Anatomic Variability of Branches of Iliac and Femoral Arteries in Human Fetuses
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Archives of the Balkan Medical Union vol. 54, no. 1, pp. 78-88 Copyright © 2019 Balkan Medical Union March 2019 ORIGINAL PAPER ANATOMIC VARIABILITY OF BRANCHES OF ILIAC AND FEMORAL ARTERIES IN HUMAN FETUSES Tatiana V. KHMARA1 , Pavlina V. HRYHORIEVA1, Alla V. VASYLCHYSHYNA1, Alexander V. TSYHYKALO1, Igor I. ZAMORSKII1, Mariana A. RYZNYCHUK1 1 Higher State Educational Institution of Ukraine „Bukovinian State Medical University“, Chernivtsi, Ukraine Received 04 Jan 2019, Accepted 18 Febr 2019 https://doi.org/10.31688/ABMU.2019.54.1.11 ABSTRACT RÉSUMÉ Introduction. The anatomy of the gluteal and anteri- La variabilité anatomique des branches artérielles or femoral regions is characterized by considerable age iliaque et fémorale chez les foetus humains and individual variability of the muscles and neurovas- cular formations, which is a rather common cause of Introduction. L’anatomie des régions fémorale et complications during surgical interventions. iliaque antérieure est caractérisée par un âge considé- Objective. The study aimed at determining the age rable et une variabilité individuelle des muscles et des and individual anatomical variability of the parietal nerfs vasculaires, ce qui est une cause assez fréquente branches of the internal iliac artery and the branches de complications lors des interventions chirurgicales. of the external iliac and femoral arteries during the Le but de l’étude. Déterminer l’âge et la variabili- fetal period of human ontogenesis. té anatomique individuelle des branches pariétales Materials and methods. The study included 80 de l’artère iliaque interne et des branches des artères specimens of fetuses, aged 4-10 months, of 81.0-375.0 iliaque et fémorale externes au cours de la période foe- mm of crown-rump length (CRL), without external tale de l’ontogenèse humaine. signs of anatomical impairments o r developmental Matériaux et méthodes. 80 préparations de foetus malformations. âgés de 4 à 10 mois et d’une longueur pariéto-coccy- Results. The branches of the iliolumbar artery anas- lique (LPC) de 81,0 à 375,0 mm ont été étudiées sans tomosis with the deep circumflex iliac artery and obtu- signes externes d’anomalies anatomiques ou de déve- rator artery; the lateral sacral arteries anastomosis with loppement. the branches of the median sacral artery. The branch- Résultats. Les branches de l’artère lombaire sont es of the right and left superior gluteal arteries (SGA) anastomosées avec une artère de flexion profonde de anastomosis at different frequencies with the internal l’os iliaque et une artère verrouillable; les artères sa- pudendal artery, the inferior gluteal artery (IGA), crales latèrales sont anastomosées avec des branches de the deep circumflex iliac artery, the lateral femoral l’artère sacrale interne. Les branches des artères sacrées Address for correspondence: Tatiana V. KHMARA Higher State Educational Institution „Bukovinian State Medical University“, Chernivtsi, Ukraine Address: Chernivtsi, 58001, Ukraine e-mail: [email protected]; phone: +38 099 751 65 50 Archives of the Balkan Medical Union circumflex artery (LFCA), the fourth lumbar artery supérieures droite et gauche (ASS) sont anastomosées and the obturator artery. The inferior epigastric artery avec des fréquences variables avec l’artère thoracique anastomoses with the inferior posterior intercostal ar- interne, l’artère fossale inférieure (AFI), l’artère de teries, the lumbar arteries, and the superior epigastric flexion profonde de l’os iliaque, l’artère oblongue laté- artery. The latter also anastomoses with the branches rale de la cuisse (AOAC), la quatrième artère lombaire of the superficial epigastric artery. The branches of et l’artère chordale. L’artère abdominale inférieure est the right and left medial femoral circumflex artery anesthésiée avec les artères inférieures du cerveau pos- (MFCA) with different frequency form anastomoses térieur, les artères lombaires et l’artère suprapubienne with the obturator artery, IGA and SGA, the internal supérieure. Cette dernière est ègalement une anasto- pudendal artery, LFCA and the first perforating artery. mose des branches de l’artère suprapéritonèale super- Also. the variants of the topography of the accompa- ficielle. Sont également incluses des variantes de la nying artery of the sciatic nerve in human fetuses were topographie de l’artère accompagnant le nerf sciatique indicated. chez le fœtus humain. Conclusions. 4-10-month-old fetuses are character- Conclusion. Chez les fœtus âgés de 4 à 10 mois, l’âge ized by the age and individual anatomical variability et la variabilité anatomique individuelle des artères des of the arteries of the pelvic and femoral walls. parois du bassin et des cuisses ont été détectés. Keywords: fetal period, arterial branching, gluteal Mots-clés: période foetale, ramification artérielle, and anterior femoral region. zone fémorale postérieure et antérieure. INTRODUCTION extremities remain an important issue of modern health care2. In recent years, much attention has been The anatomy of the gluteal and anterior femoral paid to selective medication therapy, which is carried regions is characterized by considerable age and indi- out by catheterization of vessels that supply blood to a vidual variability of the muscles and neurovascular specific area, which allows the administration of high formations, which is a rather common cause of com- toxicity drugs (cytostatic, antibiotics) directly to the plications during surgical interventions performed pathological site. This method of treatment allows a within the range of the supra- and infrapiriform significant decrease of drugs doses and a directly sup- foramina, the obturator canal, the femoral ring, the ply of the damaged tissue, avoiding the liver, spleen femoral triangle and the adductor canal. The data and lymph nodes. Surgeons, traumatologists, and dealing with previously unknown variants of topog- oncologists must take into account the variant pecu- raphy and branching of the arteries and nerves of the liarities of the structure of the main neurovascular gluteal and anterior femoral regions into clinical prac- bundle within the area of the adductor canal and the tice provides the successful performing of diagnostic femoral triangle, in order to prevent postoperative and therapeutic manipulations on the neurovascular complications while performing surgical procedures formations. Awareness of age and individual anatomi- on the lower extremity3-5. cal variability of main arteries determines the success The arterial bleeding from the internal iliac ar- of planned and urgent surgical interventions, as well tery may lead to serious and sometimes fatal conse- as some diagnostic procedures. The variants of topog- quences. Some authors6,7 note the variability of the raphy and branching of the system of the iliac and topography of the obturator artery. Other research- femoral arteries, their age and individual anatomical ers7 observed the obturator artery originating from variability deserve special attention among the topical the anterior trunk of the internal iliac artery in 79% problems of fetal anatomy. of cases. In 19% of observations, the obturator ar- Neglecting the data on certain topographic vari- tery was branching from the external iliac artery as ants of the vessels of the pelvis and the lower extremi- an independent branch or was arising along with the ties can cause iatrogenic damage to the arteries, and inferior epigastric artery. In 2% of cases, the double as a consequence – the occurrence of bleeding and origin of the obturator artery from the internal and ischemia of the distal parts of the extremity, and ne- external iliac arteries was detected. The iliac artery crosis development. As some authors1 emphasize, it is pool is one of the main objects of surgical interven- possible to avoid iatrogenic vessel damage by a proper tions, due to frequent involvement of the external knowledge of the anatomical and topographic pecu- iliac arteries in the pathological process. liarities in the area of surgery, performing operations The endovascular embolization of the major carefully, and by preferring noninvasive methods of trunks of vessels is the main method of treatment diagnosis. Arterial occlusive diseases of the lower of arterial aneurysms8. Data dealing with the variant March 2019 / 79 Anatomic variability of branches of iliac and femoral arteries in human fetuses – KHMARA et al anatomy of branching of the main and collateral the Ethical Principles of Scientific Medical Research pathway of the deep femoral artery are contradictory9. with Human Participation (1964-2013), the Order The persistent sciatic artery that replaces the of the Ministry of Health of Ukraine No 690, dated femoral artery is an anomaly difficult to diagnose, September 23, 2009, and taking into account the leading to ischemia of the lower extremity7,10-13. The methodological recommendations of the Ministry of resources contain data of topographic variants of the Health of Ukraine „Procedure of exemption of bio- accompanying artery of sciatic nerve14-17. Clinical ob- logical objects from dead persons whose bodies are servation of a patient with abnormal course of iliac subject to forensic medical examination and patho- and femoral arteries is reported by Tsygankov et al13. logical examination for scientific purposes“ (2018). The anomaly did not allow to perform the emboliza- The Committee on Biomedical Ethics of the HSEI of tion of afferent arteries of the lower leg in case of Ukraine „Bukovinian State Medical University“