Superior gluteal artery injury during iliosacral screw placement due to aberrant anatomy

Percutaneous iliosacral screws are considered the standard of care for disruptions of the sacroiliac joint. This article describes a case of iatrogenic injury to the superior gluteal artery during iliosacral screw insertion and analyzes the possible reasons for this complication.A 32-year-old man diagnosed with an unstable pelvic ring injury underwent percutaneous fixation of the right sacroiliac joint. A 2-cm skin incision was made, and a straight cannulated awl was placed with the tip directly lateral to the S1 body. A guide wire was inserted and a partially threaded 6.5-mm cannulated screw with a washer was then placed over the guide wire and was found to be in excellent position. At this time, increased bleeding from the incision was observed. The incision was enlarged and dissection was carried down through the muscle. The bleeding vessel could not be visualized. Therefore, the wound was packed with sponges, and coil embolization of the right superficial gluteal artery was successfully performed.Analysis of the angiography reveled that our patient's superficial branch of the superior gluteal artery measured more than twice the average length reported in a previous anatomic study. We believe this is the first case of superior gluteal artery bleeding due to aberrant superior gluteal artery anatomy. When planning iliosacral screw insertion, the possibility of anatomical variance of the superior gluteal artery should be acknowledged and sought after in preoperative angiography, when available.