Download RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE

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