Variant anatomy of the internal iliac vein and its applications

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

The article analyzed data from relevant literature that focused on anatomical variations of the internal iliac vein (IIV), its structure, and morphometric characteristics.

P.A. LePage et al. (1991), D. Venieratos et al. (2012), and P. Kanjanasilp et al. (2019) have previously evaluated anatomical variations of the IIV using postvital materials. M. Shin et al. (2015) extensively analyzed the architectonics of the main trunk of the IIV according to vestibular methods (n=2488) and identified eight variants. This approach formed the basis of a similar work (n=1071) by A. Hekimoglu and O. Ergun (2021). D. Sat-Muñoz et al. (2020) and M.G. Shkvarko et al. (2021) also conducted a morphometric study of IIVs. D. Sat-Muñoz et al. categorized variants of IIV formation into three types, according to the classification of R. Gregoire (2007), based on the relationship of the IIV with its artery. According to D. Kachlik et al. (2010), in approximately 50% of cases, the root of the IIV is the internal genital vein, which penetrates the pelvis through the subclavian orifice; in 30%, the anterior and posterior trunks can be identified in the architectonics of the IIV by analogy with the internal iliac artery, which are the roots; in 20%, the IIV trunk is formed by many small tributaries, and roots and trunks could not be identified.

Our data revealed that the typical IIV variant is the one in which its roots and tributaries (except for the umbilical vein) correspond to the branches of the artery of the same name, and a typical variant of IIV architectonics should be considered the fusion of the anterior and posterior trunks, with the internal genital vein and superior gluteal vein as the roots, respectively. All visceral tributaries flow into the anterior trunk, and nearly all extramural tributaries accompanying branches of the internal iliac artery flow into the posterior trunk.

The majority of authors studied the architectonics of the main trunk of the IIV without the systematization of its tributaries. Based on the review of available literature, no modern clinically oriented classification of the variability of IIV architectonics has been established, satisfying the needs of modern surgery during interventions on the pelvic organs. Knowledge of the IIV anatomical variants and its tributaries is necessary when performing surgical interventions in the small pelvis, particularly during evisceration, to prevent blood loss.

This article outlined promising directions in the study of the IIV and its tributaries, namely, methods of three-dimensional modeling, including the use of augmented reality technology, at various stages of surgical treatment of locally advanced pelvic tumors.

Full Text

Restricted Access

About the authors

Valery N. Rumyantsev

Military Medical Academy named after S.M. Kirov

Author for correspondence.
Email: doctorelanmp@bk.ru
ORCID iD: 0000-0001-7526-6282
SPIN-code: 8166-9820

MD

Russian Federation, Saint Petersburg

Ivan V. Gaivoronsky

Military Medical Academy named after S.M. Kirov; Saint Petersburg State University

Email: i.v.gaivoronsky@mail.ru
ORCID iD: 0000-0002-7232-6419
SPIN-code: 1898-3355

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Dmitry A. Surov

Military Medical Academy named after S.M. Kirov

Email: sda120675@mail.ru
ORCID iD: 0000-0002-4519-0018
SPIN-code: 5346-1613

MD, Dr. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg

Gennady I. Nichiporuk

Military Medical Academy named after S.M. Kirov; Saint Petersburg State University

Email: nichiporuki120@mail.ru
ORCID iD: 0000-0001-5569-7325
SPIN-code: 3532-1203

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Oleg V. Balyura

Military Medical Academy named after S.M. Kirov

Email: olegbalura@gmail.com
ORCID iD: 0000-0001-7826-8056
SPIN-code: 9260-9850

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

References

  1. Gajvoronskij IV, Kotiv BN, Kovalenko NA, et al. Alternative anatomy of a gastrolic trunk of genle and her applied value in surgery. Bulletin of The Russian Military Medical Academy. 2018;(2):124–129. EDN: XRZEVV doi: 10.17816/brmma1228
  2. Nayak SB. Dangerous twisted communications between external and internal iliac veins which might rupture during catheterization. Anat Cell Biol. 2018;51(4):309–311. doi: 10.5115/acb.2018.51.4.309
  3. Tubbs RS, Shoja MM, Loukas M. Bergman’s comprehensive encyclopedia of human anatomic variation. 1st edition. 2016. doi: 10.1002/9781118430309
  4. Gajvoronskij IV. Normal human anatomy. Saint Petersburg: SpecLit; 2020. (In Russ). EDN: ULBAEX
  5. Kachlik D, Pechacek V, Musil V, Baca V. The venous system of the pelvis: new nomenclature. Phlebology. 2010;25(4):162–173. doi: 10.1258/phleb.2010.010006
  6. Moore KL, Persaud TVN, Torchia MG. The developing human. Elsevier; 2016.
  7. Sadler TW. Langman’s medical embryology. Philadelphia: Lippincott William & Wilkins; 2010.
  8. Lotz PR, Seeger JF. Normal variations in iliac venous anatomy. AJR Am J Roentgenol. 1982;138(4):735–738. doi: 10.2214/ajr.138.4.735
  9. LePage PA, Villavicencio JL, Gomez ER, et al. The valvular anatomy of the iliac venous system and its clinical implications. J Vasc Surg. 1991;14(5):678–683. doi: 10.1067/mva.1991.31717
  10. Venieratos D, Panagouli E, Lolis E. Variations of the iliac and pelvic venous systems with special attention to the drainage patterns of the ascending lumbar and iliolumbar veins. Ann Anat. 2012;194(4):396–403. doi: 10.1016/j.aanat.2011.12.003
  11. Kanjanasilp P, Ng JL, Kajohnwongsatit K, et al. Anatomical variations of iliac vein tributaries and their clinical implications during complex pelvic surgeries. Dis Colon Rectum. 2019;62(7):809–814. doi: 10.1097/DCR.0000000000001335
  12. Morita S, Saito N, Mitsuhashi N. Variations in internal iliac veins detected using multidetector computed tomography. Acta Radiol. 2007;48(10):1082–1085. doi: 10.1080/02841850701589308
  13. Shin M, Lee JB, Park SB, et al. Multidetector computed tomography of iliac vein variation: prevalence and classification. Surg Radiol Anat. 2015;37(3):303–309. doi: 10.1007/s00276-014-1316-4
  14. Hekimoglu A, Ergun O. Evaluation of iliac venous variations with multidetector computed tomography. Surg Radiol Anat. 2021;43(9):1441–1448. doi: 10.1007/s00276-021-02740-7
  15. Chong GO, Lee YH, Hong DG, et al. Anatomical variations of the internal iliac veins in the presacral area: clinical implications during sacral colpopepxy or extended pelvic lymphadenectomy. Clin Anat. 2015;28(5):661–664. doi: 10.1002/ca.22482
  16. Sat-Muñoz D, Balderas-Peña MA, Cortés-Torres EJ, et al. Venas extrapélvicas posteriores tributarias de las venas iliacas internas: morfometría, tipos y variants. Cir Cir. 2020;88(3):306–313. doi: 10.24875/CIRU.19001325
  17. Shkvarko MG, Radeckaya KA, Smit O, et al. Surgical anatomy of the superior gluteal arteryand internal iliac vein in individuals of the brahimorphic somatotype. Health and Ecology Issues. 2021;18(2):86–93. EDN: GECCNH doi: 10.51523/2708-6011.2021-18-2-13
  18. Vidal V, Monnet O, Jacquier A, et al. Accessory iliac vein: surgical implications. J Spinal Disord Tech. 2010;23(6):398–403. doi: 10.1097/BSD.0b013e3181b26c88
  19. Majstrenko NA, Hvatov AA, Uchvatkin GV, Sazonov AA. Exenteration of the small pelvis in treatment of local tumors. Grekov’s Bulletin of Surgery. 2014;173(6):37–42. EDN: TAAFEV doi: 10.24884/0042-4625-2014-173-6-37-42
  20. Tsar’kov PV, Efetov SK, Tulina IA, Sidorova LV. Technique of sacrectomy at the combined operations for locally advanced rectal cancer. Rossijskij zhurnal gastrojenterologii, gepatologii, koloproktologii. 2016;26(5):92–98. EDN: YHTGCV doi: 10.22416/1382-4376-2016-26-5-92-98
  21. Fornalik H, Fornalik N. Uterus transplantation: robotic surgeon perspective. Fertil Steril. 2018;109(2):365. doi: 10.1016/j.fertnstert.2017.10.038
  22. Wagenknecht LV. New treatment of increased venous drainage in organic impotence: ligation of internal iliac veins. Eur Urol. 1989;16(3):172–174. doi: 10.1159/000471563
  23. Höckel M. Cancer permeates locally within ontogenetic compartments: clinical evidence and implications for cancer surgery. Future Oncology. 2012;8(1):29–36. doi: 10.2217/fon.11.128
  24. Höckel M. Laterally extended endopelvic resection: surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies. Am J Obstet Gynecol. 1999;180(2 Pt 1):306–312. doi: 10.1016/s0002-9378(99)70204-8
  25. Coker DJ, Austin KKS, Eyers AA, Young CJ. Pre-emptive triple tributary internal iliac vein ligation reduces catastrophic haemorrhage from sacrectomy during pelvic exenterative surgery. Tech Coloproctol. 2017;21(6):445–450. doi: 10.1007/s10151-017-1638-4
  26. Ishii M, Shimizu A, Lefor AK, Noda Y. Surgical anatomy of the pelvis for total pelvic exenteration with distal sacrectomy: a cadaveric study. Surg Today. 2021;51(4):627–633. doi: 10.1007/s00595-020-02144-x
  27. Beckett D, Santos SJ, Dabbs EB, et al. Anatomical abnormalities of the pelvic venous system and their implications for endovascular management of pelvic venous reflux. Phlebology. 2018;33(8):567–574. doi: 10.1177/0268355517735727
  28. Cardinot TM, Aragao AH, Babinski MA, Favorito LA. Rare variation in course and affluence of internal iliac vein due to its anatomical and surgical significance. Surg Radiol Anat. 2006;28(4):422–425. doi: 10.1007/s00276-006-0110-3
  29. Chuang VP, Mena CE, Hoskins PA. Congenital anomalies of the inferior vena cava. Review of embryogenesis and presentation of a simplified classification. Br J Radiol. 1974;47(556):206–213. doi: 10.1259/0007-1285-47-556-206
  30. Hayashi S, Naito M, Hirai S, et al. Proposal for a new classification of variations in the iliac venous system based on internal iliac veins: a case series and a review of double and left inferior vena cava. Anat Sci Int. 2013;88(4):183–188. doi: 10.1007/s12565-013-0182-1
  31. Mehta K, Iwanaga J, Tubbs RS. Absence of the right common iliac vein with the right internal iliac vein arising from the left common iliac vein: case report. Cureus. 2019;11(4): e4575. doi: 10.7759/cureus.4575
  32. Oto A, Akpinar E, Sürücü HS, et al. Right internal iliac vein joining the left common iliac vein: case report demonstrated by CT angiography. Surg Radiol Anat. 2003;25(3–4):339–341. doi: 10.1007/s00276-003-0123-0
  33. Grebenkov VG, Rumyancev VN, Ivanov VM, et al. Perioperative augmented reality technology in surgical treatment of locally advanced recurrent rectal cancer. Pirogov Russian Journal of Surgery. 2022;(12–2):44–53. EDN: QJDFIK doi: 10.17116/hirurgia202212244

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Variants of inferior vena cava and common iliac veins formation (M. Shin et al. [13]): 1 — IVС, typical variant; 2 — CIV, high formation (2a — on the right; 2b — on the left); 3 — EIV (3a — flow of the right IIV into the left CIV; 3b — flow of the left IIV into the right CIV); 4 — IIV (4a — right and left IIVs form a common trunk flowing into the confluence of the IVC; 4b — variant 4a + presence of anastomoses with the CIV on both sides); 5 — common venous trunk (a, b — presence of anastomosis of IIV with contralateral IIV; c, d — presence of anastomosis of IIV with contralateral CIV); 6 — venous anastomosis (a–e — variants of IVC doubling with/without anastomosis); 7 — “mirror” architectonics of CIV formation and their confluence with IVC; 8 (a, b) — variants of CIV doubling. Here: IIV — internal iliac vein, EIV — external iliac vein, IVС — inferior vena cava, CIV — common iliac vein; * the features of the architectonics are marked in gray in the figures.

Download (1MB)
Indexing metadata

Copyright (c) 2023 Eco-Vector


Периодический печатный журнал зарегистрирован как СМИ Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор): № 0110212 от 08.02.1993.
Сетевое издание зарегистрировано как СМИ Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор): ЭЛ № ФС 77 - 84733 от 10.02.2023.