The lateral sacral artery usually originates from the posterior trunk of the internal iliac artery. The current study of 342 specimens from 171 cadavers (79 male, 92 female) investigated the origin and course of the lateral sacral artery. It was observed to arise from the posterior trunk in 79.1%. Occasionally it originated from the anterior trunk that occurred in 1%. It arose from the sciatic artery in 8.8%, from the superior gluteal artery in 16.8%, and from the inferior gluteal artery in 5.4%. Conversely, the lateral sacral artery is congenital absence in 0.3%. In addition, the lateral sacral artery was single, double, triple, and quadruple in 77.2%, 19.8%, 2.3%, and 0.3%, respectively. Consequently, variability of the lateral sacral artery origin is due to vascular demand as the lateral sacral artery plexus does arise from the earlier trunk development. With variability of the lateral sacral artery origin, there is a variability of the sciatic nerve supply. Knowing the variability of origins, surgeons have to avoid prolonged ligation of the internal iliac artery or its posterior trunk during surgical procedures which may lead to sciatic neuropathy. Therefore, the lateral sacral artery origin, course, and branches are important for clinicians to improve their knowledge and patient management. 1. Introduction The lateral sacral artery typically arises from the posterior trunk of the internal iliac artery and then divides into superior and inferior branches. The larger superior branch passes dorsally to anastomose with the middle sacral artery giving branches to supply the contents of the sacral spinal canal, by passing through the first and second anterior sacral foramen and the skin and muscle over the dorsum of the sacral region as they exit from the first and second posterior sacral foramen. The inferior branch passes obliquely over the ventral surface of piriformis and the sacral roots of the sciatic nerve giving branches which pass through the anterior sacral foramen to supply the contents of the lower part of the sacral spinal canal and the skin and muscle over the dorsal surface of the lower sacral region [1, 2]. On series studies, the lateral sacral artery is found to be variable with no clear incidence of its variable origin. Knowing the incidence of variable origin of lateral sacral artery, the radiologists may alert the orthopedic surgeons to avoid iatrogenic errors such as internal hemorrhage as from lateral sacral artery laceration in internal fixation of sacrum. Therefore, the current study includes the variability of lateral sacral
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