Three-dimensional computed tomography angiography reconstruction of the origin of the uterine artery and its clinical significance

In women, the uterine artery is the main branch of the internal iliac artery, vascularizing most of the uterus. Knowledge of its origin and variations is essential during extensive gynaecological surgery and interventional radiological procedures. We aimed to investigate its origin and explore its anatomical variations by three-dimensional (3D) reconstructed computed tomography (CT) angiography. This was a retrospective, monocentric observational study involving CT scans of the abdomen and lower limbs of women < 50 years old with 3D reconstructed CT images of the internal and external iliac arterial axes. Between 01 January 2014 and 31 December 2015, among 986 cases of CT scans performed in women, for all indications, 3D reconstructed images for 43 women could be analysed. The uterine artery originated from a common trunk with the umbilical artery in 62.7% of cases, from a direct branch of the internal iliac artery in 25.6% of cases, directly from the superior gluteal artery in 9.3% of cases and from the internal pudendal artery in 2.3%. Three-dimensional(3D) reconstructed CT angiography can detect the point of origin of the uterine artery. Therefore, it can be used as a mapping tool of the pelvic arterial tree. Our study corroborates data from the literature that the uterine artery most often originates from a common trunk with the umbilical artery. However, surgeons and intervention radiologists must be aware of the variability of its origin to facilitate the safety of the patients during procedures.