Acta Chir Orthop Traumatol Cech. 2015; 82(1):48-50 | DOI: 10.55095/achot2015/006
Risk of Bleeding from the Internal Iliac Artery and Its Branches in Pelvic Fractures: Cadaver StudyOriginal papers
- 1 Ústav anatomie 3. LF UK v Praze
- 2 Ortopedicko-traumatologická klinika 3. LF UK a FNKV v Praze
- 3 Centrum pro integrované studium pánve 3. LF UK v Praze
PURPOSE OF THE STUDY:
The study was designed to investigate whether anatomical variations of the anterior and posterior divisions of the internal iliac artery and their branches are associated with different risks of bleeding resulting from injury to the posterior pelvic segment.
MATERIAL AND METHODS:
The study was carried out on 19 cadavers. The dissected area included the internal iliac artery from the common iliac artery bifurcation to the origins of the superior gluteal artery, the inferior gluteal artery and the internal pudendal artery. Using an electronic slide rule, distances between the bifurcation and the origin of each branch from either the anterior or the posterior division were measured. The diameter of each vessel was also determined. Findings of the study were compared with variations described in the literature. The degree of risk for bleeding related to different anatomical variations of the internal iliac artery and its branches was evaluated based on the proximity to the bone.
RESULTS:
There are six anatomical variations of internal iliac artery branches. Four of them were found: type A1 was recorded in 10 specimens, type A2 in six, type B1 in two and type C in one specimen. Types B2 and D were not seen.
DISCUSSION:
The type B2 and C anatomical variations were considered to carry higher risks of bleeding due to injury to the posterior pelvic segment. These variations are characterized by vessels larger in diameter and a longer course of the posterior division along the posterior part of the greater sciatic notch (area often involved in unstable pelvic ring fractures). On the other hand, the type C variation showed a longer internal iliac artery separated from the bone with a thick layer of soft tissue, which suggested lower risk than was attributed to the dominant type A1 variation. It was not possible to evaluate type B2 variation because it is very rare and was not found in study material. In type A2 and B1 variations, the branches were separated from bony structures similarly to the dominant type A1 variation.
CONCLUSIONS:
The cadaver study designed to assess the risk of bleeding associated with different morphological variations of the branching pattern of the internal iliac artery did not identify any anatomical arrangement that might carry a higher risk of injury to the vessels by free bone fragments of the posterior segment in unstable pelvic fractures. It can be concluded that less common branching patterns of the internal iliac artery are not associated with higher risk of bleeding than the dominant type A1 variation.
Keywords: pelvic injury, risk of arterial bleeding, internal iliac artery and its branches
Published: February 1, 2015 Show citation
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References
- Adachi, B.: Arteriensystem der Japaner. Band II. Kyoto, University Tokyo 1928.
- ASHLEY, F. L., ANSON, B. J.: The hypogastric artery in American Whites and Negroes. Amer. J. Phys. Anthrop., 28: 381-891, 1941.
Go to original source...
- Bilhim, T., Casal, D., Furtado, A., Pais, D., O'Neill, J. E., Pisco, J. M.: Branching patterns of the male internal iliac artery: imaging findings. Surg. Radiol. Anat., 33: 151-159, 2011.
Go to original source...
Go to PubMed...
- BRAITWAITE, J. L.: Variations in origin of the parietal branches of the internal iliac artery. J. Anat., 86: 423-430, 1952.
- Daeubler, B., Anderson, S. E., Leunig, M., Triller, J.: Hemorrhage secondary to pelvic fracture. J. Endovasc. Ther., 10: 676-680, 2003.
Go to original source...
Go to PubMed...
- Gänsslen, A., Hildebrand, F., Pohlemann, T.: Management of hemodynamic unstable patients "in extremis" with pelvic ring fractures. Acta Chir. orthop. Traum. čech., 79: 193-202, 2012.
Go to original source...
- Giannoudis, P. V., Grotz, M. R., Tzioupis, C, Dinopoulos, H., Wells, G. E., Bouamra, O., Leckey, F.: Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. J. Trauma, 63: 875-883, 2007.
Go to original source...
Go to PubMed...
- Chmelová J., Džupa V., Pleva L.: Diagnostika poranění pánve: role zobrazovacích metod u izolovaných traumat i polytraumat (Pelvic fractures: role of imaging methods in the diagnosis of isolated pelvic fractures and multi-trauma). Acta Chir. orthop. Traum. čech., 75: 93-98, 2008.
Go to original source...
- Kachlík, D, Báča, V., Bozděchová, I., Čech, P., Musil, V.: Anatomical terminology and nomenclature: past, presence and highlights. Surg. Rad. Anat., 30: 459-466, 2008.
Go to original source...
Go to PubMed...
- Kachlík, D., Bozděchová, I., Čech, P., Musil, V., Báča, V.: Mistakes in the usage of anatomical terminology in clinical practice. Biomed. Papers, 153: 157-162, 2009.
Go to original source...
Go to PubMed...
- LIPSHUTZ, B.: A composite study of the hypogastric artery and its branches. Ann. Surg., 67: 584-608, 1918.
Go to original source...
Go to PubMed...
- Metz, C. M., Hak, D. J., Goulet, J. A., Williams, D.: Pelvic fracture patterns and their corresponding angiographic sources of hemorrhage. Orthop. Clin. North Am., 35: 431-437, 2004.
Go to original source...
Go to PubMed...
- Miller, P. R., Moore, P. S., Mansell, E., Meredith, J. W., Chang, M. C.: External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage. J. Trauma, 54: 437-443, 2003.
Go to original source...
Go to PubMed...
- Netter, F. H.: Netterův anatomický atlas člověka. Vyd. 1., Brno, Computer Press 2010.
- Pick, J. W., BARRY, J., ANSON, B. J., ASHLEY, F. L.: The origin of the obturator artery: a study of 640 body-halves. Am. J. Anat., 70: 317-343, 1942.
Go to original source...
- Pohlemann, T., Regel, G., Tscherne, H.: Klassifikation und Begriffsbestimmungen. In: Tscherne, H., Pohlemann, T. (eds): Becken und Acetabulum. Berlin, Springer 1998, 47-62.
Go to original source...
- Sobotta, J., Putz, R., Pabst, R. (Eds): Sobottův atlas anatomie člověka. Vyd. 1. české (překlad 22. vyd.), Praha, Grada 2007.
- Standring, S.: Gray's anatomy: the anatomical basis of clinical practice. 40th ed., Edinburgh, Elsevier Churchill Livingstone 2008.
- Tile, M., Helfet, D. L., Kellam, J. F. (Eds): Fractures of the Pelvis and Acetabulum. Third edition. Philadelphia, Lippincot Williams & Wilkins 2003.
- Yamaki, K., Saga, T., Doi, Y., Aida, K., Yoshizuka, M.: A statistical study of the branching of the human internal iliac artery. Kurume Med. J., 45: 333-340, 1998.
Go to original source...
Go to PubMed...