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Case Reports
. 2015 Apr;28(2):210-2.
doi: 10.1080/08998280.2015.11929232.

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

Allen Lee  1 , Stephen E Hohmann  1 , William P Shutze  1
Affiliations
Case Reports

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

Allen Lee et al. Proc (Bayl Univ Med Cent). 2015 Apr.

Abstract

Persistent sciatic artery is a rare developmental anomaly. In its complete form, it provides the major arterial supply to the lower leg since the femoral system is hypoplastic. These unique arteries are prone to aneurysm formation and most commonly present with complications related to aneurysm formation, which can lead to limb loss. We encountered a 68-year-old man presenting with bilateral lower-extremity ischemia who was found to have bilateral persistent sciatic artery aneurysms. One aneurysm had already thrombosed, but the other was still patent. We treated this patient with a hybrid open and endovascular repair on the patent side. The aneurysm was excluded with an Amplatzer™ plug (St. Jude Medical, Inc., St. Paul, MN) followed by a femoropopliteal bypass with saphenous vein in situ to revascularize the lower leg. To our knowledge, this is only the second report of a persistent sciatic artery aneurysm successfully treated with Amplatzer plug occlusion.

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Figures

Figure 1.
Figure 1.
Coronal reconstructed contrast-enhanced CT angiogram demonstrating bilateral persistent sciatic arteries. Note the left persistent sciatic artery (PSA), which begins as a continuation of the internal iliac artery and proceeds caudally exiting the pelvis to course inferiorly into the thigh. The patent PSA aneurysm on the left is marked by the arrow. The sciatic artery aneurysm on the right is thrombosed, and while it is not demonstrated on this reconstructed image, it is easily identified on the original axial CT slices (not shown). Both superficial femoral arteries are hypoplastic, and the PSA supplies both popliteal arteries.
Figure 2.
Figure 2.
(a) The popliteal artery was accessed in a retrograde fashion (arrow) to perform the sciatic artery aneurysm embolization. (b) The superficial femoral artery (arrow) was noted to be hypoplastic.
Figure 3.
Figure 3.
(a) Coils were left within the aneurysm sac (dashed arrow) and a second Amplatzer plug (solid arrow) was placed just distal to the aneurysm sac. (b) Amplatzer plugs with endovascular coils (circle) are noted within the persistent sciatic artery aneurysm with no flow. The femoropopliteal artery bypass (arrow) is patent.
Figure 4.
Figure 4.
Conventional radiograph of the pelvic region showing endovascular coils within the persistent sciatic artery aneurysm (circle) and distally migrated coils (arrow).
See this image and copyright information in PMC

References

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