Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 4  |  Page : 131-135

Study of Variations in the Origin of Obturator Artery


Department of Anatomy, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India

Date of Web Publication30-Sep-2016

Correspondence Address:
Preeti Dnyandeo Sonje
Department of Anatomy, Dr. D. Y. Patil Medical College, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.191494

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  Abstract 

Introduction: Obturator artery is the branch of anterior division of internal iliac artery. Variations in its origin are quite common and are very important from surgical point of view. Methods: To study the variations in the origin of the obturator artery 35 dissected vessels were studied. Results: Commonest variation of its origin from the posterior division of internal iliac artery was found in five cases. Other variations like its origin from internal pudendal artery or from inferior gluteal artery were also found, which are also discussed along with its embryological basis and clinical significance. Conclusions: Knowledge of anomalous origin of obturator artery from posterior division is helpful to vascular surgeons while planning endovascular treatment.

Keywords: External iliac artery, internal iliac artery, obturator artery, posterior division, variations


How to cite this article:
Sonje PD, Vatsalaswamy P. Study of Variations in the Origin of Obturator Artery. Indian J Vasc Endovasc Surg 2016;3:131-5

How to cite this URL:
Sonje PD, Vatsalaswamy P. Study of Variations in the Origin of Obturator Artery. Indian J Vasc Endovasc Surg [serial online] 2016 [cited 2020 Sep 28];3:131-5. Available from: http://www.indjvascsurg.org/text.asp?2016/3/4/131/191494


  Introduction Top


The abdominal aorta bifurcates into the right and left common iliac arteries to the left side of the fourth lumbar vertebral body. These arteries diverge as they descend to divide at the level of the sacroiliac joint into external and internal iliac arteries. The external iliac artery is the principal artery of the lower limb, and the internal iliac artery provides the principal supply to the pelvic viscera and walls, the perineum and the gluteal region.

The internal iliac artery, formerly known as the hypogastric artery, is the main artery of the walls and contents of the pelvis. The arrangement of the branches of the internal iliac artery is very variable.

Each internal iliac artery, 4 cm long, descends posteriorly to the superior margin of greater sciatic foramen where it divides into the anterior trunk, which continues in the same line toward ischial spine, and a posterior trunk, which passes back to the greater sciatic foramen.

Obturator artery is one of the branches of anterior division of internal iliac artery. It runs forward along the lateral wall of pelvis with the obturator nerve and leaves the pelvis through the obturator canal. Although the obturator artery is considered the branch of the anterior division of internal iliac artery, it shows numerous variations in its origin. [1]

The obturator artery runs anteroinferiorly from the anterior trunk on the lateral pelvic wall to the upper part of the obturator foramen. It leaves the pelvis through the obturator canal and divides into anterior and posterior branches. In the pelvis, it is related laterally to the fascia over obturator internus and is crossed on its medial aspect by the ureter and in the male by the vas deferens. The obturator nerve is above the artery, the obturator vein below it.

Occasionally, the obturator artery is replaced by an enlarged pubic branch of the inferior epigastric artery which descends almost vertically to the obturator foramen. It usually lies near the external iliac vein, lateral to the femoral ring, and is rarely injured during femoral hernia surgery. Sometimes it curves along the edge of the lacunar part of the inguinal ligament, partly encircling the neck of a hernial sac, and may be inadvertently cut during enlargement of the femoral ring in reducing a femoral hernia. [2]


  Materials and Methods Top


Thirty-five pelvises from thirty-five cadavers comprised the material for the present study. These cadavers were embalmed with 10% formalin and fixed. They were labeled from 1 to 35, left and right side. After separating the pelvis from the cadaver, sagittal section of the pelvis was taken. Origin of obturator artery was studied, and variations in its origin were observed.


  Results Top


Thirty-five pelvises were dissected to see the variations in the origin of obturator artery, which is the branch of the internal iliac artery. Obturator artery was studied on both the sides and in both the sexes, following variations were found:

A. Obturator artery was arising from the posterior division of internal iliac artery [Figure 1]. This type of variation was found in eight cases. Of these, six were male cadavers and two were female cadavers. In three cases, it was bilateral while in five cases it was unilateral
Figure 1: Obturator artery arising from the posterior division of internal iliac artery. CIA - common iliac artery, IIA - internal iliac artery, EIA - external iliac artery, OA - obturator artery, AD - anterior division, PD - posterior division

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B. (a) Obturator artery was seen arising from an external iliac artery in three cases [Figure 2]. This variation was bilaterally seen in two cases, while it was unilateral in one case. Of three, two were male cadavers and one was female cadaver. (b) Of three, in one case the obturator artery was arising from a common stem for obturator and inferior epigastric artery [Figure 3]
Figure 2: Obturator artery arising from the external iliac artery. IIA - internal iliac artery, EIA - external iliac artery, OA - obturator artery, IEA - inferior epigastric artery

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Figure 3: Obturator artery arising from a common stem for obturator and inferior epigastric artery. IIA - internal iliac artery, EIA - external iliac artery, OA - obturator artery, IEA - inferior epigastric artery, CS - common stem

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C. In three cases, it was arising from internal pudendal artery [Figure 4]. All three were male cadavers. It was unilateral in two cases and bilateral in one case

D. In two cases, the obturator artery was arising from inferior gluteal artery [Figure 5]. In both the cases, it was unilateral and both were male cadavers.[Table 1]
Figure 4: Obturator artery arising from the internal pudendal artery. CIA - common iliac artery, IIA - internal iliac artery, EIA - external iliac artery, OA - obturator artery, IPA - internal pudendal artery

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Figure 5: Obturator artery arising from the inferior gluteal artery. CIA - common iliac artery, IIA - internal iliac artery, EIA - external iliac artery, OA - obturator artery, IGA - inferior gluteal artery

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Table 1: Percentage of different findings in present study

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Table 2: Comparison of present study findings with previous studies


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  Discussion Top


Normally, the obturator artery originates from the anterior division of internal iliac artery, but it shows numerous variations in its origin. The blood vascular tree has at all times been a particularly interesting phase of the anatomical study. Its influence on the development of the individual, its practical importance in medicine, surgery, and anesthesia is very important. Awareness of the variations of arteries is essential during surgery for safe and successful surgeries.

Levi reported two roots for the obturator artery, one from the anterior division and the other from the posterior division. [3]

Benjamin Lipchitz found the origin of obturator artery from the internal iliac before its division into anterior and posterior divisions in 9.1% cases, while as a common stem with middle rectal in 5.4% of cases. The obturator was arising from the inferior gluteal in 2% of cases; also it was found that it was arising from the internal pudendal in 4% of cases, it was also reported that the obturator artery was arising from the femoral artery in some cases. [4]

Bergman et al. observed that obturator was arising as a common stem with the internal pudendal and inferior gluteal arteries in 2% of cases; also it was arising as a common stem with iliolumbar from the internal iliac artery. Sometimes it was seen arising separately from the external iliac and sometimes as a common stem with the inferior epigastric artery. [5]

According to Jusoh et al., obturator artery was arising from the posterior division and also it was giving rise to the inferior vesical artery in 5.8% cases. It was found to arise from the external iliac in 7.1% of cases. [6]

In the present study obturator artery was arising from the posterior division of internal iliac artery in 10 % of cases.

Present study showed double obturator artery in one case, one was from the posterior division of internal iliac artery but it was very thin and rudimentary. The other was arising from the external iliac artery

Embryologically, the anomaly may be explained on certain factors. As per description by previous researchers, Obturator artery has been reported to arise late in the development. Unusual selection of channels from the primary capillaries is thought to account for the anomalies affecting the arterial patterns. A simple view is that the most appropriate channels enlarge with the others retracting or disappearing, which may result in the final arterial pattern. In the later period, the persistence of the arterial channels near the posterior division may have resulted in the anomalous origin of the obturator artery from the posterior division of the internal iliac artery while the anterior channels may have disappeared. [6]

Dubreuil-Chambardel has described different types of origins of obturator artery as follows-

  • From the anterior division of internal iliac artery
  • From the internal pudendal artery.
  • From inferior gluteal artery.
  • From a common trunk for inferior gluteal artery and internal pudendal artery.
  • From the posterior division.
  • From the lateral sacral artery
  • Obturator and iliolumbar As a common stem from the trunk of internal iliac artery. [7]
Pushpa M. S. et al. observed anomalous branching pattern of Internal iliac artery which showed origin of the obturator artery from the posterior division instead of arising from anterior division of Internal iliac artery [Table 2]. [8] {Table 2}

Mangala M Pai et al found that in 79% of the specimens, the obturator artery was a branch of the internal iliac artery. It branched off at different levels either from the anterior division or posterior division, individually or with other named branches. In 19 cases, the obturator artery branched off from the external iliac artery as a separate branch or with the inferior epigastric artery. [9]

Parsons and Keith reported variations in the branching pattern of the obturator artery.

It originates within the pelvis from external iliac or the hypogastric (internal iliac artery), the anterior or posterior division of the later, or a branch of either division.

Anomalous origin of obturator artery from the posterior division may be beneficial to vascular surgeons ligating the internal iliac artery. The obturator artery is known to supply the head of the femur and in the event of the obturator artery arising from the posterior division of the internal iliac artery; it may be spared during any injury to the anterior division.

Obturator artery arising from the external iliac artery is called as aberrant obturator artery. General surgeons dealing with laparoscopic herniorrhaphy should be aware of the aberrant obturator artery that crosses the superior pubic ramus and is susceptible to injuries during surgery. It may cause serious complications during femoral ring procedures or laparoscopic interventions. It may compress the external iliac vein and can result in venous stagnation in the lower limb. Besides, it may be an additional source of bleeding in cases of hemorrhage secondary to pelvic fracture. The "corona mortis '' is an anatomical variant, an anastomosis between the obturator and the external iliac or inferior epigastric arteries, located on superior pubic ramus. It is significant because hemorrhage may occur if the corona mortis is accidentally cut and achievement of subsequent hemostasis is difficult .Orthopedic surgeons planning an anterior approach to the acetabulum, such as the ilioinguinal or the intrapelvic approach, must be cautious when dissecting near the superior pubic ramus. [11]

Cruveilhier and Theile described that sometimes the obturator artery is the branch of the superior gluteal artery. [12]

Adachi pointed out that an obturator artery with two roots probably occurred more frequently than reported, because one of the roots might be too small to recognize readily. [13] This type of finding was not reported in the present study.

Kumar D. and Rath G found that left obturator artery was arising from the posterior division of internal iliac artery. It was given off at a distance of 8mm, from the point of bifurcation of the left internal iliac artery. [14]

The obturator artery and vein are usually described as branches or tributaries of the internal iliac vessels although variations with connections to the external iliac or inferior epigastric vessels have been reported. Because these anomalous vessels are at risk in groin or pelvic surgeries that require dissection or suturing along the pelvic rim, we measured the frequency of these variations in 105 pelvic walls (45 in the United States and 60 in China). Our data show that 70-82% of pelvic halves and 83-90% of whole pelves had an artery, vein, or both in the variant position. Arteries were most often found in the normal position only but normal and anomalous veins were most frequently found together. These data show that it is far more common to find a vessel coursing over the pelvic rim at this site than not and have implications for both pelvic surgeons and anatomists. [15]

Acknowledgment

I am very much thankful to Dr. Vasanti Arole for supporting me for this study. I am also thankful to attendants, Amol, Deepak, Umesh, and Kamble mama for their timely help.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mcminn RM. Last′s Anatomy Regional and Applied. 9 th ed. New York: Churchill Livingstone; 1994. p. 394-8.  Back to cited text no. 1
    
2.
Gray H, Standring S. The Anatomical Basis of Clinical Practice. 40 th ed. Spain: Elsevier Churchill Livingstone; 2008. p. 1088.  Back to cited text no. 2
    
3.
Levi G. Observations sur les variations de arteries iliaques (Observations on changes in iliac arteries) Arch Ital Biol 1902a; 37:489.  Back to cited text no. 3
    
4.
Lipshutz B. A composite study of the hypogastric artery and its branches. Ann Surg 1918;67:584-608.  Back to cited text no. 4
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Bergman RA, Thompson SA, Afifi AK, Saadeh FA. Compendium of Human Anatomic Variation. Munich and Baltimore: Urban and Schwarzenberg; 1925.  Back to cited text no. 5
    
6.
Jusoh AR, Abd Rahman N, Abd Latiff A, Othman F, Das S, Abd Ghafar N, et al. The anomalous origin and branches of the obturator artery with its clinical implications. Rom J Morphol Embryol 2010;51:163-6.  Back to cited text no. 6
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7.
Dubreuil-Chambardel L. Variations in the origin of obturator artery coming from the external iliac artery. Paris: Masson;1925. Available from: http://www.anatomyatlases.org/Anatomic variants/Anatomy HP.shtml. [Last accessed on 2016 Sep 20].  Back to cited text no. 7
    
8.
Pushpa MS, Kulkarni R, Sheshgiri C, Kulkarni RN. Variations in the branching pattern of internal iliac artery -a case report. J Anat Soc India 2006;55:83.  Back to cited text no. 8
    
9.
Pai MM, Krishnamurthy A, Prabhu LV, Pai MV, Kumar SA, Hadimani GA. Variability in the origin of the obturator artery. Clinics (Sao Paulo) 2009;64:897-901.  Back to cited text no. 9
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10.
Parsons FG, Keith A. Sixth Annual Report of the Committee of Collective Investigation of the Anatomical Society of Great Britain and Ireland. Mode of origin of the branches of the internal iliac artery. J Anat Physiol London 1897;31:31-44.  Back to cited text no. 10
    
11.
Hollinshead WH. Anatomy for Surgeons. 5 th ed., Vol. 2. New York, Evanston, San Francisco, London: Harper and Row Publishers: 1969. p. 665-70.  Back to cited text no. 11
    
12.
Cruveilhier, Theile GH. Variations in the origin of obturator artery. Illustrated encyclopedia of human anatomic variations. 1925. Available from: http://www.anatomyatlases.org/Anatomic variants/Anatomy HP.shtml. [Last accessed on 2016 Sep 20]  Back to cited text no. 12
    
13.
Adachi B. Das Arteriensystem der Japaner, Supp. to Acta Scholae Medicinalis Universitatis Imperalis in Kyoto, 1928;9:1926-7.  Back to cited text no. 13
    
14.
Kumar D, Rath G. Anomalous origin of obturator artery from the internal iliac artery. Int J Morphol 2007;25:639-41.  Back to cited text no. 14
    
15.
Gilroy AM, Hermey DC, DiBenedetto LM, Marks SC Jr., Page DW, Lei QF. Variability of the obturator vessels. Clin Anat 1997;10:328-32.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2]


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