Variation and Surgical Anatomy of the Deep Circumflex Iliac Artery: A Systematic Review and Meta-analysis

Abstract

The deep circumflex iliac artery (DCIA) is a principal pedicle for iliac-crest osteomyocutaneous reconstruction, but its anatomical variation is reported mainly in small anatomical and imaging studies. PubMed, Web of Science and Google Scholar were searched from inception to July 2026 for adult human studies reporting DCIA origin, diameter, length, branching or perforator anatomy. Two reviewers screened studies, extracted data and assessed risk of bias using the five-domain AQUA tool. Pooled estimates used random-effects models with method- and definition-based stratification. Thirty-one studies were included after eight duplicate, spurious, or unverifiable records were removed during eligibility assessment and source verification. Eighteen studies contributed data to at least one meta-analysis (1,417 verified specimens, sides or cases), and 13 were retained for narrative context. In vessel-defined studies, the DCIA arose from the external iliac artery in 96% of cases (95% CI 89–100%; I²=84%; four studies). In position-defined studies, it arose at or above the inguinal ligament in 57% (95% CI 42–71%; I²=85%; three studies). The pooled diameter at origin was 2.38 mm (95% CI 2.21–2.55; I²=91%; four studies), and endpoint-harmonised usable pedicle length was 7.07 cm (95% CI 6.90–7.24; three studies). Bifurcation occurred in 83% (95% CI 73–92%; I²=81%; four studies), and a clinically suitable or dominant perforator was present in 83% (95% CI 63–96%; I²=81%; four studies). DCIA calibre and usable length are consistent, but origin, branching, and perforator anatomy vary sufficiently to justify preoperative imaging, especially when a perforator flap is planned, or a low/femoral origin is suspected.