Bilateral common iliac artery coiling: radiological case report with emphasis on possible clinical significance for pelvic surgery and endovascular procedures

Abstract

Abstract. The common iliac arteries (CIAs) are typically straight conduits that bifurcate from the abdominal aorta at L4–L5 to supply the pelvis and lower limbs. Although degrees of arterial tortuosity are not uncommon, true 360° coiling is exceedingly rare and may have important clinical implications during endovascular or surgical procedures. Herein, we report an incidental finding of bilateral 360° coiling of the CIAs identified during computed tomography angiography on an asymptomatic 81-year-old woman. Three-dimensional reconstructions demonstrated a pronounced coil of the right CIA at L5 and of the left CIA at S2, with elongation of the left external iliac artery. No additional vascular variants or associated pathological findings were identified. Although frequently asymptomatic, pronounced iliac tortuosity has the potential to increase procedural complexity, prolong fluoroscopy and contrast use, and may theoretically predispose to hemodynamic disturbances or compression of adjacent neurovascular structures. Recognition of such variation is critical for preprocedural planning, particularly for endovascular aortic repair and pelvic surgery, where tortuosity can challenge access and device delivery. Bilateral 360° coiling of the CIAs is an exceptionally uncommon anatomic variation. Even in asymptomatic individuals, comprehensive radiologic documentation and communication with treating teams are essential to support safe procedural planning.