Persistent sciatic artery—A curious vascular anomaly

Bilateral Persistent Sciatic Artery: Literature Review and Case Report Follow-up for More than Five Years

We report a 42-year-old male patient with bilateral persistent sciatic arteries (PSAs), diagnosed by computer tomography angiography for right thigh trauma and follow-up for more than 5 years. A review of 61 bilateral PSA patients reported in the international literature was performed. There was no gender predilection (male versus female: 46% vs. 54%). The same type of PSA in both sides was 74%. The complete PSA type was 77% in the right side and 75% in the left side. Symptomatic bilateral PSA was 72%, including aneurysm in 57% (combined with ischemia or embolism 39%), and the mean age was 61 ± 12 years. The asymptomatic bilateral PSA was 13%, and the mean age was 27 ± 8 years. Most asymptomatic PSAs were diagnosed by arteriography with demonstration of the proximal vessels, such as during embolization of the uterine arteries. One case experienced the loss of a limb to inadvertent embolization of PSA. The presented patient was treated with debridement and lifestyle modification to avoid repetitive PSA compression, and was followed up for more than 5 years without complications. The characteristics are no different between bilateral and unilateral PSAs. PSA complications may be avoided if we can prevent the acquired factors. We should pay attention to PSA in our clinical work to avoid severe complications.

Bypass Graft Failure Resulting from Misidentification of the Aberrant Anatomy of a Persistent Sciatic Artery

A persistent sciatic artery (PSA) is a rare vascular anomaly in which, in contrast to normal embryonic development, the sciatic artery does not involute. Although prone to aneurysm formation and thrombosis, this is, to our knowledge, the first case of early femoral popliteal bypass failure due to a PSA.

Basic data underlying decision making in nonatherosclerotic causes of intermittent claudication

Although most cases of vasculogenic intermittent claudication are caused by atherosclerosis, there is an important minority of cases that are due to nonatherosclerotic causes. Because of their rarity and younger population affected, often without traditional atherosclerotic risk factors, there is frequently a significant delay in diagnosis of nonatherosclerotic peripheral arterial diseases by several months to years in some cases. Here, we review the literature on nonatherosclerotic causes of lower extremity claudication, symptoms, management including surgical and endovascular interventions, and outcomes. Conditions included are popliteal artery entrapment syndrome, cystic adventitial disease, pseudoxanthoma elasticum, persistent sciatic artery, fibromuscular disease, giant cell arteritis, iliac endofibrosis, neurogenic claudication, and chronic exertional compartment syndrome.

Bilateral persistent sciatic arteries complicated with chronic lower limb ischemia

INTRODUCTION

Persistent sciatic artery (PSA) is a rare vascular anomaly associated with a higher rate of aneurysm formation or thromboembolic complications causing lower extremity ischemia.

PRESENTATION OF CASE

A 15-year-old female patient with bilateral PSA presented with lower extremity ischemia. Considering the age and symptoms of the patient, we did not perform any intervention, but continued surveillance with duplex ultrasonography in case of the high incidence of aneurysmal formation or thromboembolic event.

DISCUSSION

Epidemiology, development, anatomical structure, diagnosis and treatments of PSAs are discussed.

CONCLUSION

PSAs, are prone to early atheromatous degeneration and aneurysm formation. Treatment of a PSA mainly dependent on the symptoms is either by surgical procedures or by endovascular interventions.

Persistent sciatic artery

Persistent sciatic artery (PSA) is a very uncommon congenital malformation. Its incidence is estimated to be 0.025-0.04%. If it is accompanied by hypoplasia of the femoral artery system, its presence is essential for perfusion of the limbs. The usual form of presentation is as an aneurysm (25-58%) and/or its complications (thrombosis, distal remobilization, local compression). A 66-year-old woman presented with a painful mass of several months' progression. After performing angio-computed tomography, a fusiform aneurysmal dilation was observed in the left gluteal mass dependent on the left obturator artery, which was identified as the left lower gluteal artery. For this reason, we decided to perform therapeutic embolization. During the angiogram, a left aneurysmal PSA with distal thrombosis was observed. In view of these findings, a bypass from the superficial femoral artery to the tibioperoneal trunk was performed, with a contralateral inverted saphenous vein. The PSA was subsequently embolized with an occluder (AGA Medical IZASA, Plymouth, MN). The patient was discharged after checking complete exclusion of the aneurysm by ultrasound, with distal pulses during follow-up. Combined treatment using embolization, before surgical revascularization of the limb, markedly decreases the morbidity and mortality by avoiding the pelvic approach by the posterior route.

Ruptured persistent sciatic artery aneurysm managed by endovascular embolization

Persistent sciatic artery (PSA) is a rare vascular anomaly present in 0.025% to 0.05% of the population. They are particularly prone to aneurysmal degeneration, potentially leading to distal ischemia, sciatic neuropathy, or rarely rupture. Here, we describe a case of a ruptured PSA aneurysm managed by endovascular embolization. A 70-year-old man initially presented with acute left lower extremity ischemia. He was found to have a popliteal embolus originating from a complete persistent sciatic artery aneurysm. He underwent thrombolysis followed by a femoropopliteal bypass and ligation of the proximal popliteal artery to exclude the PSA. Four weeks later he re-presented with severe pain, a pulsatile buttock mass, and anemia in the setting of hemodynamic instability. A ruptured PSA aneurysm was confirmed by computed tomography angiography (CTA). This was managed emergently by endovascular exclusion of the inflow and outflow vessels using Amplatzer vascular plugs. His postoperative course was complicated by both a foot drop, likely secondary to sciatic nerve ischemia, and a buttock abscess. To our knowledge, this is the first report detailing the endovascular management of a ruptured PSA aneurysm. The etiology, management, and complications associated with the treatment of this rare vascular entity are discussed.