Abstract | March 24, 2024

Internal Iliac Artery: Embryology, Anatomy, Variations, and Clinical Significance

Mahant Malempati, BS, Medical Student, 3rd Year, Tulane University School of Medicine, New Orleans, LA

Leila Kataria, BS, 2nd Year Medical Student, LSU, New Orleans, LA

Learning Objectives

  1. Embryological Development: Understand the embryonic origins of the internal iliac artery (IIA), emphasizing the role of ventral segmental and dorsolateral intersegmental branches and the significance of caudal displacement of umbilical arteries in IIA formation
  2. Anatomical Proficiency: Gain a comprehensive grasp of IIA's anatomy, including branching patterns, contributions to pelvic vascularization, and variations impacting surgical procedures and clinical diagnoses
  3. Clinical Relevance and Management: Explore the clinical significance of IIA in lower extremity artery disease (LEAD) and isolated internal iliac artery stenosis (IIS). Learn non-invasive diagnostic techniques, such as duplex ultrasound, and understand treatment modalities, including medical interventions, revascularization procedures, and the role of internal iliac artery ligation in preventing hemorrhage during pelvic surgeries

This review delves into the embryology, anatomy, variations, and clinical importance of the internal iliac artery (IIA), a vital vessel crucial for pelvic blood supply. The embryological journey of the IIA originates from the dorsal aortae, with key contributions from ventral segmental and dorsolateral intersegmental branches. The anatomical landscape involves the bifurcation of the abdominal aorta into common iliac arteries, with the IIA assuming a pivotal role in pelvis vascularization. Its branches include the iliolumbar, lateral sacral, superior gluteal arteries, and various arteries on its anterior aspect.

Variations in IIA branching patterns impact surgical procedures and clinical diagnoses, necessitating a thorough understanding for optimal outcomes. Notably, variations in internal iliac branches, especially involving the superior and inferior gluteal arteries, internal pudendal artery, and obturator artery, require attention for surgical planning. In clinical contexts like lower extremity artery disease (LEAD), isolated internal iliac artery stenosis (IIS) poses diagnostic challenges, often resembling other conditions. Diagnostic techniques, including duplex ultrasound and advanced imaging, are crucial in identifying IIS.

The clinical relevance of IIA extends to conditions like buttock claudication in LEAD. Various non-invasive diagnostic tools aid in detecting IIS, while innovative assessments like exercise transcutaneous oxygen pressure and near-infrared spectroscopy show promise in evaluating pelvic ischemia. Management of IIS spans medical interventions with medications like aspirin and clopidogrel, alongside revascularization procedures such as angioplasty and stent placement. Internal iliac artery ligation proves vital in preventing hemorrhage during pelvic surgeries.

In summary, exploring the IIA’s developmental origins, anatomical intricacies, variations, and clinical implications emphasizes its pivotal role in medicine. Insight into IIA nuances guides diagnosing and managing conditions like IIS, facilitating effective medical and surgical interventions in the pelvic region. Ongoing research is essential for advancing medical knowledge and enhancing patient care.

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