Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

 

Superior Gluteal Artery

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Overview

The superior gluteal artery is the largest branch of the internal iliac artery.

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Clinical Importance

• Injury can cause massive hemorrhage
• At risk in:
  • Pelvic fractures
  • Acetabular surgery
• Damage may lead to:
  • Gluteal muscle ischemia

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Origin

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Arterial Pathway

• Abdominal aorta divides at L4 into:
  • Right common iliac artery
  • Left common iliac artery

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• Each common iliac artery divides into:
  • External iliac artery
  • Internal iliac artery

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Source of Superior Gluteal Artery

• Arises from:
  • Posterior division of internal iliac artery

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Course

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The artery follows this pathway:

1. Exits pelvis through greater sciatic foramen
2. Passes above the piriformis muscle
3. Enters the gluteal region

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Branches

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1. Superficial Branch

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Course

• Between:
  • Gluteus maximus
  • Gluteus medius

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Supply

• Gluteus maximus
• Overlying skin

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2. Deep Branch

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Course

• Between:
  • Gluteus medius
  • Gluteus minimus
• Lies on deep surface of gluteus medius

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Supply

• Gluteus medius
• Gluteus minimus
• Tensor fascia lata

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Comparison: Inferior Gluteal Artery

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Origin

• Anterior division of internal iliac artery

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Course

• Exits pelvis:
  • Below piriformis

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Supply

• Gluteus maximus
• Posterior thigh

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Key Difference

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Additional Branches

• Sciatic artery (vasa nervorum) — supplies sciatic nerve
• Anastomotic branches — contribute to cruciate anastomosis

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Clinical Importance

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1. Posterior Iliac Crest Bone Graft

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Risk

• Extension into greater sciatic notch may injure artery

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Consequence

• Severe hemorrhage

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2. Extended Iliofemoral (Letournel) Approach

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Used For

• Complex acetabular fractures

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Key Point

• Gluteal muscles remain attached mainly via:
  • Superior gluteal artery

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Risk of Injury

• Devitalization of gluteal muscles
• Muscle necrosis

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3. Pelvic Fractures

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Sources of Bleeding

1. Venous (most common)
2. Bone
3. Arterial (~10%)

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Injuries Associated With

• Sacroiliac joint disruption
• Anteroposterior compression injuries
• Shear injuries

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Complications

• Massive hemorrhage
• Hypovolemic shock

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Massive Transfusion Protocol

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Ratio

• 1 : 1 : 1

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Components

• Packed RBC
• Fresh frozen plasma
• Platelets

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Diagnosis of Arterial Injury

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Investigations

• CT angiography
• Pelvic angiography

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Indication for Angiography

• Persistent hemodynamic instability
• Despite >/= 4 units blood transfusion in first hour

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Treatment

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Angiographic Embolization

• Effective method to control bleeding
• Superior gluteal artery can be embolized

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Surgical Risk

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At Risk During

• Screw placement near sciatic notch
• Acetabular fracture fixation

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Precaution

• Palpate sciatic notch
• Avoid screw penetration

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Management of Intraoperative Injury

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Steps

1. Attempt arterial clipping
2. Avoid injury to superior gluteal nerve
3. Perform packing
4. Call:
   • Vascular surgeon
   • Interventional radiologist
5. Ensure adequate blood transfusion

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Key Exam Points

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Origin

• Posterior division of internal iliac artery

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Exit

• Greater sciatic foramen (above piriformis)

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Supply

• Gluteus maximus
• Gluteus medius
• Gluteus minimus
• Tensor fascia lata

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Clinical Relevance

• Pelvic fracture hemorrhage
• Iliac crest graft complications
• Acetabular surgery risk
• Sciatic notch screw placement