The iliac and femoral arteries: Dimensions and tortuosity in a South African radiological sample

Background

Arterial morphology varies and changes with increasing age. This may challenge the success of endovascular procedures and influence candidate selection. The study aimed to determine the mean dimensions, tortuosity severity, and tortuosity phenotype of the iliofemoral pathway of adult males and females from a South African sample. Furthermore, the relationship between increased age and changes in vessel morphology was investigated.

Design

A retrospective cross-sectional study was conducted using a sample of 224 (117 males and 107 females) computed tomography angiograms of patients hospitalized due to traumatic injuries (aged 18–80 years), accessed from Tygerberg Hospital, Cape Town, South Africa.

Methods

The arterial lengths and lumen diameters of the common iliac (CIA), external iliac (EIA), and femoral arteries (FA) were measured. Tortuosity severity was described by visual estimation and quantified using the tortuosity index (TI) and inflection count metric (ICM). The data were compared between right and left sides of the body, the sexes, and age categories.

Results

On average, the common iliac artery was the widest (9.50 ± 1.53 mm), while the external iliac artery was the longest (110.89 ± 16.04 mm). Bilateral asymmetries were observed. Arterial diameters were larger in males. Regression analysis revealed a strong positive relationship between arterial tortuosity and increasing age, particularly in females. Tortuosity was most frequently observed in the external iliac artery. However, the c-shaped curving tortuosity phenotype was observed in all three arteries investigated.

Conclusion

The morphology of the iliofemoral arterial pathway varied bilaterally, between the sexes, and with increased age. These findings align with previous studies, noting the variable morphology of the iliofemoral pathway, in countries outside of Sub-Saharan Africa. Sex- and age-specific descriptions of arterial anatomy may enhance the safety of endovascular procedures and interventions. These descriptions contribute towards the development of a reference database of typical arterial anatomy in South Africa, ultimately assisting with patient selection and the identification of vascular pathologies.