{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:09:34Z","timestamp":1787238574755,"version":"build-2736575974"},"reference-count":77,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T00:00:00Z","timestamp":1703635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe obstetrical or gynecologic hemorrhage, IIA ligation can be a lifesaving procedure. Regrettably, IIA ligation has not gained widespread popularity, primarily due to limited surgical training and concerns regarding possible complications, including buttock claudication, impotence, and urinary bladder and rectum necroses. Nowadays, selective arterial embolization or temporary balloon occlusion are increasingly utilized alternatives, which can be applied preoperatively or intraoperatively for threatening severe genital or pelvic bleeding. However, IIA ligation retains its relevance, as the previously described procedures are not always available and have limitations. This article provides a step-by-step guide to the IIA ligation procedure and its possible complications. It also includes a detailed description of the anatomy of the IIA and pelvic arterial anastomoses. This review highlights the importance of a thorough understanding of pelvic anatomy as a prerequisite for safe IIA ligation and posits that training in this procedure should be an integral part of obstetrics and gynecology curricula.<\/jats:p>","DOI":"10.3390\/clinpract14010005","type":"journal-article","created":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T07:45:32Z","timestamp":1703663132000},"page":"32-51","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Internal Iliac Artery Ligation in Obstetrics and Gynecology: Surgical Anatomy and Surgical Considerations"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5279-3095","authenticated-orcid":false,"given":"Stoyan","family":"Kostov","sequence":"first","affiliation":[{"name":"Research Institute, Medical University Pleven, 5800 Pleven, Bulgaria"},{"name":"Department of Gynecology, Hospital \u201cSaint Anna\u201d, Medical University, 9002 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yavor","family":"Kornovski","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Hospital \u201cSaint Anna\u201d, Medical University, 9002 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6828-1887","authenticated-orcid":false,"given":"Rafa\u0142","family":"Watrowski","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Helios Hospital M\u00fcllheim, 79379 M\u00fcllheim, Germany"},{"name":"Faculty Associate, Medical Center, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4830-6159","authenticated-orcid":false,"given":"Stanislav","family":"Slavchev","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Hospital \u201cSaint Anna\u201d, Medical University, 9002 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonka","family":"Ivanova","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Hospital \u201cSaint Anna\u201d, Medical University, 9002 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7719-382X","authenticated-orcid":false,"given":"Angel","family":"Yordanov","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,27]]},"reference":[{"key":"ref_1","unstructured":"Gray, H., Standring, S., Hrold Ellis, H., and Berkovitz, B. 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