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Deep circumflex iliac artery

The deep circumflex iliac artery (DCIA) is a branch of the external iliac artery, arising just above the inguinal ligament. It courses laterally and superiorly toward the anterior superior iliac spine (ASIS), then runs along the inner lip of the iliac crest between the transversus abdominis and internal oblique muscles.

It gives off a large ascending branch that anastomoses with the iliolumbar and superior gluteal arteries, and smaller branches that supply the abdominal wall muscles, iliac crest, and iliacus muscle. The DCIA is accompanied by the deep circumflex iliac vein, which drains into the external iliac vein.

Clinically, the DCIA is important as it provides the vascular pedicle for the deep circumflex iliac artery flap (DCIA flap) used in mandibular reconstruction and abdominal wall surgery. Injury to the DCIA during pelvic or abdominal surgery can result in significant hemorrhage.

Synonyms

  • Arteria circumflexa ilium profunda

  • Iliac crest artery

Function

  • Supplies the iliacus muscle, iliac crest, abdominal wall muscles (internal oblique, transversus abdominis)

  • Contributes to pelvic collateral circulation via anastomoses with iliolumbar, superior gluteal, and deep inferior epigastric arteries

  • Provides vascular basis for free flap and bone graft procedures in reconstructive surgery

MRI Appearance

T1-weighted images:

  • Appears as a linear hypointense flow void near the ASIS and iliac crest

  • Surrounded by hyperintense fat, aiding in identification

T2-weighted images:

  • Vessel lumen is signal void in normal flow

  • Thrombosis or occlusion appears as intermediate to hyperintense signal

STIR:

  • Fat suppression enhances conspicuity of the artery along iliac crest

  • Detects perivascular edema, inflammation, or hematoma

T1 Fat-Saturated Post-Gadolinium:

  • Artery enhances brightly and homogeneously

  • Outlines its origin from external iliac artery, course toward ASIS, and ascending branch

  • Useful for surgical planning in DCIA flap harvest

MRA Pelvis with Gadolinium:

  • Demonstrates the origin, course, and branches of the DCIA

  • Maps anastomoses with iliolumbar, superior gluteal, and inferior epigastric arteries

  • Excellent for preoperative flap planning, vascular mapping, and variant identification

CT Appearance

Non-contrast CT:

  • Vessel not well seen unless calcified

  • Bony landmarks (iliac crest, ASIS) help locate its course

CT Post-Contrast:

  • Vessel opacifies brightly, tracing its path along the iliac crest

  • Detects aneurysm, stenosis, or active bleeding

  • 3D reconstructions helpful for trauma evaluation and surgical planning