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Lateral sacral artery

The lateral sacral artery is a paired artery arising from the posterior division of the internal iliac artery. It descends along the pelvic surface of the sacrum, supplying the sacral vertebrae, meninges, sacral canal, and surrounding muscles. It plays an important role in vascularizing the sacral plexus and cauda equina structures through spinal branches.

Its intimate relation to the sacral nerves and bony sacrum makes it an important structure in pelvic surgery, embolization procedures, and trauma management.

Synonyms

  • Arteria sacralis lateralis

  • Lateral branches of internal iliac artery

Origin, Course, and Branches

  • Origin:

    • Usually arises from the posterior division of the internal iliac artery (occasionally directly from the main trunk)

  • Course:

    • Runs medially and inferiorly along the pelvic surface of the sacrum

    • Lies anterior to the sacral ventral rami

    • Sends branches into the anterior sacral foramina to accompany the sacral nerves

  • Branches:

    • Spinal branches: Enter anterior sacral foramina, supply meninges, sacral nerves, and cauda equina

    • Muscular branches: Supply piriformis and posterior pelvic wall muscles

    • Anastomoses with the median sacral artery and superior gluteal artery

Relations

  • Anteriorly: Sacral plexus and ventral rami of sacral nerves

  • Posteriorly: Bony pelvic surface of sacrum

  • Superiorly: Internal iliac artery and posterior iliac vessels

  • Inferiorly: Median sacral artery and coccygeal plexus

Function

  • Provides vascular supply to the sacral vertebrae, meninges, and sacral canal contents

  • Contributes to blood supply of the sacral plexus and cauda equina

  • Supports posterior pelvic wall musculature

Clinical Significance

  • Important artery in pelvic trauma and hemorrhage control

  • Can be a target for embolization in pelvic bleeding

  • May be involved in vascular tumors or arteriovenous malformations of sacrum

  • Close relation to sacral plexus makes it relevant in nerve-sparing pelvic surgeries

  • Identified in angiographic procedures for pelvic vascular mapping

MRI Appearance

T1-weighted images:

  • Appears as a flow void (dark linear/round structure) along pelvic surface of sacrum

  • Surrounded by bright fat planes for contrast

T2-weighted images:

  • Vessel lumen appears as flow void (dark signal)

  • Slow flow or thrombus may appear with higher signal intensity

STIR (Short Tau Inversion Recovery):

  • Normal artery appears dark signal (flow void)

  • Surrounding edema or pathology (hematoma, inflammation) appears bright

T1 Fat-Sat Post-Contrast:

  • Enhances brightly and uniformly as a vascular structure

  • Useful for detecting aneurysm, vascular malformations, or abnormal collateral vessels

3D T2 SPACE / CISS:

  • Artery appears as a dark linear flow void surrounded by bright CSF and fat

  • Provides high-resolution detail of vessel relation to sacral foramina and nerves

CT Appearance

Non-Contrast CT:

  • Not well visualized unless calcified (arterial wall calcification may be seen)

  • Appears as small tubular soft tissue density along sacral surface

Post-Contrast CT (CT Angiography):

  • Enhances as a bright tubular structure coursing along sacrum

  • Branches visible entering sacral foramina

  • Useful for identifying traumatic bleeding, aneurysms, or vascular malformations

MRI image

Lateral sacral artery mri coronal anatomy image-img-00000-00000

MRI image

Lateral sacral artery mri coronal anatomy image-img-00000-00000_00001

MRI image

Lateral sacral artery mri coronal anatomy image-img-00000-00000_00002

MRI image

Lateral sacral artery mri axial

CT image

Lateral sacral artery ct axial anatomy image-img-00000-00000