Internal iliac

The blood supply to the vagina is through the uterine arteries and the internal iliac artery. Blood returns to the venous system through veins that empty into the internal iliac vein. Lymphatic drainage is through the external and internal iliac lymph nodes and superficial inguinal lymph nodes. 

Larsen DW, Halbach VV, Teitelbaum GP, McDougaU CG, Higashida RT, Dowd CF, Hieshima GB (1995) Spinal dural arteriovenous fistulas supplied by branches of the internal iliac arteries. Surg Neurol 43 35-40 discussion 40-1 Lasjaun ias P, Berenstein A, ter Brugge KG (2001) Surgical Neu-... 

Spiller W (1909) Thrombosis of the cervical anterior median spinal artery. I Nerv Ment Dis 36 601 Stein SC, Ommaya AK, Doppman JL, Di Chiro G (1972) Arteriovenous malformation of the cauda equina with arterial supply from branches of the internal iliac arteries. Case report. J Neurosurg 36 649-651 Stepper F, Lovblad KO (2001) Anterior spinal artery stroke demonstrated by echo-planar DWI. Eur Radiol 11 2607-2610 Suh T.H., Alexander L (1939) Vascular system of the human spinal cord. Arch Neurol Psychiat 41 659-677 Suzuki T, Kawaguchi S, Takebayashi T, Yokogushi K, Takada J, Yamashita T (2003) Vertebral body ischemia in the posterior spinal artery syndrome case report and review of the literature. Spine 28 E260-264... 

The human vagina, a fibromuscular tube 10-15 cm long, extends upwards and backwards from the vulva to the lower uterine cervix. Blood is supplied to the vagina via the uterine and pudendal arteries, and is drained from the vagina by a rich plexus, which flows into the internal iliac veins. The surface of the vaginal epithelium is kept moist by cervical secretions. The pH of vaginal fluid is 4-5. 

Live kids were euthanized by C02 asphyxiation, and lung tissue and abomasal fluid were collected on all kids bom or aborted. A month following the last birth or abortion, all dams were euthanized by captive-bolt and exsanguination. The following tissues were collected parotid, prescapular, internal iliac, and supra.mamma.ry lymph nodes liver spleen and mammary gland. All tissues collected were stored at -20°C until cultured for bacteriological analysis. 

Dam tissues homogenized and plated included parotid, prescapular, and supramammary lymph nodes liver spleen and internal iliac and mammary gland. 

Animals inoculated conjunctively usually are colonized in the parotid lymph node within the first 3 days postinfection, with the organism disseminating to the liver and spleen by 7 days postinfection. The supramammary and internal iliac lymph nodes should show signs of colonization by 14 days postinfection [15],... 

Internal Iliac Artery Embolization in the Stent-Graft Treatment of Aortoiliac Aneurysms... 

The advance of endovascular therapy for aorto-iliac aneurysmal disease has also brought about yet another flourishing application of embolotherapy. Embolization of the internal iliac artery plays an important adjunct initial modality to allow endovascular treatment of aortic aneurysms with extension into the common iliac arteries [78-80], It also plays an crucial role in the secondary management of complications related to endoleaks [81-84],... 

A spectrum of end-organ ischemic complications can occur with embolotherapy. Bowel infarction can complicate splanchnic embolization targeting bleeding or could result from inadvertent non-target embolization from an upstream source [88]. Gallbladder infarction or bile duct necrosis can complicate hepatic artery embolization or che-moembolization [89, 90]. Splenic abscess and overwhelming sepsis can occurs following splenic embolization [91]. Skin necrosis and nerve injury have been reported as a result of ethanol embolization of vascular malformations [53, 54]. Buttock muscular necrosis, buttock claudication and sexual dysfunction can occur as a result of internal iliac branch embolization, especially when distal or bilateral [92-95]. 

After completion of the primary embolization procedure, it is important to check other potential collateral pathways. For example, profunda femoris and contralateral internal iliac arteries are injected following embolization of an internal iliac bleeding source. 

Engelke C, Elford J, Morgan RA, Belli AM (2002) Internal iliac artery embolization with bilateral occlusion before endovascular aortoiliac aneurysm repair - clinical outcome of simultaneous and sequential intervention. J Vase Intervent Radiol 13 667-676... 

Schoder M, Zaunbauer L, Holzenbein T, et al. (2001) Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms frequency, efficacy, and clinical results. AJR Am J Roentgenol 177 599-605... 

Ramirez Jl, Velmahos GC, Best CR, Chan LS, Demetriades D (2004) Male sexual function after bilateral internal iliac artery embolization for pelvic fracture. J Trauma 56 734-739... 

Su WT, Stone DH, Lamparello PJ, Rockman CB (2004) Gluteal compartment syndrome following elective unilateral internal iliac artery embolization before endovascular abdominal aortic aneurysm repair. J Vase Surg 39 672-675... 

Kritpracha B, Pigott JP, Price Cl, Russell TE, Corbey MJ, Beebe HG (2003) Distal internal iliac artery embolization a procedure to avoid. J Vase Surg 37 943-348... 

Pisco JM, Martins JM, Correia MG (1989) Internal iliac artery embolization to control hemorrhage from pelvic neoplasms. Radiology 172 337-339... 

Hare WSC, Holland CJ (1983) Paresis following internal iliac artery embolization. Radiology 146 47-51... 

The IMA supplies colon distal to the splenic flexure including the descending colon, sigmoid colon, and rectum. When embolizing rectal branches off of the superior hemorrhoidal branch of the IMA, one must remember the rich collateral network around the rectum with middle hemorrhoidal branches arising from the internal iliac arteries. The internal iliac arteries should be studied after embolizing a rectal branch to exclude the possibility of collateral flow to the bleeding site. 

Differences in segmental arterial supply probably also impact on the risk of infarction. The rectum is likely to tolerate embolization better than other regions since it has a dual blood supply with the superior hemorrhoidal artery off of the inferior mesenteric artery and middle hemorrhoidal arteries arising from the internal iliac circulation. This translates into increased potential for collateral blood flow and thus decreased risk of ischemia. The cecum may be more prone to ischemia since there is not a well developed arcade along the mesenteric border of the cecum and instead there are separate anterior and posterior cecal branches. The tissue supplied by these individual branches may be more susceptible to ischemia and in fact infarction of the cecum (even after microcatheter embolization) has been reported [13]. 

Fig.9.3a,b. Right iliac angiogram showed collateral pathways from the artery supplying the round ligament after embolization of both right internal iliac and uterine arteries... 

Catheterization of bilateral uterine arteries is mandatory. A cobra-shaped catheter is the best catheter to use for easy insertion into uterine arteries. The cobra catheter is available in three different types, each according to the degree of opening of the curve. The medium sized catheter (C2) is the one most commonly used. When using a 4-F catheter, one should make sure that the lumen of the catheter is able to accept 0.038-in. guidewire for possible microcatheter use. The contralateral internal iliac artery is catheterized first and can be reached by pushing the cobra. In some difficult cases, a curved catheter, such as SOS or sidewinder, could be handy to cross the aortic bifurcation. 

For this reason, when an embolotherapy is planned we recommend immediate cessation of prostaglandin Ej agonist infusion. In case of arterial spasm at the ostium of the uterine artery, the use of a coaxial system with a microcatheter is then required. It is possible to successfully catheterize the distal part of the uterine artery in most cases. In these circumstances, the preferred embolic agent is the one that can be easily delivered through a microcatheter, such as PVA (Polyvinyl alcohol) or Embospheres. We prefer to use particles with larger diameters, such as Embospheres 700-900 mg. Even if these particles are used for the above-mentioned reasons, additional Gelfoam embolization of internal iliac arteries is performed because of the extensive collateral pathways of the female pelvis. 

In the absence of arterial spasm, embolization with Gelfoam pledge of both uterine and internal iliac arteries is always performed in order to obtain a bilateral proximal and distal embolization to prevent rebleeding. Even with Gelfoam pledge, we always use large-cut sizes to prevent embolization that is too distal. Embolization with coils is not per-... 

Since the first embolization of PPH performed by Brown in 1979, the reported success rate in 138 patients over a 20-year period was as high as 94.4% [35-43]. To date, 160 patients have been treated at our institution (the first author s institution) by selective uterine and/or internal iliac arteries embolization for intractable bleeding following delivery. Despite the variety of the etiologies and risk factors in our series, no maternal deaths were observed. The main cause of hemorrhage was related to uterine atony, with an incidence of 75%. Cesarean delivery... 

Fig.9.7a-d. Angiogram of right internal iliac artery demonstrates contrast media extravasation (double arrow) superselective catheterization using microcatheter and embolization with microcoils (arrows). (Courtesy of Patrice Garance)... 

Our approach to patients with abnormal placentation is to selectively embolize bilateral uterine and internal iliac arteries as soon as possible after delivery. Using the embolization technique, we obtained results similar to that of the prophylactic in controlling PPH, but without the risk of radiation to the fetus. 

The selective transcatheter technique for embolization of uterine and/or internal iliac arteries in the management of intractable bleeding after delivery is safe and effective. In order to create the best hemodynamic and clinical conditions for this therapy, a strong multidisciplinary collaboration is essential to optimize clinical outcomes. 

Dubois J, Garel L, Grignon A, Lemay M, Leduc L (1997) Placenta percreta balloon occlusion and embolization of the internal iliac arteries to reduce intraoperative blood losses. Am J Obstet Gynecol 176 723-726... 

Collins CD, Jackson JE (1995) Pelvic arterial embolization following hysterectomy and bilateral internal iliac artery ligation for intractable primary post partum hemorrhage, gin Radiol 50 710-713... 

The uterine blood supply is primarily from the uterine arteries. The uterine arteries arise as branches of the internal iliac (hypogastric) arteries. In most cases, the internal iliac artery divides into a posterior division that gives off the iliolumbar, the lateral sacral and the superior gluteal arteries and an anterior division that gives rise to parietal branches (the obturator, inferior gluteal and internal puden-... 

The uterine artery arises from the anterior division of the internal iliac artery usually close to, or in common with the middle hemorrhoidal or vaginal artery. There are several configurations for the origin of the uterine artery. It can be the first... 

---