PMC4861864_01
Axial, contrast-enhanced CT image through the level of the upper pelvis. There is absence of the common iliac arteries bilaterally. Note, however, the presence of both the right and left common iliac veins (white arrows). An enlarged median sacral artery (curved white arrow) provides a means of collateral flow. An enlarged superior hemorrhoidal artery with the paired vein is also noted (black arrowheads).
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Imaging revealed an unexpected unique arterial vasculature, with absence of the common iliac arteries bilaterally and the left internal iliac artery (Figure 1, Figure 2).
A. Frontal, three-dimensional (3D) volume-rendered image of the abdomen and pelvis. There is absence of common iliac arteries bilaterally with termination of the abdominal aorta into an enlarged median sacral artery (white curved arrow). Note the presence of the right internal iliac artery (black arrowhead). There is an enlarged left iliolumbar artery (black arrow). There is reconstitution of flow in the bilateral external iliac arteries. B. Left anterior oblique 3D volume-rendered image of the abdomen and pelvis. Note the right iliolumbar artery (black curved arrow) and right internal iliac artery (black arrowhead) with reconstitution of the right external iliac artery. There is a large left fourth lumbar artery (white arrows,) with anastomosis to a large left iliolumbar artery (black arrows). Note again a large median sacral artery (curved white arrow). C. Right anterior oblique 3D volume-rendered image of the abdomen and pelvis. There are prominent lumbar arteries (white arrows), large right (curved black arrow) and left (black arrow) iliolumbar arteries, and a prominent median sacral artery, all providing flow to the reconstituted external iliac arteries bilaterally.
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Imaging revealed an unexpected unique arterial vasculature, with absence of the common iliac arteries bilaterally and the left internal iliac artery (Figure 1, Figure 2). Prominent collaterals were noted, including enlarged iliolumbar arteries, lumbar arteries, and the median sacral artery, which contributed to the reconstitution of flow into the external iliac arteries (Fig. 2A). On the right, there was absence of the common iliac artery with an enlarged right iliolumbar artery supplying the majority of flow into the external and internal iliac arteries through the lumbar arteries, as well as collateral supply by sacral branches of the median sacral artery (Fig. 2B). On the left, there was absence of both the common and internal iliac arteries with an enlarged left iliolumbar artery supplying flow into the external iliac artery and pelvic visceral branches, as well as collateral supply by the superior hemorrhoidal artery (Fig. 2C).