The iliolumbar artery is the highest branch of the internal iliac artery, ascending behind the common iliac vessels to supply the iliacus, quadratus lumborum, and psoas major. Its lumbar branch anastomoses with the fourth lumbar artery, and its iliac branch supplies the iliac bone and iliacus.
The iliolumbar artery is an important surgical landmark in ilioinguinal and posterior iliac approaches and during lumbosacral fusion with iliac fixation. It can be inadvertently ligated during high iliac crest graft harvest. Iliolumbar artery aneurysm, though rare, presents as a retroperitoneal mass and may rupture.
Iatrogenic injury during posterior spinal instrumentation or iliac crest harvest causing posterior pelvic haematoma and potential compromise of iliacus and quadratus lumborum blood supply.
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