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Konarska-Włosińska M, Ostrowski P, Del Carmen Yika A, Dziedzic M, Bonczar M, Wojciechowski W, Walocha J, Koziej M. Exploring the Topography of the Obturator Artery and Corona Mortis: a Detailed Analysis with Surgical Implications. Int Urogynecol J 2024; 35:1051-1060. [PMID: 38635039 DOI: 10.1007/s00192-024-05774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The obturator artery (ObA) is described as a branch of the anterior division of the internal iliac artery. It arises close to the origin of the umbilical artery, where it is crossed by the ureter. The main goal of the present study was to create an anatomical map of the ObA demonstrating the most frequent locations of the vessel's origin and course. METHODS In May 2022, an evaluation of the findings from 75 consecutive patients who underwent computed tomography angiography studies of the abdomen and pelvis was performed. RESULTS The presented results are based on a total of 138 arteries. Mostly, ObA originated from the anterior trunk of the internal iliac artery (79 out of 138; 57.2%). The median ObA diameter at its origin was found to be 3.34 mm (lower quartile [LQ] = 3.00; upper quartile [UQ] = 3.87). The median cross-sectional area of the ObA at its origin was found to be 6.31 mm2 (LQ = 5.43; UQ = 7.32). CONCLUSIONS Our study developed a unique arterial anatomical map of the ObA, showcasing its origin and course. Moreover, we have provided more data for straightforward intraoperative identification of the corona mortis through simple anatomical landmarks, including the pubic symphysis. Interestingly, a statistically significant difference (p < 0.05) between the morphometric properties of the aberrant ObAs and the "normal" ObAs originating from the internal iliac artery was found. It is hoped that our study may aid in reducing the risk of serious hemorrhagic complications during various surgical procedures in the pelvic region.
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Affiliation(s)
- Monika Konarska-Włosińska
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Alicia Del Carmen Yika
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Martyna Dziedzic
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Wadim Wojciechowski
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College Mikołaja, Kopernika 12, 33-332, Kraków, Poland.
- Youthoria, Youth Research Organization, Kraków, Poland.
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Kostov S, Kornovski Y, Watrowski R, Slavchev S, Ivanova Y, Yordanov A. Internal Iliac Artery Ligation in Obstetrics and Gynecology: Surgical Anatomy and Surgical Considerations. Clin Pract 2023; 14:32-51. [PMID: 38248429 PMCID: PMC10801552 DOI: 10.3390/clinpract14010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe obstetrical or gynecologic hemorrhage, IIA ligation can be a lifesaving procedure. Regrettably, IIA ligation has not gained widespread popularity, primarily due to limited surgical training and concerns regarding possible complications, including buttock claudication, impotence, and urinary bladder and rectum necroses. Nowadays, selective arterial embolization or temporary balloon occlusion are increasingly utilized alternatives, which can be applied preoperatively or intraoperatively for threatening severe genital or pelvic bleeding. However, IIA ligation retains its relevance, as the previously described procedures are not always available and have limitations. This article provides a step-by-step guide to the IIA ligation procedure and its possible complications. It also includes a detailed description of the anatomy of the IIA and pelvic arterial anastomoses. This review highlights the importance of a thorough understanding of pelvic anatomy as a prerequisite for safe IIA ligation and posits that training in this procedure should be an integral part of obstetrics and gynecology curricula.
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Affiliation(s)
- Stoyan Kostov
- Research Institute, Medical University Pleven, 5800 Pleven, Bulgaria;
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Yavor Kornovski
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Rafał Watrowski
- Department of Obstetrics and Gynecology, Helios Hospital Müllheim, 79379 Müllheim, Germany;
- Faculty Associate, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Stanislav Slavchev
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Yonka Ivanova
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria
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