Variations in the length and anatomy of the common iliac vessels and their clinical consideration during anterior pelvic approaches.

The bifurcation and confluence of the common iliac vessels and their course are critical considerations for safe surgical acetabular fracture repair. Anatomical variations in the expected placement of these vessels have been associated with intraoperative complications, including hemorrhage. The purpose of this study was therefore to define vertebral levels of bifurcation and confluence of the common iliac vessels and trace their passage across the quadrilateral plate, a surgically significant landmark. The findings revealed 57% and 11% of bifurcation and confluence, respectively, were located at vertebral levels higher than the commonly reported level of L4. Variations were also more common than previous reports, with the current study observing cases of absent common iliac veins and aberrant communicating veins. The course trajectories revealed 10.6% of the study sample would have been predisposed to surgical complications involving the common iliac vessels.