Effectiveness of exclusion of a persistent sciatic artery aneurysm with an Amplatzer™ plug

Successful Hybrid Approach Treatment of a Large Persistent Sciatic Artery Aneurysm-A Case Report

Background and Objectives: Persistent sciatic artery (PSA) is a rare congenital vascular anomaly that is often asymptomatic, but can be associated with aneurysm formation and potential complications, such as thromboembolism or aneurysm rupture in some cases. We present a case of a 75-year-old woman with a symptomatic thrombus-containing aneurysm of the left PSA. Materials and Methods: The treatment of the PSA aneurysm involved a successful hybrid approach, which included open surgical bypass and endovascular embolization. The open surgical bypass was performed from the left common femoral artery to the left above-the-knee popliteal artery using a synthetic graft, while the aneurysm exclusion was achieved through endovascular plug embolization. Results: Control angiography revealed complete exclusion of the PSA aneurysm. At the 1-month follow-up, there were no palpable pulsatile masses in the left gluteal region, and the patient reported no symptoms. Conclusions: Given the high incidence of limb- and life-threatening complications associated with a PSA aneurysm, accurate diagnosis and appropriate treatment are crucial. In this case, a combination of open surgical and endovascular techniques resulted in a favorable outcome for the patient, highlighting the effectiveness of the hybrid approach in managing PSA aneurysms. Further studies are warranted to explore and refine treatment strategies for these complex vascular anomalies.

Diagnosis and surgical treatment of a persistent sciatic artery aneurysm

The persistent sciatic artery is situated superficially in the gluteal region wherein it can be traumatized in normal daily activities: during a prolonged sitting position or while attempting to sit down. This leads to an early atherosclerotic lesion of the sciatic artery, to the development of aneurysmatic dilatation, and damage to the arterial wall. The present article describes a 72-year-old female patient presenting with a persistent sciatic artery of the left leg and a PSA aneurysm which consequently resulted in critical ischaemia of her left lower limb. This abnormality was detected during an examination and the woman was subjected to the operation of internal iliac-posterior tibial bypass grafting using an autologous vein with ligation of the sciatic artery. The bypass graft has been functioning for 5 months, with no events of critical ischaemia.

Endovascular Solution of Acute Limb Ischemia Engendered by Persistent Sciatic Artery Pseudoaneurysm due to Stent Fracture

We report a case of acute limb ischemia (ALI) due to a thromboembolism from a persistent sciatic artery (PSA) pseudoaneurysm precipitated by a fractured stent. Patient, previously treated for ALI by fibrinolysis and stent implantation, presented with a PSA pseudoaneurysm (undetected during first hospitalization), stent fracture (SF), and occlusion of vessels below the knee. Fibrinolysis was performed, restoring direct flow to the foot. A week later, an endovascular procedure was attempted to reline SF and exclude the PSA pseudoaneurysm by deployment of two 13 × 100-mm peripheral endografts (Viabahn; W.L. Gore & Associates, Flagstaff, AZ). At 1-year follow-up, patient was asymptomatic without further clinical events.

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.