Internal iliac artery ligation—a contemporary simplified approach

      Bilateral ligation of the anterior division of the internal iliac arteries can be a lifesaving intervention for severe pelvic hemorrhage. The procedure results in decreased pelvic perfusion and promotes coagulation. The classical method of internal iliac artery ligation involved extensive retroperitoneal dissection with complete circumferential isolation of the vessel to allow the passage of a suture around the artery. This can be surgically challenging and fraught with risks of inadvertent injury to the surrounding iliac veins. We propose a contemporary technique that requires limited dissection of the anterior division of the internal iliac artery. A few millimeters of space is created on either side of the artery by spreading right-angle forceps parallel to the vessel. The artery is occluded by 2 large vascular clips. Because circumferential vessel dissection is not necessary with this technique, there is limited disruption of the delicate underlying internal iliac vein. In addition, this approach may decrease the risk of inadvertent injury to the adjacent external iliac vein. By showcasing the ease of our approach to internal iliac artery ligation, we hope to empower surgeons with an alternative approach to this lifesaving procedure.

      Key words

      To read this article in full you will need to make a payment


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Burchell R.C.
        Internal iliac artery ligation: hemodynamics.
        Obstet Gynecol. 1964; 24: 737-739
        • Joshi V.M.
        • Otiv S.R.
        • Majumder R.
        • Nikam Y.A.
        • Shrivastava M.
        Internal iliac artery ligation for arresting postpartum haemorrhage.
        BJOG. 2007; 114: 356-361
        • Kingdom J.C.
        • Hobson S.R.
        • Murji A.
        • et al.
        Minimizing surgical blood loss at cesarean hysterectomy for placenta previa with evidence of placenta increta or placenta percreta: the state of play in 2020.
        Am J Obstet Gynecol. 2020; 223: 322-329
        • Papillon-Smith J.
        • Hobson S.
        • Allen L.
        • Kingdom J.
        • Windrim R.
        • Murji A.
        Prophylactic internal iliac artery ligation versus balloon occlusion for placenta accreta spectrum disorders: a retrospective cohort study.
        Int J Gynaecol Obstet. 2020; 151: 91-96
        • Hobson S.R.
        • Kingdom J.C.
        • Murji A.
        • et al.
        No. 383-screening, diagnosis, and management of placenta accreta spectrum disorders.
        J Obstet Gynaecol Can. 2019; 41: 1035-1049
        • Siegel P.
        • Mengert W.F.
        Internal iliac artery ligation in obstetrics and gynecology.
        JAMA. 1961; 178: 1059-1062
        • Bleich A.T.
        • Rahn D.D.
        • Wieslander C.K.
        • Wai C.Y.
        • Roshanravan S.M.
        • Corton M.M.
        Posterior division of the internal iliac artery: anatomic variations and clinical applications.
        Am J Obstet Gynecol. 2007; 197: 658.e1-658.e5