What provides blood to the gluteal region?

Blood Supply to the Gluteal Region

The gluteal region is primarily supplied by the superior and inferior gluteal arteries, which are branches of the internal iliac artery (posterior division). 1

Arterial Supply

Primary Blood Supply

• Superior Gluteal Artery

  • Largest branch of the posterior division of internal iliac artery 2
  • Exits the pelvis through the greater sciatic foramen above the piriformis muscle
  • Average length: 54.88 mm 2
  • Average diameter at origin: 6.27 mm 2
  • Supplies the gluteus maximus, gluteus medius, and gluteus minimus muscles
  • Provides approximately 45.2% of perforators to the gluteal region 3

• Inferior Gluteal Artery

  • Branch of the anterior division of internal iliac artery
  • Exits the pelvis through the greater sciatic foramen below the piriformis muscle
  • Supplies the lower portion of the gluteus maximus and structures in the posterior thigh
  • Provides approximately 30.8% of perforators to the gluteal region 3

Additional Arterial Contributions

The gluteal region also receives blood supply from:

• Fifth lumbar artery (5.8% of perforators) 3
• Internal pudendal artery (4.7% of perforators) 3
• Lateral circumflex femoral artery (4.8% of perforators) 3
• Circumflex iliac superficial artery (1.2% of perforators) 3

Clinical Significance

Diagnostic Considerations

• Inflow disease to the lower extremity may present with gluteal or thigh claudication and should be suspected when there is femoral pulse diminution or bruit 1
• The superior gluteal artery perforators are typically located adjacent to the medial two-thirds of a line drawn from the posterior superior iliac spine to the greater trochanter 4
• The inferior gluteal artery perforators are concentrated along a line in the middle third of the gluteal region above the gluteal crease 4

Surgical Applications

• The superior and inferior gluteal arteries are important landmarks in surgical procedures involving the gluteal region
• Perforator flaps based on these vessels are used in reconstructive surgery:
  • The average superior gluteal artery cutaneous vascular territory is approximately 69 cm² 4
  • The inferior gluteal artery cutaneous vascular territory is approximately 177 cm² 4
  • At least one large (>1 mm) superior gluteal artery septocutaneous perforator is present in 77.5% of patients 3

Interventional Procedures

• Embolization procedures for internal iliac artery aneurysms may require access through the inferior gluteal artery when conventional approaches are not possible 5
• Knowledge of the branching pattern variations is crucial for interventional radiologists performing arterial embolization for hemorrhage control or intra-arterial chemotherapy 6

Anatomical Variations

• The origin of the superior gluteal artery shows relatively low variability, most commonly arising from the posterior division of the internal iliac artery (56.4% of cases) 2
• However, the branching pattern of the superior gluteal artery is highly variable, with 19 different variations identified 2

Understanding the vascular anatomy of the gluteal region is essential for surgical planning, diagnostic imaging interpretation, and interventional procedures to minimize the risk of vascular complications.