8 - Clinical Implications of Variations in the Vasculature of the Gluteal Region

Poster Board Number: 8
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Abstract Body : Introduction and Objective: Variations in the branches of the internal iliac artery are common; however, the absence of an entire branch and variations of these branches in the gluteal region are rare. In this report, we describe multiple variations of the gluteal region vasculature that were identified during dissection.

Materials and Methods: Anomalies in the vasculature of the gluteal region were noted during a routine dissection of a white male cadaver. The right and left gluteus maximus muscles were reflected to reveal the musculature and neurovasculature of the region. The pelvis was then hemisected and the branches of the right and left internal iliac arteries in the pelvic cavity were exposed to reveal variations in the origins of these arteries.

Results: On the right side of the gluteal region, the superficial branch of the superior gluteal artery is large and descends inferiorly across the piriformis muscle to give off branches that travel with the inferior gluteal nerve. The inferior gluteal artery is present, but miniscule and with few branches. The internal pudendal artery typically passes through the gluteal region without branching, but in this individual the artery gives off several branches, one of which contributes to the cruciate anastomosis. On the left side of the gluteal region, the inferior gluteal artery is completely absent. An enlarged superficial branch of the superior gluteal artery descends over the piriformis muscle into the inferior half of the gluteal region. A small branch from the superficial branch runs within the sacrotuberous ligament before traveling to the undersurface of the gluteus maximus muscle.

Conclusions: The large superior gluteal artery and the branches of the internal pudendal artery on the right side appear to be compensating for the small inferior gluteal artery. On the left side, the enlarged superior gluteal artery descends to replace the inferior gluteal artery.

Significance: Variations of the superior and inferior gluteal arteries and the cruciate anastomosis may not present clinically with any symptoms. Gluteal flaps used in the reconstruction of trunk wounds and pressure sores utilize the knowledge that there are both superior and inferior gluteal arteries feeding the local musculature. In cases where both gluteal arteries may not be present, like in the current study, lifting a flap based on one artery may lead to necrosis of adjacent musculature due to the loss of its blood supply. Knowledge of these types of anomalies may prompt surgeons to proceed with more caution during surgical interventions in the gluteal region.