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Anatomical Study on the Internal Iliac Artery In International Journal of Anatomy and Research, Int J Anat Res 2017, Vol 5(1):3599-06. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2017.116 ANATOMICAL STUDY ON THE INTERNAL ILIAC ARTERY IN FETUS AND ITS IMPLICATIONS IN UMBILICAL ARTERY CATHETERIZATION Chongtham Rajlakshmi *1, Thounaojam Oken 2, Lemtur Martula 3, Chongtham Shyamsunder 4. * 1Associate Professor, Department Of Anatomy, Regional Institute of Medical Sciences (RIMS), Imphal, India. 2, 3 Postgraduate Trainee, Department Of Anatomy, Regional Institute of Medical Sciences (RIMS), Imphal, India. 4 Associate Professor & HOD, Department Of Pediatrics, Regional Institute of Medical Sciences (RIMS), Imphal, India. ABSTRACT Introduction: Umbilical artery catheterization (UAC) is a procedure for investigation and treatment purpose. The catheter negotiates the umbilical artery, internal iliac artery, common iliac artery to reach aorta of desired level. Studies so far have not correlated the type of internal iliac artery associated with the complications encountered during or after the procedure. Materials and Methods: Forty four pelvic halves, from ten males and twelve female full term fetus of Manipuri population were used to determine the incidence of type of branching pattern of internal iliac artery. The length of the portion of the artery from the umbilical ring upto the bifurcation of aorta was measured. Results: Only Type I-IV were observed. Type I was observed more in males (40.9%) and Type IV was more in females (36.4%). The total length of the artery from umbilical ring to aortic bifurcation was 7.3± 0.35 and 7.4± 0.29 on right and left side respectively. Discussion: The study emphasise the importance of the ‘bend’, the branches issued from the bend present in the internal iliac artery from perspective of UAC. Conclusion: The study presents a baseline data of length of the artery negotiated by the catheter. The study hypothesises the possible association of a type II & IV of internal iliac artery with complications associated with the UAC. Detail knowledge of anatomy of arteries traversed by the catheter would be of paramount significance for the clinicians, radiologists and academicians alike. KEY WORDS: Umbilical artery, internal iliac artery, variation, umbilical artery catheterization Address for Correspondence: Dr. Chongtham Rajlakshmi MS (Anatomy), PhD(Anatomy), Associ- ate Professor, Department Of Anatomy, Regional Institute of Medical Sciences (RIMS), Imphal, India. E-Mail: [email protected] Access this Article online Quick Response code Web site: International Journal of Anatomy and Research ISSN 2321-4287 www.ijmhr.org/ijar.htm Received: 16 Jan 2017 Accepted: 24 Feb 2017 Peer Review: 20 Jan 2017 Published (O): 31 Mar 2017 DOI: 10.16965/ijar.2017.116 Revised: None Published (P): 31 Mar 2017 INTRODUCTION with the allantois. During the fourth week, each artery acquires a secondary connection with the In fetus, umbilical arteries are the major chan- dorsal branch of aorta, the common iliac artery, nels from the aorta to the placenta. They are and loses its earliest origin. After birth the proxi- initially paired ventral branches of dorsal aorta mal portions of umbilical arteries persist as the that course to the placenta in close association internal iliac and superior vesical arteries, and Int J Anat Res 2017, 5(1):3599-06. ISSN 2321-4287 3599 Chongtham Rajlakshmi, Thounaojam Oken, Lemtur Martula, Chongtham Shyamsunder. ANATOMICAL STUDY ON THE INTERNAL ILIAC ARTERY IN FETUS AND ITS IMPLICATIONS IN UMBILICAL ARTERY CATHETERIZATION. the distal parts are obliterated to form the branching pattern of internal iliac artery medial umbilical ligaments. From the newly documented in anatomy textbooks are based on formed secondary vessel there arises the studies on adult [5]. There is paucity of inferior gluteal artery, the first formed main reference data of full term fetus. Review of artery of the lower limb. Later, a second branch literatures suggests studies done on adult becomes the external iliac artery and the femo- cadavers with implication in adult patients only. ral arteries of the adult. Finally, the portion of Present study is therefore, an attempt to study the umbilical stem dorsal to external iliac be- the variations in the branching pattern of comes the common iliac artery, and the ventral internal iliac artery in fetus and secondly, to part becomes the internal iliac artery. But the measure the combined length of the artery - part of the original umbilical artery that runs to umbilical artery, internal iliac and common iliac the umbilicus, and on to the placenta, is still artery which is negotiated by the catheter in called the umbilical artery [1,2]. Functionally, the full-term fetus. umbilical arteries close few minutes after birth, MATERIALS AND METHODS although the actual obliteration of the lumen by fibrous proliferation may take two to three This is a pilot study of descriptive type months. Initial closure of the arteries is performed on forty four pelvic halves from 22 accomplished by contraction of the smooth full-term human fetus (9 males , 13 females) musculature in their walls which is influenced used by the postgraduate trainees for different by thermal stimuli, mechanical stimuli and research work in the Department of Anatomy, change in oxygen tension [1]. Regional Institute of Medical Sciences, Imphal In adults internal iliac artery divides into from 2012-2015. The fetuses were collected anterior and posterior branch. These two from Obstetrics & Gynaecology Department, divisions give parietal and visceral branches to RIMS after ethical clearance from the institu- the pelvic structures. The larger anterior tional ethics committee. The fetuses were free division breaks up into as many as nine branches, of malformation affecting cardiovascular namely –superior vesical, obliterated umbilical, anomalies. The anterior abdominal wall is inferior vesical, middle rectal, uterine, vaginal, reflected inferiorly to expose the internal obturator, internal pudendal, inferior gluteal surface of the anterior abdominal wall (FIG 1). artery. Posterior division breaks up into 3 The pelvic viscera were already removed wholly branches, namely – iliolumbar, lateral sacral and or partially in most of the fetuses. The pelvic superior gluteal. The umbilical artery is usually walls were removed of pelvic fascia to expose the first and highest branch to arise from the internal iliac artery and its branches. The anterior division and in adult it is merely a internal iliac veins and its tributaries were fibrous remnant of the erstwhile umbilical removed to get a clear exposure of the branches. artery of fetal stage [3]. However, umbilical ar- The intra abdominal umbilical artery, internal tery is important clinically because it is used as iliac artery and its branches were followed by a route to extract arterial blood gas sample in meticulous dissection. Adachi used four princi- newborn with respiratory problem. In this pal parietal branches as criteria of classifying procedure called umbilical artery catheterization the variations in origins: umbilical, superior (UAC), catheter is passed in the lumen of one of gluteal, inferior gluteal, internal pudendal into the artery in the umbilical cord. Catheter is five types [6]. Adachi’s classification was used passed gently under constant tension to in the present study because it is widely overcome the resistance encountered at two accepted by many researchers and also lends points where the artery turns just below the skin itself best to our purpose. surface and where the arteries turn upward Vernier caliper was used to measure the total toward the iliacs [4]. Therefore, anatomy of length of the artery from point of exit of branching pattern of internal iliac artery in umbilical artery (umbilical ring) via internal iliac newborn is important from perspective of artery and common iliac upto bifurcation of the umbilical artery catheterization. Variations in the abdominal aorta. This distance (AD) gives the Int J Anat Res 2017, 5(1):3599-06. ISSN 2321-4287 3600 Chongtham Rajlakshmi, Thounaojam Oken, Lemtur Martula, Chongtham Shyamsunder. ANATOMICAL STUDY ON THE INTERNAL ILIAC ARTERY IN FETUS AND ITS IMPLICATIONS IN UMBILICAL ARTERY CATHETERIZATION. total distance of the artery negotiated by the iliac artery (AB) is 4.5± 0.44 cm and 4.5 ± 0.41 catheter from the umbilical ring to the aortic cm on right and left side respectively. The bifurcation. The parameters measured are: distance BC is 1.2±0.15 cm and 1.1 ±0.24 cm on 1) AB= Distance between umbilical ring to the right and left side respectively. The distance ‘bend’ in the internal iliac artery between point of bifurcation of common iliac to 2) BC= From the ‘bend’ to the point of bifurca- the point of bifurcation of abdominal aorta (CD) tion of common iliac are 1.6± 0.39 and 1.55± 0.37 on right and left side respectively (Table 1). 3) CD= From the point of bifurcation of common iliac to the bifurcation of aorta Table 1: Total length of the artery from umbilical ring (point of exit through abdominal wall) to aortic Fig. 1: Anterior abdominal wall reflected inferiorly to bifurcation. expose the intra abdominal course of umbilical artery, Left side internal iliac artery, external iliac artery, common iliac Parameters Right side (cm) artery and aorta. The ‘bend’ in the internal iliac artery is (cm) the part where internal iliac artery makes a U-turn AB 4.5±0.44 4.5±0.41 BC 1.2±0.15 1.1±0.24 CD 1.6±0.38 1.5±0.37 Total 7.45±0.29 7.3±0.35 CRL (cm)=30.1±1.27 ; weight (kg)=2.8±0.33 ; n=44; p value>0.05 AB=umbilical ring to the ‘bend’ in the internal iliac artery; BC=from the ‘bend’ to the point of bifurcation of common iliac artery; CD=bifurcation of common iliac artery to aortic bifurcation Table 2: Variation in the origin of the three parietal branches of internal iliac artery.
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