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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. Name of the Candidate Dr. SAMEEN TAJ and Address P.G. IN ANATOMY (in block letters) J.J.M. MEDICAL COLLEGE, DAVANGERE – 577 004. KARNATAKA. 2. Name of the Institution J.J.M. MEDICAL COLLEGE, DAVANGERE - 577 004. 3. Course of study and subject POST GRADUATE DEGREE M.D. – ANATOMY 30th MAY 2008 4. Date of Admission to course 5. Title of the Topic 6. Brief Resume of the intended work : “STUDY OF INTERNAL ILIAC ARTERY AND ITS BRANCHING PATTERN IN PELVIS” 6.1 Need for the study : The internal iliac artery is the major artery of the pelvis and perineum. It provides blood supply to most of the pelvic viscera, viz. rectum, urinary bladder, prostate and seminal vesicles in male, uterus in females, pelvic walls, structures in the perineum including erectile tissues of the clitoris and the penis, lower posterior abdominal wall, the gluteal region, the adductor region of thigh and in fetus, the placenta. Knowledge of internal iliac artery and its branching pattern is not only important for the anatomists but also for surgeons, obstetricians and gynaecologists, urologists and the vascular surgeons. 1 For surgeons, while operating on pelvic organs for eg: in haemorrhoids operation and rectal malignancies, the knowledge of internal iliac artery and its branching pattern is very much required. Effective ligation of the bilateral internal iliac artery is one of the life saving maneuvers in the treatment of uncontrolled post partum haemorrhage. Intractable haemorrhage during transurethral resection of prostate can be controlled by ligation of internal iliac artery. But embolisation of internal iliac artery is preferred and now widely practiced because it is a minimally invasive technique. The intentional ligation of internal iliac artery is also done in the treatment of endovascular repair of aortoiliac aneurysms. The iliac crest flap pedicled on the ilio-lumbar artery, a branch of posterior division of internal iliac artery, is being used as a reliable bone flap. In all the above mentioned surgeries, the knowledge of internal iliac artery and its branching pattern is essential. Hence this study is undertaken. 6.2 Review of literature : Each internal iliac artery is 4cm long, begins at the common iliac bifurcation, level with the lumbosacral intervertebral disc and anterior to the sacroiliac joint. It descends posteriorly, to the superior margin of the greater sciatic foramen where it divides into an anterior trunk, which continues in the same line towards the ischial spine, and a posterior trunk, which passes back to the greater sciatic foramen.1 In the fetus, the blood is returned to the placental circulation through the umbilical artery, the first branch of internal iliac artery. 2 There is great variation in the precise branching pattern of the internal iliac artery. Nine major types of branching and 49 subtypes have been described. The structures and the regions supplied by the branches of the artery, however are quiet constant.2 The branches of the anterior division are mainly visceral i.e., they supply the bladder, rectum and reproductive organs. It also has two parietal branches that pass to the buttock and thigh. The arrangement of the visceral branches is variable. The branches from the posterior division of internal iliac artery are mainly muscular i.e., the superior gluteal artery, ilio-lumbar and lateral sacral arteries.3 In a study of 169 pelvic halves, the parietal branches of the internal iliac artery were dissected from their sites of origin from the parent trunk and their destinations and any abnormalities found were recorded. They were classified into 5 types based on modified Adachi classification (1928). Type-I arrangement was the most frequent finding (58.5%).4 In a study of 316 pelvises of formalin fixed adult cadavers, in one adult male cadaver the obturator artery was arising from the posterior division of internal iliac artery. It is documented that in 41.4% of cases obturatory artery arose from the common iliac or anterior division of internal iliac, in 25% from inferior epigastric, in 10% from superior gluteal, in 10% from inferior gluteal/internal pudendal trunk, in 4.7% from inferior gluteal, in 3.8% from internal pudendal artery and in 1.1% from external iliac artery.5 3 In a study based on the dissection of 645 pelvic havles of Japanese cadavers, the branching of internal iliac artery was classified according to Adachi’s classification and the data was compared with the previous reports. Type I was predominant in this study also (80%).6 In another study, dissections were performed in 54 female cadavers. Average length of internal iliac artery was 27mm. Posterior division branches arose from a common trunk in 62.3%. In the remaining specimens, branches arose independently, with the ilio lumbar noted as the first branch in 28.3%, lateral sacral in 5.7% and superior gluteal in 3.8%. The average width of the first branch was 5mm.7 6.3 Objectives of the study : 1. To study the branching pattern of internal iliac artery by dissection method. 2. To study the variations in the pattern of branches. 7. Material and methods : 7.1 Source of data : From embalmed cadavers from the Department of Anatomy, J.J.M. Medical College, Davangere. From embalmed cadavers from the Department of Anatomy, S.S. Institute of Medical Sciences and Research Centre, Davangere. 7.2. Method of collection of data (including sampling procedure if any): Dissection method Sample size : 30 4 7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly. No 7.4. Has ethical clearance been obtained from your institution in case of 7.3? Obtained 8. References : 1. Standring S. Gray’s Anatomy. The anatomical basis of clinical practice. 39th Ed., London : Elsevier Churchill Livingstone; 2005. p.1360-62. 2. Hollinshead WH, and Rosse C. The text book of anatomy. 4th Ed. U.S.A.: Harper and Row; 1985. p.745-47. 3. Moore KL. Clinically oriented anatomy. 4th Ed., Baltimore, U.S.A.: Williams and Wilkins; 1992. p.350-55. 4. Braithwaite JL. Variations in origin of the parietal branches of the internal iliac artery. J Anat Soc India 1952;86:423-30. 5. Kumar D, and Rath G. Anamolous origin of obturator artery from the internal iliac artery. A case report. Int J Morphol 2007;25(3):639-41. 6. Yamaki K, Saga T, Doy Y, Aida K, Yoshizuka M. A statistical study of the branching of the human internal iliac artery. Kurume Med J 1998;45(4):333-40. 7. Bleich AT, Rahn DD, Wieslander CK, Wai CY, et al. Posterior division of internal iliac artery: anatomic variations and clinical applications. Am J Obstet Gynecol 2007;197(6):658. 5 9. Signature of candidate 10 Remarks of the guide 11 Name & Designation of (in block letters) 11.1 Guide The present study may be undertaken to know the branching pattern of internal iliac artery, which may be useful for surgeons, gynaecologists, orthopaedicians and urologists. Dr. A.V. ANGADI M.S., PROFESSOR, DEPARTMENT OF ANATOMY, J.J.M. MEDICAL COLLEGE, DAVANGERE - 577 004. 11.2 Signature 11.3 Co-Guide (if any) -- 11.4 Signature -- 11.5 Head of Department DR. C.M. RAMESH M.S., PROFESSOR AND HEAD, DEPARTMENT OF ANATOMY, J.J.M. MEDICAL COLLEGE, DAVANGERE - 577 004. 11.6 Signature 12 Remarks of the Chairman & Principal 12.2. Signature. 6