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Median Sacral Artery

arteria sacralis mediana

The median sacral artery is a small unpaired vessel arising from the posterior surface of the abdominal aorta, just above its bifurcation. It descends in the midline anterior to the sacrum and coccyx, anastomosing with the lateral sacral arteries and ultimately ending at the coccygeal glomus (a small arteriovenous anastomosis). It represents a vestigial caudal aorta from embryological development.

Region: Pelvis & Hip

Clinical Relevance

Clinical Notes

The median sacral artery is an important landmark in anterior lumbosacral surgery, where it must be controlled before exposure of the L5-S1 disc and the lumbosacral junction. Injury during anterior lumbar interbody fusion (ALIF) or anterior sacral approaches causes difficult midline haemorrhage that is challenging to control due to the vessel's close proximity to the sacral promontory. Retrograde ejaculation, a complication of anterior lumbosacral surgery from sympathetic plexus disruption, is often associated with dissection in the median sacral artery region.

Pathology

Common Injuries & Conditions

Median Sacral Artery Injury in ALIF

Inadvertent injury during retraction for anterior lumbar interbody fusion exposes the vessel adherent to the presacral fascia and sacral promontory, causing difficult-to-control venous and arterial haemorrhage requiring direct suture ligation at the sacral bone surface.