A cadaveric study on the origins of the uterine artery

Abstract

The uterine artery (UA) is a visceral branch from the anterior division of the internal iliac artery (IIA). Knowledge of the variant origins of this artery is critical during radiologic and surgical procedures of the pelvis, especially those involving the uterus, where managing blood flow is vital. Though its path and destination are well agreed upon, the origin of the UA differs notably, and has led many anatomists to create numerous descriptions for the distinctive variation. This project investigated the origin of the UA in the unique South Texas population of female cadavers donated to the UT Health San Antonio and established a fundamental and comprehensive classification system of the origin of this vessel which readily accommodates previous systems while improving its descriptive terminology. As the UA was identified, its origin was classified into three different ranks—primary, secondary, or tertiary. Primary‐ranked vessels originated directly from the internal iliac artery (IIA) and took three different formations as a separate branch, bifurcation with another vessel, or trifurcation with two other vessels. Secondary‐ranked UAs originated from primary vessels and tertiary‐ranked vessels originated from secondary vessels. 58.97% (23/39) of the UAs studied arose from the IIA as a primary‐ranked vessel, 38.5% (15/39) as a secondary rank, and 2.6% (1/39) as a tertiary rank. 21.7% (5/23) of primary‐ranked UAs took origin from IIA as a separate branch, 56.5% (13/23) as bifurcation with another vessel and 21.7% (5/23) as trifurcation with two other vessels. The UA originated as a bifurcation with the umbilical artery (UmbA) in 13/13 cases. UA origin as a trifurcation was observed in 3 different patterns: 40% (2/5) with the UmbA and the superior vesical artery (SVA); 40% (2/5) with the UmbA and vaginal artery (VA); 20% (1/5) with SVA and the internal pudendal artery (IPA). 93.3% (14/15) of secondary‐ranked UA arose from the UmbA and 6.7% (1/15) from the IPA. We observed a single tertiary ranked UA arising from the vaginal artery (VA), which took origin from the UmbA, a branch of the anterior division of the IIA. It is imperative that the prevalence of these primary‐ranked UA bifurcations and trifurcations be further established since permanent occlusion at the vessel’s origin may subsequently lead to necrosis of unintended tissues. Larger sample sizes amongst differing populations may lead to the discovery of uncommon bifurcation and trifurcation patterns, or with similar vessels in differing proportions. It would also be important to translate the evaluation criteria used in this study into 3D and 4D digital subtraction angiography or cone‐beam computed tomography software for clinical studies. Increasing awareness of the variant origins of the UA will ultimately improve patient treatment outcomes, particularly for female reproductive health.