches of the obturator artery anastomose with the inferior epigastric artery, a branch of the external iliac artery [ 38 ].…”

“…After ligation, the pubic branches of the obturator artery anastomose with the inferior epigastric artery, a branch of the external iliac artery [ 38 ]. Some different indications regarding the IIA ligation are uterine laceration during endovascular repair of aortoiliac arterial aneurysm, radical hysterectomy or exenteration, postpartum hemorrhage secondary to abruption or placenta previa, and—as stated earlier—profuse pelvic hemorrhage from fracture of the pelvis or gunshot injury to the pelvis [ 37 ]. Pelvic arterial embolization is an effective treatment for intractable pelvic hemorrhages, including the IIA branching pattern where arteriographic facilities are available [ 39 ].…”