The median sacral artery (Figs. 5.65A and 5.66) originates from the posterior surface of the aorta just superior to the aortic bifurcation at vertebral level LIV in the abdomen. It descends in the midline, crosses the pelvic inlet, and then courses along the anterior surface of the sacrum and coccyx. It gives rise to the last pair of lumbar arteries and to branches that anastomose with the iliolumbar and lateral sacral arteries.