The iliolumbar artery arises from the internal iliac artery and ascends behind the lumbosacral trunk to supply the iliacus, psoas major, quadratus lumborum, and posterior ilium. It anastomoses with the lumbar arteries and represents the transition between the parietal lumbar and pelvic vascular territories.
The iliolumbar artery is a consistent surgical landmark in anterior lumbosacral approaches where it must be identified and controlled before L5-S1 disc exposure. In pelvic fracture surgery, the iliolumbar artery may be a source of significant posterior pelvic haemorrhage. It anastomoses with L4-L5 segmental arteries providing collateral circulation after iliac vessel occlusion.
Iliolumbar artery haemorrhage during anterior L5-S1 disc access producing significant retroperitoneal bleeding requiring immediate vascular control before disc space preparation.
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