Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Pelvis
Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed
The epigastric may arise from the external iliac at a higher point than usual; it has been found 6.2 cm above the inguinal ligament.
It may arise from the femoral below the inguinal ligament or even from the profundus femoris artery, or as a common trunk with the circumflex iliac.
The inferior epigastric may be doubled.
The inferior epigastric may arise from, or conversely, give rise to the obturator artery. This variation is due to the anastomosis of the epigastric and obturator through their pubic branches. It is of considerable importance to the surgeon, since the obturator artery, when derived from the inferior epigastric, may run either lateral or medial to the femoral ring to reach the obturator foramen. This origin of the obturator artery from the epigastric occurs in about 20% of individuals.
From Pick, et al.(1942), "The pubic branch of the inferior epigastric anastomoses with the pubic branch of the obturator. Although usually small, the anasomosis may be considerably enlarged as an accessory obturator artery and is sometimes known as the abnormal obturator artery. At this point its exact course becomes of significant clinical interest. It may pass caudally on the medial side of the femoral vein and therefore lateral to the femoral ring, or it may course medial to the femoral ring and pass along the free edge of the lacunar ligament, in which situation it would be exposed to injury in surgical intervention. This unusual origin of the obturator artery occurs in 30% of all subjects, but in a portion of these cases only, the artery courses around the medial side of the femoral ring, in which situation it is liable to injury in operation for femoral hernia."
The inferior epigastric occasionally provides the dorsal artery of the penis/clitoris, circumflex iliac, superficial epigastric, and medial femoral circumflex arteries.
The deep inferior epigastric artery was present in all bodies bilaterally, most frequently as a single-stem vessel lying on the posterior aspect of the rectus femoris muscle, and enters the substance of the muscle in its middle third according to Milloy, Anson and McAfee (1960).
The superior epigastric artery is occasionally not seen on the dorsal surface of the rectus muscle, being either absent or buried in the muscle tissue. When present, it is usually a single stem that enters the medial portion of the muscle after a short course on the surface. According to Milloy, et al. (1960), in only 1 instance of 162 specimens examined, did the superior and inferior epigastric arteries anastomose on the surface of the rectus muscle in the pattern frequently depicted in anatomy texts. When muscle fibers were dissected away from the arteries, only 40% of the superior and inferior epigastric arteries were found to have any gross anastomoses.
Image 23, Image 128A, Image 215
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See Image 23
Anson, B.J., Ed. (1966) Morris' Human Anatomy, 12th ed. The Blakiston Division, McGraw-Hill Book Company, New York.
Bergman, R.A., Thompson, S.A., Afifi, A.K. and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. Urban & Schwarzenberg, Baltimore and Munich.
Delitzin, S. (1896) über eine complicierte Anomalie im Gebiete der Arteria obturatoria und epigastrica inferior. Arch. Anat. Physiol. Wissen. Med. 1896:413-422.
Dubreuil-Chambardel, L. (1925) Variations des Arteries du Pelvis et du Membre Inferieur. Masson, Paris.
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von Hochstetter, A. (1961) Eine Schleife der Arteria epigastrica inferior im Canalis inguinalis. Anat. Anz. 109:221-224.
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Milloy, F.J., Anson, B.J. and D.K. McAffee. (1960) The rectus abdominis muscle and the epigastric arterias. Surg., Gynecol. Obstet.. 110:293-302.
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Redfern, P. (1850) Origin of the epigastric and obturator arteries by a common trunk from the internal iliac; with an inquiry into the amount of danger occasioned by various positions of arteries in the ordinary operations for femoral and inguinal herniae. Monthly Journal of Medicine, Edinburgh 9:203-222.
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