Anatomic considerations

Familiarity with the relevant vascular anatomy is absolutely essential before discussion of the uterine artery embolization (UAE) procedure itself. The internal iliac artery typically bifurcates into two divisions. The posterior division typically originates postero-medially and sweeps laterally out of the pelvis. The dominant vessel of the posterior division is the superior gluteal artery. When performing UAE, the posterior division and its branches must be avoided, as inadvertent embolization of these vessels can lead to severe complications such as buttock necrosis and damage to the sciatic nerve.

The anterior division originates anterolaterally and courses caudad from the internal iliac bifurcation. It has a number of important branches. The dominant vessel of the anterior division is the inferior gluteal artery. The main branches of the anterior division (in the female) are the uterine artery, the cystic artery, the vaginal artery, the rectal artery, and the internal pudendal artery.

The uterine artery is usually the first branch of the anterior division. This pattern is seen in just under half of patients. Most of the standard anatomic texts describe its origin as antero-medial. Experience has shown that the origin of the uterine artery is just as likely to be antero-lateral as antero-medial. There are two common anatomic variants for the origin of the uterine artery.