[Clinical anatomy of intrapelvic anastomoses of the obturator artery].

Abstract

Background: One of the main principles of contemporary endovascular surgery is that interventions should be as selective as possible. During treatment of prostatic hyperplasia when there is a need for endovascular occlusion of the rami prostatici, an operation of choice will be selective exclusion from blood flow of namely these peripheral branches. However, a series of recent studies have demonstrated that the presence of well-developed intrapelvic anastomoses in arteries, which are formed from the internal iliac artery may result in destruction or early recanalization (within 2-3 weeks) of endovascular emboli previously placed inside the branches of these arteries. The lack of information in specialized literature concerning the location of intrapelvic anastomotic branches of the obturator artery makes it difficult to develop surgical methods of treatment.

Objective: The purpose of this study was to investigate the anatomy of collaterals of the obturator artery (OA) in the pelvic cavity.

Material and methods: The study was carried out on 206 cadavers of men (aged from 22 to 82 years) and 113 cadavers of women (from 32 to 93 years of age) who had died of accidental causes not related to pathology of pelvic organs. Our aim was achieved by means of cadaveric dissection followed by intravascular injection and statistical processing of the obtained findings.

Results: It was found that in men, the OA formed anastomotic branches in the pelvic cavity in 10.2% of cases on the right and in 8.3% of cases on the left. In women, the OA anastomosed on the right half of the pelvis in 5.3% of cases and in 4.4% of cases on the left half. Two thirds of all exposed anastomoses in men and women were located in the proximal third of the intrapelvic part of the OA. The anastomotic branches of the OA met with both parietal and visceral branches of the internal iliac artery. We revealed no gender-related statistically significant differences between the average diameters of the OA and the average diameters of its anastomoses. It was determined that large arterial anastomoses were formed from the obturator artery in both genders irrespective of its diameter.

Conclusion: The number of intrapelvic anastomoses of the obturator artery in men and women decreased in the direction from the place of the origin of this artery to that part of it located immediately at the entrance to the obturator canal.