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Case report: Description of a venous annulus of the external iliac vein
ARTICLE IN PRESS Ann Anat 188 (2006) 451—453
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Case report: Description of a venous annulus of the external iliac vein Gabriel Djedovic, Diana Putz Innsbruck Medical University, Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology (Head. O. Univ. Prof. Dr. med. Helga Fritsch), Mu ¨ llerstrasse 59, A-6020 Innsbruck, Austria Received 18 March 2006; accepted 12 April 2006
KEYWORDS External iliac vein; Venous annulus
Summary This report describes a case of a venous annulus of the left external iliac vein. Above the inguinal ligament the external iliac vein divides into two branches, which are interlinked by a communicating branch, forming two loops. The first loop is situated around the external iliac artery, the second loop is found between the communicating branch and the common iliac vein. Although variations of the external iliac vein have already been reported, we could not find any description which would match to our observation. & 2006 Elsevier GmbH. All rights reserved.
Introduction
Case report
The internal iliac vein is supplied by the veins arising from the organs of the pelvis and from the perineum. The external iliac vein is the continuation of the femoral vein and collects the blood from the inferior epigastric vein, the deep circumflex iliac vein and the pubic branch. Both, the internal and external iliac veins are localized medially and dorsally to the homonymous arteries (Frick et al., 1992).
During cadaver dissection for student education in our institute, a case of loop anastomosis between the internal and external iliac veins was observed on the left side in a 74-year-old female specimen (Fig. 1). Immediately after the passage through the lacuna vasorum the left external iliac vein is localized medially to the homonymous artery (Figs. 2 and 3). Three centimetres above the inguinal ligament the external iliac vein divides into two branches, one situated medially and one laterally (Fig. 3). The lateral branch first crosses over the external iliac artery, then runs
Corresponding author. Tel.: +43 512 507 3057;
fax: +43 512 507 2862. E-mail address: [email protected] (D. Putz).
0940-9602/$ - see front matter & 2006 Elsevier GmbH. All rights reserved. doi:10.1016/j.aanat.2006.04.003
ARTICLE IN PRESS 452
G. Djedovic, D. Putz
Fig. 1. Overview of the pelvis. a ¼ external iliac artery; v ¼ external iliac vein; il ¼ inguinal ligament.
Fig. 2. Left external iliac artery and left external iliac vein. The left external iliac vein divides into a medial and a lateral branch 3 cm above the inguinal ligament. a ¼ external iliac artery; v ¼ external iliac vein; mb ¼ medial branch of the external iliac vein; lb ¼ lateral branch of the external iliac vein; il ¼ inguinal ligament.
dorso-laterally and finally meets the common iliac vein. The medial branch is situated dorso-medially to the external iliac artery and meets the internal iliac vein. Dorsal to the external iliac artery these two branches are interlinked by a communicating branch (Fig. 4). This anastomosis is localized 2 cm underneath the confluence of the external and internal iliac vein to the common iliac vein. Thus, there result two loops. The first loop is situated around the external iliac artery, the second loop is found between the communicating branch and the common iliac vein. No structures were observed pervading the second loop (Fig. 4).
Fig. 3. The medial and the lateral branch of the left external iliac vein surround the left external iliac artery. a ¼ external iliac artery; v ¼ external iliac vein; mb ¼ medial branch of the external iliac vein; lb ¼ lateral branch of the external iliac vein; il ¼ inguinal ligament.
On the right side the topographic anatomy of the iliac veins corresponds with the normal one already mentioned in the introduction.
Discussion It has already been reported, that the internal iliac vein may form a venous annulus around the internal iliac artery and that the external iliac vein
ARTICLE IN PRESS Description of a venous annulus
453 may be doubled or lie laterally to the external iliac artery (Bergman et al., 1988). Adachi (1933) described a vena iliaca accessoria which anastomoses with the right iliac vein in front of the right iliac artery. Henle mentioned that the right common iliac vein forms an island, but without detailed description. Henle (1868) related his information about the variations of the iliac veins to the descriptions of Quain (1844) and probably to a case reported by Haller (1765). According to Quain’s anatomy, the common iliac vein is sometimes divides into two vessels for a portion of its extent (Scha ¨fer and Thane, 1892). However, we could not find any description which would match to our observation.
Acknowledgement We are indebted to Mr. Herbert Maurer and Mr. Bernhard Moriggl for their advices and constructive support.
References
Fig. 4. Overview of the anastomosis between the lateral and the medial branch of the external iliac vein with the illustration of the two loops separated by the communicating branch. a ¼ external iliac artery; v ¼ external iliac vein; mb ¼ medial branch of the external iliac vein; lb ¼ lateral branch of the external iliac vein; cb ¼ communicating branch; 1 ¼ First loop; 2 ¼ Second loop.
Adachi, B., 1933. Anatomie der Japaner, Venensytem. Bergman, R.A., Thomson, S.A., Afifi, A.K., Saadeh, F.A., 1988. Compendium of Human Anatomic Variation. Urban and Schwarzenberg. Baltimore, Munich. Frick, H., Leonhardt, D., Starck, D., 1992. Spezielle Anatomie II. 4.Auflage. Thieme. Stuttgart, New York. Haller, A., 1765. Elem. Physiol. VII: 512 (We have not had access to this reference). Henle, J., 1868. Handbuch der systematischen Anatomie des Menschen; 3.Band: Handbuch der Gefa ¨sslehre des Menschen. Verlag von Friedrich Vieweg und Sohn, Braunschweig. p. 397. Quain, 1844. Taf. LVIII, Fig. 5. Scha ¨fer, E.A., Thane, G.D., 1892. Quain’s Elements of Anatomy, vol. II, part II. tenth Ed. Longmans, Green and Co. London, New York. p. 536.
www.elsevier.de/aanat
Case report: Description of a venous annulus of the external iliac vein Gabriel Djedovic, Diana Putz Innsbruck Medical University, Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology (Head. O. Univ. Prof. Dr. med. Helga Fritsch), Mu ¨ llerstrasse 59, A-6020 Innsbruck, Austria Received 18 March 2006; accepted 12 April 2006
KEYWORDS External iliac vein; Venous annulus
Summary This report describes a case of a venous annulus of the left external iliac vein. Above the inguinal ligament the external iliac vein divides into two branches, which are interlinked by a communicating branch, forming two loops. The first loop is situated around the external iliac artery, the second loop is found between the communicating branch and the common iliac vein. Although variations of the external iliac vein have already been reported, we could not find any description which would match to our observation. & 2006 Elsevier GmbH. All rights reserved.
Introduction
Case report
The internal iliac vein is supplied by the veins arising from the organs of the pelvis and from the perineum. The external iliac vein is the continuation of the femoral vein and collects the blood from the inferior epigastric vein, the deep circumflex iliac vein and the pubic branch. Both, the internal and external iliac veins are localized medially and dorsally to the homonymous arteries (Frick et al., 1992).
During cadaver dissection for student education in our institute, a case of loop anastomosis between the internal and external iliac veins was observed on the left side in a 74-year-old female specimen (Fig. 1). Immediately after the passage through the lacuna vasorum the left external iliac vein is localized medially to the homonymous artery (Figs. 2 and 3). Three centimetres above the inguinal ligament the external iliac vein divides into two branches, one situated medially and one laterally (Fig. 3). The lateral branch first crosses over the external iliac artery, then runs
Corresponding author. Tel.: +43 512 507 3057;
fax: +43 512 507 2862. E-mail address: [email protected] (D. Putz).
0940-9602/$ - see front matter & 2006 Elsevier GmbH. All rights reserved. doi:10.1016/j.aanat.2006.04.003
ARTICLE IN PRESS 452
G. Djedovic, D. Putz
Fig. 1. Overview of the pelvis. a ¼ external iliac artery; v ¼ external iliac vein; il ¼ inguinal ligament.
Fig. 2. Left external iliac artery and left external iliac vein. The left external iliac vein divides into a medial and a lateral branch 3 cm above the inguinal ligament. a ¼ external iliac artery; v ¼ external iliac vein; mb ¼ medial branch of the external iliac vein; lb ¼ lateral branch of the external iliac vein; il ¼ inguinal ligament.
dorso-laterally and finally meets the common iliac vein. The medial branch is situated dorso-medially to the external iliac artery and meets the internal iliac vein. Dorsal to the external iliac artery these two branches are interlinked by a communicating branch (Fig. 4). This anastomosis is localized 2 cm underneath the confluence of the external and internal iliac vein to the common iliac vein. Thus, there result two loops. The first loop is situated around the external iliac artery, the second loop is found between the communicating branch and the common iliac vein. No structures were observed pervading the second loop (Fig. 4).
Fig. 3. The medial and the lateral branch of the left external iliac vein surround the left external iliac artery. a ¼ external iliac artery; v ¼ external iliac vein; mb ¼ medial branch of the external iliac vein; lb ¼ lateral branch of the external iliac vein; il ¼ inguinal ligament.
On the right side the topographic anatomy of the iliac veins corresponds with the normal one already mentioned in the introduction.
Discussion It has already been reported, that the internal iliac vein may form a venous annulus around the internal iliac artery and that the external iliac vein
ARTICLE IN PRESS Description of a venous annulus
453 may be doubled or lie laterally to the external iliac artery (Bergman et al., 1988). Adachi (1933) described a vena iliaca accessoria which anastomoses with the right iliac vein in front of the right iliac artery. Henle mentioned that the right common iliac vein forms an island, but without detailed description. Henle (1868) related his information about the variations of the iliac veins to the descriptions of Quain (1844) and probably to a case reported by Haller (1765). According to Quain’s anatomy, the common iliac vein is sometimes divides into two vessels for a portion of its extent (Scha ¨fer and Thane, 1892). However, we could not find any description which would match to our observation.
Acknowledgement We are indebted to Mr. Herbert Maurer and Mr. Bernhard Moriggl for their advices and constructive support.
References
Fig. 4. Overview of the anastomosis between the lateral and the medial branch of the external iliac vein with the illustration of the two loops separated by the communicating branch. a ¼ external iliac artery; v ¼ external iliac vein; mb ¼ medial branch of the external iliac vein; lb ¼ lateral branch of the external iliac vein; cb ¼ communicating branch; 1 ¼ First loop; 2 ¼ Second loop.
Adachi, B., 1933. Anatomie der Japaner, Venensytem. Bergman, R.A., Thomson, S.A., Afifi, A.K., Saadeh, F.A., 1988. Compendium of Human Anatomic Variation. Urban and Schwarzenberg. Baltimore, Munich. Frick, H., Leonhardt, D., Starck, D., 1992. Spezielle Anatomie II. 4.Auflage. Thieme. Stuttgart, New York. Haller, A., 1765. Elem. Physiol. VII: 512 (We have not had access to this reference). Henle, J., 1868. Handbuch der systematischen Anatomie des Menschen; 3.Band: Handbuch der Gefa ¨sslehre des Menschen. Verlag von Friedrich Vieweg und Sohn, Braunschweig. p. 397. Quain, 1844. Taf. LVIII, Fig. 5. Scha ¨fer, E.A., Thane, G.D., 1892. Quain’s Elements of Anatomy, vol. II, part II. tenth Ed. Longmans, Green and Co. London, New York. p. 536.