Arteria Iliaca Interna’nın Dallanma Paterni ve Varyasyonları ile Klinik Etkileri Arasındaki İlişkiler

Abstract

SELCUK, I., Variations and branching pattern of internal iliac artery: Clinical applications. Hacettepe University Graduate School of Health Sciences Anatomy Department, Anatomy Doctor of Philosophy Thesis, Ankara, 2022. Internal iliac artery is the major arterial supply of pelvis, gluteal region and perineum. Internal iliac artery has 2 major divisions which are posterior and anterior, with several arteries branching from them. Iliolumbar artery, lateral sacral artery, superior gluteal artery, inferior gluteal artery, internal pudendal artery, obturator artery, middle rectal artery, superior vesical artery, uterine artery, vaginal artery, inferior vesical artery, prostatic artery and umbilical artery are the branches originating from the internal iliac artery which will have different branching patterns, common trunks or variations. Several cadaveric dissection studies evaluated the anatomy of internal iliac artery and its branches, however there is still need for comprehensive radiological studies. Modern and advanced imaging methods used today will be able to present detailed information about the internal iliac artery and its branches. The aim of this study is to evaluate the branching pattern and variations of internal iliac artery with clinical applications using computed tomography angiography, which is an advanced imaging method. In this study, radiological images of 50 female and 50 male patients aged 20-60 years, who had no history of vascular pathology or interventional procedure related to the internal iliac artery and its branches and who had undergone computed tomography angiography for various reasons at Hacettepe University Medical Faculty Hospital Department of Radiology between January 1st, 2019- December 31th, 2020 were retrospectively evaluated. Scope of the study is; the length of the common iliac artery, the distance from the iliac bifurcation to the internal iliac artery posterior division branching point, the distance between the iliac bifurcation and internal iliac artery anterior division first branch, the name of the artery branching from the internal iliac artery in the first, second, third, fourth, fifth and sixth order with their branching directions and common trunks and analysis of the internal iliac artery branching pattern according to Adachi classification. As a result, within 5cm (with standard deviation) from the iliac bifurcation, the internal iliac artery posterior division arteries are branched. The distance between the internal iliac artery posterior division branching point and internal iliac artery anterior division first branch is approximately 1cm. Internal iliac artery posterior division branches are often directly branched from the internal iliac artery and the most distal artery is most frequently formed by the superior gluteal artery. Internal iliac artery anterior division arteries are usually branched in common trunks, particularly uterine artery in females and internal pudendal artery and prostatic artery in males have a common trunk with other arteries. Internal iliac artery posterior division arteries often arise in the posterior direction, whereas the anterior division arteries frequently arise in the anterior and medial direction. Obturator artery may originate directly from the external iliac artery or have a common trunk with the inferior epigastric artery. Adachi Type 3 classification in which superior gluteal artery, inferior gluteal artery and internal pudendal artery arise as separate branches from the internal iliac artery is the most common branching pattern in the whole cohort. These results can be applied in pelvic surgery and interventional radiology procedures related to the internal iliac artery and its branches to prevent possible complications.