Radical sacral surgery can be associated with life-threatening blood loss. Effective and safe methods for controlling this blood loss remain elusive. We here report the use of an inflatable sizing balloon to intermittently occlude the distal abdominal aorta and control blood loss during sacral tumor resections. The balloon catheter was introduced into the abdominal aorta via the femoral artery. Pulse oxygen saturation signals from bilateral toes and ultrasonography were used to guide and confirm the location of the balloon in the abdominal aorta and distal to the renal arteries. The balloon was deflated for 10 min after each 60 min occlusion period. In five patients undergoing sacral tumor resection, the estimated blood loss when using balloon occlusion was <300 mL, and surgical duration was <2 h. No significant change in kidney, pelvic organ, and lower extremity function was found after the surgeries. Percutaneous aortic balloon occlusion can provide safe and effective control of blood loss during sacrococcygeal tumor resection.