Level of Abdominal Aorta Bifurcation and Its Relation to the Ureter: A Radiological Study with Clinical Implications

Background/Objectives: The abdominal aorta (AA) bifurcates at the level of the L4 vertebra, giving origin to the right and left common iliac arteries (CIA). The CIA then bifurcates into external iliac arteries (EIA) and internal iliac arteries (IIA). The present radiological study aimed to (i) measure the diameter of the right and left CIA, (ii) measure the distance between the AA bifurcation and the point where the ureter crossed the ipsilateral iliac vessels, (iii) examine the angle of AA bifurcation, and (iv) observe the vertebral level at which the AA bifurcated. Methods: The retrospective cross-sectional study included contrast-enhanced CT angiograms of 200 patients (n = 144 males and 56 females) who attended the radiology department from 1 January 2022 to 31 December 2023. Two independent radiologists interpreted the angiograms. The results were interpreted using parametric and non-parametric statistical tests. Results: The mean angle of the AA bifurcation was 40.46° and 44.68° in males and females, respectively (p = 0.013). The mean diameter of the right and left CIA was wider in males than in females, but no statistical significance was found. The average distance between the AA bifurcation and the point where the right and left ureter crossed the ipsilateral iliac arteries was longer in females (60.99 and 60.29 mm, respectively) than in males (59.05 and 59.95 mm, respectively), but no statistical difference was found (p > 0.05). The most common vertebral level for AA bifurcation was the L4 vertebra, which was found in 137 (68.50%) patients. The AA bifurcated at the level of L3 and L5 in 52 (26.00%) and 11 (5.50%) patients, respectively. Conclusions: Understanding the radiological anatomy of the CIA and AA bifurcation and its relation to the ureter is crucial for surgeons performing aortic and pelvic surgeries.