The origin variability of the iliolumbar artery and iatrogenic sciatica

Abstract

The iliolumbar artery (ILA) is a standard branch from the posterior trunk of the internal iliac artery. It is the only pelvic artery ascending from pelvic cavity. Current study comprises 171 cadavers dissection to assess the origin variability of ILA. The present study identified the incidence of the ILA origin variability in Caucasian population which also clarified the iliolumbar variability in males and females. The current study shows that the ILA arises from the common iliac artery in 2%, from the external iliac artery in 0.3% and from the internal iliac artery in 13.8% either from its dorsal or dorsomedial aspects in 1 and 12.8%, respectively. The common, external and internal iliac arteries are defined as a high (early) origin and occurred in 16.1%. The posterior trunk of the internal iliac artery is the most common origin of the ILA found to be in 77.9%. Occasionally, it also arose from the superior gluteal artery (0.7%) and the sciatic artery (0.3%). Furthermore, the ILA arises from the anterior trunk indirectly as from the inferior gluteal artery in 0.3%. The ILA arising from the superior or inferior gluteal artery or from the sciatic artery is defined as a low (delayed) origin and occurred in 1.3%. In contrast, the ILA was 4.7%. Consequently, variability of the ILA leads to vascular variability of the lumbosacral trunk of the sciatic nerve. Clinicians have to be aware of these variations to avoid unnecessary ligation to prevent sciatic neuropathy.

Assessment of the iliolumbar artery: its structural variations and applied aspect

“…In 0.7 percent of cases, it came from the inferior gluteal artery, as well as the sciatic artery. 12 In our study we have found ILA to be originating from either trunk of IIA or from PD. There were no branches coming from the common iliac or gluteal arteries (Figure 1 Several factors such as genetics, race and tissue vascular demand may have been the cause of such variability.…”

“…Embryologically, the inconsistent origin of ILA may be due to flaw in either the growth or regression of the primitive ILA (plexus). 12 The medial umbilical ligament (superior vesical artery) and the inferior gluteal artery were the two main trunks of IIA during development. The two trunks and the intersection between them are the source of the majority of the branches and any variation in its pattern.…”

The Origin Variability of the Iliolumbar Artery: A Cadaveric Study With Clinical Significance

“…In the present study, ILA originated from the common iliac artery in 13.33%. Our findings were comparatively lower than the results of Koc T et al (29.4%) [19] but higher than the percent given by the Talalwah et al (2%) [18]. Last and very rare variation i.e.…”

“…A study conducted by Teli et al showed that the most common origin of the iliolumbar artery was from the posterior division of IIA proper with the incidence 80% of cases [17]. A similar pattern of origin was observed by Al Talalwah et al with the incidence of 77.9% [18]. The iliolumbar artery arises from posterior division of IIA proper was documented by Naguib et al, Rusu et al in 44% and 32.5% of cases respectively [14,15].…”

“…So far very few reports have been documented on the absence of iliolumbar artery. Lipshutz et al and Al Talalwah et al reported the absence of IA in 5% and 4.7% respectively [9,18]. Additional to the efficacy of the IIA ligation during any pelvic surgeries to control hemorrhage, ILA and its branches are used in bone reconstructions and particularly in lumbar spinal surgery because it's not a sole and chief artery to supply iliac crest.…”