Anatomical Variations in the Course of the Superior Gluteal Artery and Its Relationship to the Internal Iliac Vein: A Cadaveric Study

Background/Objectives: The superior gluteal artery (SGA) is usually the largest branch of the internal iliac artery. It lies close to the ventral rami of the sacral plexus and to the internal iliac vein (IIV). The purpose of the present study was to describe the course of the SGA among the ventral rami and the position of the IIV relative to the SGA. Methods: Fifty-eight formalin-embalmed adult cadavers (12 whole bodies and 46 isolated hemipelves) were studied, giving 70 hemipelves (35 left, 35 right). The SGA course was assessable in 56 hemipelves and the IIV position in 22. The other specimens were excluded because of poor preservation, previous teaching dissection or an unclassifiable venous pattern. Side differences were tested with Fisher’s exact test and, in whole bodies, with the exact McNemar test. Results: The SGA passed between the lumbosacral trunk and the first sacral ventral ramus in 44/56 hemipelves (78.6%; 95% CI 66.2–87.3%). This is the classic suprapiriform route. In 12/56 hemipelves (21.4%), it passed between the L4 and L5 ventral rami (16.1%) or lateral to the lumbosacral trunk (5.4%). The IIV lay medial to the SGA in 16/22 hemipelves (72.7%; 95% CI 51.8–86.8%) and lateral in 6/22 (27.3%). No statistically significant side difference was detected (p = 0.746 and p = 1.000; paired analysis, p = 1.000). Conclusions: The SGA followed a non-classic course in 21.4% of assessable hemipelves. The venous findings are exploratory and are not population estimates. Awareness of these variations may help during internal iliac artery ligation and pelvic sidewall dissection.