Variations observed of the internal iliac artery and their possible clinical implications

Understanding the variation of the internal iliac artery (IIA) is of interest to the medical community because vascular compromise of this region can lead to pathologies like IIA occlusive disease, and lower extremity arterial disease. Anatomic variation can lead to confusion in surgeries such as embolization and angioplasty or can lead to lingering symptoms after surgery. We studied variations in the internal iliac artery, which contains the inferior gluteal, internal pudendal, middle rectal, obturator, umbilical, superior vesical, inferior vesical, uterine, superior gluteal, lumbosacral, and iliolumbar arteries. 25 cadavers were studied and, for each individual, branching patterns of 10 arteries from both the anterior and posterior divisions of the internal iliac artery were observed. Our most interesting observations were of a muscular artery entering the psoas muscle, because it has never been reported before. We found this branch in 13/25 of the cadavers studied, where the majority of them were coming off the superior gluteal artery. Another interesting observation was of the uterine artery, where 4 of them originated from the common trunk of the superior vesical and umbilical arteries. We also found significant variation in the obturator artery, but this has been previously well studied. These studies suggest that compromise of vessels that are not normally considered high risk for pathologies such as gait issues or severe bladder dysfunction should be assessed properly in the treatment plan of a patient. Significant variation exists in the pelvic region, and if not appropriately evaluated, can lead to unforeseen end organ damage.