Images in Gynecologic Surgery

Unusual Branch of External Iliac Artery Deeksha Pandey, MD, Kuan-Gen Huang, MD*, and Chyi-Long Lee, MD From the Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, India (Dr. Pandey), and Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan (Drs. Huang and Lee).

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The external iliac artery is a direct continuation of the common iliac artery. It terminates behind the inguinal ligament to become the femoral artery. Normally it has 2 branches immediately above the inguinal ligament, i.e., the inferior epigastric and deep circumflex iliac arteries. Herein is reported for the first time in the English literature the case of an unusual branch of the right external iliac artery in a 75-year-old patient during laparoscopic staging of endometrial adenocarcinoma. The unusual vessel (approximately 1.5 cm long) arose at the junction of the middle and distal thirds of the external iliac artery (approximately 4.5 cm from the origin of the external iliac artery) and continuing toward the lateral pelvic wall. This artery seemed to be a muscular branch of the iliacus muscle. (Fig. 1). Computed tomographic angiography later, however, proved it to be an obliterated vessel. Thus there is a possibility that this small vessel might be an embryologic remnant. To date, only 2 branching abnormalities of the external iliac artery have been reported in the English literature since 1816 (PubMed). In the first case, during cadaveric dissection an unusual branch of the external iliac artery was noted midway between its origin and termination. This unusual artery divided into 2 branches, i.e., an ascending and a descending branch. The ascending branch Disclosures: None declared. Corresponding author: Kuan-Gen Huang, MD, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St, Kweishan, Taoyuan 333, Taiwan. E-mail: [email protected] Submitted April 28, 2014. Accepted for publication August 13, 2014. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2015 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2014.08.011

supplied the iliacus muscle and iliac crest. The descending branch entered the femoral triangle by passing behind the femoral sheath, supplying the muscles of the femoral triangle [1]. In another report, under the inguinal ligament a common trunk was composed of the femoral artery, the lateral circumflex femoral artery, and the profunda femoris artery at the transition of the external iliac artery to the femoral artery [2]. Although some other variations in the origin, length, and course of the external iliac artery have been described previously [3–5], the present report is the first that describes an unusual branch in a living

Fig. 1 Laparoscopic image during pelvic lymphadenectomy shows an unusual branch arising from the junction of the middle and distal thirds of the right external iliac artery and seems to be a muscular branch of the iliacus muscle. EIA 5 external iliac artery; EIV 5 external iliac vein; IM 5 iliacus muscle; PM 5 psoas major muscle.

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subject. Awareness of this rare variation in branching of the external iliac artery might be useful during pelvic lymphadenectomy. References 1. Nayak SB. Abnormal branch of external iliac artery in the iliac fossa. Int J Morphol. 2008;26:445–446.

Journal of Minimally Invasive Gynecology, Vol 22, No 3, March/April 2015 2. Ranganath V, Gayathri T. Unusual branching pattern of external iliac artery: case report. Int J Morphol. 2013;31:942–944. 3. Bergman RA, Thomson SA, Afifi AK. Compendium of Human Anatomical Variations. Baltimore, MD: Urban & Schwarzenberg; 1988. 4. Mansfield AO, Howard JM. Absence of both common iliac arteries: a case report. Anat Rec. 2005;150:363–364. 5. Moul JW, Wind GG, Wright CR. Tortuous and aberrant external iliac artery precluding radical retropubic prostatectomy for prostate cancer. Urology. 1993;42:450–452.

Unusual branch of external iliac artery.

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