CLINICAL ASSESSMENT OF THE INTERNAL ILIAC ARTERY BRANCHING VARIANTS AT X-RAY EXAMINATIONS IN PATIENTS WITH MULTIFOCAL ATHEROSCLEROSIS

The variant anatomy of the Internal Iliac Artery (IIA) is diverse and complex. Due to the complexity of the pelvic arterial system, thorough anatomical knowledge is paramount. We evaluated the applicability of the Adachi and Yamaki classification with Computerized Tomography Angiography (CTA) and Digital Subtraction Angiography (DSA) in the evaluation of patients with multifocal atherosclerosis. Results of these diagnostic research methods were compared. Our purpose was to evaluate the ability of CTA and DSA, to determine a branch typing of IIA, to improve diagnosis and treatment in patients with complex multifocal lesions. The single-center retrospective analysis of CTA and DSA findings in 30 male patients with multifocal atherosclerosis was made. The branching patterns of IIA were classified according to the Adachi and Yamaki classifications. The comparison of the research methods was based on revealing atherosclerotic lesions of IIA or the Internal Pudendal Arteries (IPA) during the standard diagnostic investigation: CTA versus DSA. At the same time, we calculated the sensitivity and specificity of DSA in the diagnosis of IPA lesions and the main arteries of the iliac segments. Computerized Tomography Angiography and Digital Subtraction Angiography findings did not allow the classification of all the pelvic sides according to the Adachi and Yamaki classifications. So, only 65.95 % of the investigated branch types of IIA were determined due to CTA, and only 47.83 % – due to DSA. The DSA sensitivity and specificity in the diagnosis of main vessel lesions was 93.1 and 80.0 %, respectively. The DSA sensitivity and specificity in the diagnosis of IPA lesions was 60.0 and 75.0 %, respectively. The Adachi and Yamaki classifications are radiologically reproducible but do not allow easy recognition of the main IIA branches in patients with multifocal atherosclerosis. Due to the complexity and variability of the pelvic arterial system, especially in patients with multifocal lesions, it is necessary to carry out primarily CTA for modeling possible surgical or endovascular intervention.

internal iliac artery, internal pudendal artery, anatomic variation, angiography, computerized tomography angiography, digital subtraction angiography

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