Minimally invasive diagnosis of persistent sciatic artery by multidetector-row computed tomographic angiography

Persistent sciatic artery: A case report and literature review

The persistent sciatic artery is an uncommon disease, considered an axial congenital vascular malformation due to the lack of involution of the sciatic artery during embryonic development. It may be associated with abnormalities in the development of the iliac, common femoral and superficial femoral arteries. Patients may be asymptomatic, or they could present chronic pain, such as sciatic neuralgia, caused by nerve damage, since it is close to the abnormal persistent vessel, or due to ischemic pain, as a result of a thrombosis or embolism of an aneurysm, which could compromise the viability of the limb.

Persistent sciatic artery: A case report and literature review

The persistent sciatic artery is an uncommon disease, considered an axial congenital vascular malformation due to the lack of involution of the sciatic artery during embryonic development. It may be associated with abnormalities in the development of the iliac, common femoral and superficial femoral arteries. Patients may be asymptomatic, or they could present chronic pain, such as sciatic neuralgia, caused by nerve damage, since it is close to the abnormal persistent vessel, or due to ischemic pain, as a result of a thrombosis or embolism of an aneurysm, which could compromise the viability of the limb.

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.

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.