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common iliac artery

The common iliac arteries are paired large vessels that arise from the bifurcation of the abdominal aorta at the level of L4. Each common iliac artery runs inferolaterally toward the pelvic brim, where it terminates by dividing into the internal iliac artery (supplying the pelvis) and the external iliac artery (supplying the lower limb).

The left CIA is slightly longer than the right because of the position of the aorta. Along their course, both arteries are accompanied by the common iliac veins. They are crossed anteriorly by the ureters and are closely related to lumbosacral nerves posteriorly.

The CIA supplies blood indirectly to the pelvis, abdominal wall, and lower limbs via its terminal branches. Clinically, the CIA is important in atherosclerotic disease, aneurysms, dissections, trauma, and endovascular procedures.

Synonyms

  • Arteria iliaca communis

  • Iliac trunk

Function

  • Transmits oxygenated blood from the abdominal aorta to the pelvis and lower limbs

  • Divides into the internal iliac artery (pelvic organs, gluteal region, perineum) and external iliac artery (lower limbs, abdominal wall)

  • Serves as a major vascular landmark in radiology and surgery

MRI Appearance

T1-weighted images:

  • Artery lumen appears as flow void (hypointense)

  • Surrounding fat provides contrast for localization

T2-weighted images:

  • Lumen: signal void under normal laminar flow

  • Thrombosis or slow flow: hyperintense intraluminal signal

  • Vessel wall thickening visible in inflammatory or atherosclerotic disease

STIR:

  • Highlights perivascular edema, hematomas, or inflammatory changes as bright signals

  • Vessel wall itself remains dark

T1 Fat-Suppressed Post-Gadolinium:

  • Normal artery enhances brightly and homogeneously

  • Demonstrates vessel wall pathology, stenosis, aneurysms, or dissection flaps

MRA (Magnetic Resonance Angiography):

  • Contrast-enhanced MRA: CIA appears as a bright, well-opacified vessel from aortic bifurcation to terminal branches

  • Depicts lumen caliber, stenosis, aneurysms, dissections, and collaterals

  • Non-contrast MRA (TOF/PC): limited use due to flow artifacts, but can still show patency and gross stenosis

  • Excellent for pre-surgical mapping and follow-up after endovascular stenting

CT Appearance

Non-contrast CT:

  • Artery visible as a tubular soft-tissue density anterior to vertebral bodies

  • Calcified plaques, mural thrombus, or aneurysmal dilation well visualized

CT Post-Contrast:

  • Enhances brightly, outlining lumen

  • Demonstrates stenosis, dissection, aneurysm, or traumatic injury

CTA (CT Angiography):

  • Gold standard for iliac artery imaging

  • Provides high-resolution 2D and 3D reconstructions of CIA origin, bifurcation, lumen, and branches

  • Detects atherosclerotic stenosis, occlusion, aneurysms, dissections, and collateral networks

  • Crucial for EVAR (endovascular aneurysm repair) planning, stent placement, and trauma evaluation

MRI image

common iliac artery MRI coronal anatomy image-img-00000-00000

CT VRT 3D image

common iliac artery 3d ct image

CT image

common iliac artery ct axial

CT image

common iliac artery ct coronal image