Systematic Review and Meta-Analysis of the Variants of the Obturatory Artery

Abstract

Background: Knowledge of vascular anatomy and its possible variations is essential for performing embolization or revascularization procedures and complex surgery in the pelvis. The obturator artery (OA) is a branch of the anterior division of the internal iliac artery (IIA), and it has the highest frequency of variation among branches of the internal iliac artery. Possible anomalies of the origin of the obturator artery (OA) should be known when performing pelvic and groin surgery, where its control or ligation may be required. The purpose of this systematic review and meta-analysis, based on Sanudo’s classification, is to analyze the origin of the obturator artery (OA) and its variants. Methods: Thirteen articles published between 1952 and 2020 were included. Results: The obturator artery (OA) was present in almost all cases (99.8%): the pooled prevalence estimate for the origin from the IIA axis was 77.7% (95% CI 71.8–83.1%) vs. 22.3% (95% CI 16.9–28.2%) for the origin from EIA axis. In most cases, the obturator artery (OA) originated from the anterior division trunk of the internal iliac artery (IIA) (61.6%). Conclusions: Performing preoperative radiological examination to determine the pelvic vascular pattern and having the awareness to evaluate possible changes in the obturator artery can reduce the risk of iatrogenic injury and complications.

Exploring the Topography of the Obturator Artery and Corona Mortis: a Detailed Analysis with Surgical Implications

“…In 1918, Lipshutz stated that "Probably no artery in the human body of proportionate size has so voluminous a literature as the obturator artery" [ 3 ]. This statement remains valid even in current times, as various original studies, systematic reviews, and meta-analyses on the anatomy of the ObA have been published in the literature and are continuously being published, showcasing new insights into this subject [ 5 , 7 , 8 ]. The origin of the ObA is remarkably variable, with some studies reporting a rate of variant ObA as high as 26% [ 8 ].…”

“…The rarest cases fall under type E, where the artery originates from the external iliac artery, and type F, where it arises from the femoral artery. On the basis of this classification, Brachini et al [ 7 ] conducted a systematic review and meta-analysis showcasing the prevalences of ObA variants based on the available data in the literature. The study demonstrated that the most frequent origin of the ObA is from the anterior trunk of the internal iliac artery (61.6%), as described in the major anatomical textbooks.…”

“…This is primarily because of the potentially life-threatening hemorrhage that can occur from accidental injury to this structure during various pubic surgical procedures [ 4 , 5 ]. Nevertheless, having adequate knowledge regarding the general topography of the ObA is also highly significant in numerous pelvic and reconstructive surgeries [ 6 , 7 ].…”

“…Although the anatomy of the said artery has been analyzed extensively by various systematic reviews and meta-analyses [ 7 , 8 ], no study has to our knowledge comprehensively showcased the topography of the ObA and corona mortis in the pelvic region. Therefore, the main goal of the present study was to create an arterial anatomical map of the ObA demonstrating the most frequent locations of the vessel’s origin and course.…”