The ischiopopliteal arterial trunk

Bilateral Persistent Sciatic Artery - An Infrequent Occurrence: A Case Report with Review of Literature

A persistent sciatic artery (PSA) is a rare congenital vascular anomaly with an extremely low incidence of about 0.04%-0.06%. It is due to the persistence of the embryological axial limb artery, representing a continuation of the internal iliac artery into the thigh through the greater sciatic foramen below the piriformis muscle and down the thigh alongside the sciatic nerve. In normal embryologic development of the lower limb, the axial artery normally regresses after week 12. Persistent sciatic artery is often asymptomatic until a complication develops, it can be classified into two types, complete and incomplete. PSA can cause serious lower limb complications such as acute or critical limb ischemia.

A hybrid approach to persistent sciatic artery fusiform aneurysm repair

A persistent sciatic artery is a rare vascular anomaly that is prone to early atherosclerotic development and aneurysmal degeneration. Repair of the degenerative aneurysm is critical because it can lead to rupture, thrombosis, distal embolization, and sciatic nerve damage from compression. We report a case of a symptomatic unilateral persistent sciatic artery fusiform aneurysm that was treated using a simultaneous open surgical and endovascular approach. The patient underwent right common femoral to below-knee popliteal artery bypass and percutaneous endovascular embolization of the right sciatic artery aneurysm. Proper surgical intervention determined by the patient's comorbidities and unique anatomy achieved favorable outcomes.

Failure of Limb Salvage in a Patient with Chronic Limb-Threatening Ischemia due to Persistent Sciatic Artery Stenosis: Direct Therapeutic Intervention is Important

A 79-year-old woman presented to our hospital with a complaint of feeling a cold sensation in her right foot. After performing a contrast-enhanced computed tomography angiography, severe stenosis in the right persistent sciatic artery (PSA) was identified. However, stenting was considered inadvisable due to compression issues when sitting. Following anticoagulant therapy, the patient's symptoms improved. However, after seventeen months, she experienced recurrent severe pain in her right foot. Catheter angiography revealed occlusions in both the anterior and posterior tibial arteries. To address the issue, we conducted endovascular therapy, followed by a femoro-popliteal artery bypass and ligation of the PSA. Unfortunately, despite these efforts, a below-knee amputation was eventually performed. Limited experience with the PSA and delayed intervention may have led to the need for amputation. Therefore, it is crucial to emphasize the importance of prompt therapeutic intervention following the onset of initial symptoms.

Bilateral persistent sciatic arteries presenting with lower extremity claudication

This is a case report of a woman in her 60s with Rutherford class 3 bilateral calf claudication and a resting right Ankle Brachial Index (ABI) 0.49 and left ABI 0.57. The arteriogram of lower extremities demonstrates bilateral persistent sciatic arteries (PSAs). The patient had severe stenosis of left common iliac artery, and thus underwent successful stenting resulting in normalisation of flow and filling of PSA with symptom resolution.

An Interesting Case of a Patient With Disabling Bilateral Lower Extremity Claudication and a Persistent Sciatic Artery

A persistent sciatic artery is a rare congenital anomaly. This case report highlights the treatment for a patient with a persistent sciatic artery no longer in continuity with the internal iliac artery and atherosclerotic peripheral vascular disease resulting in disabling bilateral lower extremity claudication. It highlights the types and anatomic locations of the sciatic artery and discusses an effective way to treat a patient with arterial insufficiency and this variant anatomy as well as other treatment options.

The persistent sciatic artery: Report of ten cases

OBJECTIVE

The persistent sciatic artery (PSA) is a rare congenital anomaly with a high rate of aneurysm formation, occlusion and stenosis. It may lead to severe complications including thrombosis, distal embolisation, or aneurysm rupture. We reported herein our experience in the management of PSA and its complications, and discuss the therapeutic options.

METHODS

Eight patients with 10 PSA were managed in our institutions between 1985 and 2017. An analysis was done for the clinical data, surgical technique, and results.

RESULTS

The series included six women and two men. The median age of the patients was 66,5 years (37-80 years). Physical examination found a pulsatile gluteal mass in five patients, sciatic neuropathy in two cases. Four patients had an acute ischemia of the lower limb. Cowie's sign was described in only two patients (diminished or absent femoral pulse but presence of popliteal pulse). Digital subtraction angiography was performed in all patients, and was completed with a computed tomography angiography (CTA) with a diagnosis of PSA, associated with a symptomatic aneurysmal lesion in seven cases and with an occlusion in one case. The treatment was surgical in all cases: bipolar exclusion of the aneurysm and bypass between the iliac artery and the PSA distal to the aneurysm was performed in four cases, only proximal and distal ligation was done in 2 other cases. A Chopart amputation was necessary in 2 cases.

CONCLUSION

We consider that the treatment of PSA is usually surgical in symptomatic cases. Surgical techniques depend on symptoms and classification describing anatomy of the PSA. However, future studies should compare the open versus the endovascular approach to optimize patient selection criteria and identify the most safe and effective strategy. In an asymptomatic patient, PSA does not require any intervention; continued follow-up is required because of the high incidence of aneurysmal formation and the risk of thromboembolic events.

The role of ultrasonography in the diagnosis of persistent sciatic artery

AIM

To investigate the accuracy of ultrasonography in the diagnosis of persistent sciatic artery (PSA) compared to computed tomography angiography (CTA).

MATERIALS AND METHODS

From May 2002 to Dec 2018, 61 consecutive patients seen at Shandong Medical Imaging Research Institute with a clinical suspicion of PSA were included. Ultrasonography was used to assess the abdominal and lower-limb arteries. The main sonographic criteria for a positive diagnosis were the visualisation of PSA, the enlarged internal iliac artery, and abnormality of common femoral artery and superficial femoral artery. These data were compared with CTA findings. Kappa statistics was applied to determine the level of agreement. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography as a diagnostic method were assessed.

RESULTS

Ultrasonography findings were positive in 16 of 61 patients with a clinical suspicion of PSA. The diagnosis was confirmed by CTA in 17 patients. There was one false-positive result and two false-negative results at ultrasonography. The kappa value was 0.875. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography were 88.2%, 97.7%, 93.8%, 95.6%, 95.1% and 0.859, respectively.

CONCLUSIONS

Ultrasonography could be a reliable, accurate, and non-invasive diagnostic imaging method in the diagnosis of patients with suspected PSA.

Endovascular Management of a Large Persistent Sciatic Artery Aneurysm

The persistent sciatic artery (PSA) is a remnant of the fetal circulatory system that is preserved in less than 0.1% of the population. Up to 60% of patients with this vascular anomaly will go on to development of a PSA aneurysm (PSAA), which can produce a variety of symptoms including neuropathy, claudication, and acute limb-threatening ischemia. Historical management is by open operation and interposition grafting, which can be highly morbid. We describe successful management of a large, symptomatic PSAA by endovascular stent grafting with intermediate term follow-up.

Transposition of the persistent sciatic artery for lower limb revascularization after resection of an embolizing proximal sciatic artery aneurysm

We present a novel surgical technique for lower limb revascularization after resection of an aneurysm of the persistent sciatic artery that had led to recurrent peripheral embolization and severe ischemia. The superficial femoral artery in this patient was hypoplastic, and the sciatic artery continued into the popliteal artery as the source of blood supply to the lower leg. For revascularization, we used the distally pedicled healthy two-thirds of the persistent sciatic artery, transposed it from its posterior position to a nearly anatomic anteromedial position, and anastomosed it to the proximal superficial femoral artery.

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.

Endovascular Stent-Graft Repair of a Persistent Sciatic Artery Aneurysm

Persistent sciatic artery (PSA) is a rare anomaly that may cause various symptoms, such as aneurysm, rupture, thromboembolism, and sciatica. Direct surgery can be performed to treat PSA aneurysm (PSAA), but is associated with complications; e.g., anatomical problems such as sciatic nerve injury. Herein we report a case of a 74-year-old woman with acute limb ischemia that developed from a distal embolism caused by a thrombus in the left PSAA; favorable results were obtained for her by treatment with a stent-graft after rapid anticoagulation therapy for limb salvage.

[The persistent sciatic artery aneurysm. A rare and painful buttock mass]

The persistent sciatic artery is a rare cause of painful buttock mass with L5-S1 radicular signs. A 56-year-old man presents a right painful buttock mass with L5-S1 radicular symptoms for 3 years. The surgical exploration found a pulsatile vascular mass like a persistent sciatic artery aneurysm. This vascular pathology is a misunderstood embryogenesis anomaly. The treatment aims to avoid serious complications. This pathology must be known from plastic surgeon.

Treatment of complete persistent sciatic artery with distal thromboembolism by thromboembolectomy only

A persistent sciatic artery (PSA) is very rare congenital vascular anomaly which is present in 0.025% to 0.04% of the population by an angiographic study. A PSA is usually combined with aneurismal disease or thromboembolic events because of its arteriosclerosis and vessel wall degeneration. The treatments of symptomatic PSA are comprised of exclusion of PSA from circulation and bypass surgery for the lower limb. However, surgical treatment should be tailored to its anatomy and presentation. We report a successful treatment of PSA with distal thromboembolism by thromboembolectomy without bypass surgery.

Persistence of the sciatic artery: a case report of a combined (complete and incomplete) type causing leg ischemia

Persistent sciatic artery is a very uncommon embryologic vascular variant, with a prevalence of 0.05% based on angiographic studies. Two different types of this anomaly can occur, complete or incomplete, on the basis of the relationship between sciatic artery and femoral artery. Although many of these patients are asymptomatic, it may represent a threat to the viability of the lower extremity because of atherosclerotic degeneration resulting in aneurysmal dilatation, occlusive thrombosis, or embolic phenomena with distal complication. We present a case of a 64-year-old man with combined, complete and incomplete, type of persistent sciatic artery causing ischemic ulcer of the first toe.

A case of bilateral persistent sciatic artery with unilateral aneurysm: an 18-year period of graft patency after excision of aneurysm

BACKGROUND

A persistent sciatic artery (PSA) is a rare vascular anomaly with an estimated incidence of 0.02-0.04% and with a high rate of complications such as aneurysm formation, thromboembolism, and ischemia, that may lead to amputation.

CASE REPORT

We present a case of a female patient with complete symptomatic ambilateral PSA and with unilateral aneurysm. The aneurysm was excised and the PTFE graft was interposed at the aneurismal sac (femoro-popliteal bypass could not be performed because of the high degree hypoplasia of the superficial femoral artery). The graft endured continuous compression and stretching during regular daily life of the patient. At check-up 18 years after the operation, the Doppler ultrasound showed a patent graft and no new aneurismal dilatation of the sciatic artery.

CONCLUSIONS

To our knowledge the follow-up of the presented case is the longest reported so far in the literature. The uneventful course of the patient confirms that classical aneurysmectomy still constitutes one of the treatment options of PSA aneurysm.

Regression of a thrombosed persistent sciatic artery aneurysm

A 79-year-old woman who had a previous history of sudden onset of pain and coldness of her right leg was referred to our hospital. There were no palpable right popliteal and pedal pulses with the ankle-brachial pressure index being 0.63. Computed tomography showed a 2.6-cm diameter right buttock mass which had a continuation from the right internal iliac artery that entered the posterior thigh and continued to the popliteal artery. It was diagnosed as thrombosed right persistent sciatic artery (PSA) aneurysm. She was treated medically with intravenous and oral antiplatelets, and was left with no right leg symptoms. Follow-up CT obtained after 3 years from onset demonstrated that the diameter of the PSA aneurysm diminished from 2.6 to 1.2 cm. It is suggested that a patient who had the occluded complete type PSA aneurysm with no critical leg ischemia, local compression, or rupture can be observed without surgery. However, careful follow-up of the patient is essential.

[Aneurysm of the superior gluteal artery]

We report the case of an aneurysm of the superior gluteal artery that occurred more than ten years after a pelvic trauma. The diagnosis of this uncommon condition is sometimes difficult because of the predominant neurologic symptoms. Rupture can be life-threatening. The patient was treated by an embolization; thereafter a surgical procedure with control of the internal iliac artery and an endoaneurysmorrhaphy was performed. The main characteristics of this pathology are indicated.

Sciatic artery: a case, review of literature and attempt of systemization

The authors describe a new case of persistent sciatic artery not yet described in the literature. This case is to be added to the four already existing classes of arterial vascularization of the pelvic members of certain animal species. This vascularization concerns two arteries of unequal significance according to the species. An embryological study of this vascularization is also performed. Following these studies, the authors will attempt an arterial systemization and parallel comparison of the different types of animal and embryologic vascularization and human variations of normal.

Persistent sciatic artery: case report, anatomy, and review of the literature

We report the case of a 64-year-old woman with an aneurysm of a left persistent sciatic artery presenting with arterial insufficiency from distal embolization. Treatment was exclusion of the aneurysm and femoropopliteal bypass after distal embolectomy with a Fogarty balloon catheter. We reviewed 71 cases in the literature to define characteristics of this anomaly which has many synonyms: including persistent sciatic artery, persistent axial artery, ischiopopliteal trunk. The persistence of the sciatic portion of the embryonic dorsal axial artery and failure of development of anastomoses with the ventral femoral network results in the anomaly. The persistent sciatic artery was "complete" in 75% of cases. In this configuration, it arises from the internal iliac artery, leaves the pelvic cavity through the lower part of the greater sciatic foramen caudad to the pyriformis muscle, reaches the posterior compartment of the thigh and continues as the popliteal artery. In 35% of cases, the artery is aneurysmal with a pulsatile mass in the buttock or a complication of the aneurysm. Arteriography required for diagnosis of the mass leads to discovery of the anomaly in many cases. The treatment of choice is exclusion followed by femoropopliteal vein bypass.