The cauda equina is composed of the lumbosacral and the coccygeal nerve roots and the filum terminale. In the embryonic period, discrepancy in development between the termination of the spinal cord and the spinal column results in elongation of the nerve roots as well as the filum terminale in this region. Although the vascular anatomy of the caudal spinal structure shares many common features with the other metameric levels, this elongation forms the basis of the characteristic vascular anatomy in this region. With the evolution of the high quality imaging techniques, vascular lesions in the cauda equina are being diagnosed more frequently than ever before. Albeit the demand for accurate knowledge of the vascular anatomy in this region, descriptions are often fragmented and not easily accessible. In this review, the author attempted to organize the existing knowledge of the vascular anatomy in the cauda equina and its implication on the vascular lesions in this region. Also reviewed is the clinically relevant embryological development of the cauda equina.