Vascular Anatomy Variations in Pelvic Surgery

Pelvic surgery demands precise knowledge of arterial architecture, which is characterised by a high degree of individual variability. The internal iliac artery typically bifurcates into anterior and posterior divisions, but the number, origin and course of its branches can differ markedly between patients. Variations in the obturator artery, the presence of accessory obturator vessels and the occurrence of the corona mortis are especially important, as unrecognised anomalies may lead to uncontrolled bleeding or nerve compression. Preoperative mapping using angiography or advanced cross-sectional imaging has become integral to identify these patterns, inform surgical planning and guide endovascular interventions such as embolisation. A range of classification systems has been proposed to reconcile anatomical detail with clinical utility, aiming to reduce iatrogenic injury in obstetric, gynaecological, urological and trauma settings. Understanding these variants supports safer dissection, targeted ligation and improved patient outcomes worldwide.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Vascular Anatomy Variations in Pelvic Surgery publication trend

The graph below shows the total number of articles in vascular anatomy variations in pelvic surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Internal iliac artery: the main arterial trunk supplying the pelvis, which normally divides into anterior and posterior branches supplying pelvic viscera and musculature.

Obturator artery: a branch typically arising from the anterior division of the internal iliac artery, with variable origins including the external iliac or inferior epigastric systems.

Corona mortis: a vascular anastomosis—arterial, venous or both—between obturator vessels and the external iliac or its branches, located near the pelvic brim.

Posterior division of the internal iliac artery: the portion of the internal iliac artery that gives rise to vessels such as the superior gluteal and iliolumbar arteries, supplying the pelvic wall and gluteal region.

Embolisation: an image-guided endovascular technique that introduces agents to occlude targeted vessels for haemorrhage control or tumour devascularisation.

References

1. Systematic Review and Meta-Analysis of the Variants of the Obturatory Artery. Journal of Clinical Medicine (2023).
2. Clinical importance of variability in the branching pattern of the internal iliac artery – An updated and comprehensive review with a new classification proposal. Annals of Anatomy - Anatomischer Anzeiger (2021).
3. Exploring the Branching Pattern of the Posterior Division of the Internal Iliac Artery: An Analysis Based on 75 Computed Tomography Angiographies. International Urogynecology Journal (2024).
4. Corona mortis: clinical evaluation of prevalence, anatomy, and relevance in anterior approaches to the pelvis and acetabulum. European Journal of Orthopaedic Surgery & Traumatology (2024).