A case of persistent sciatic artery aneurysm with recurrent embolism

Abstract

Introduction: Persistent sciatic artery (PSA) is a rare congenital vascular anomaly. It has several clinical features with the formation of aneurysms. Among the complications, leg ischemia is severe problem and the management involves revascularization and prevention of recurrence. We herein describe an anatomically annoying case of PSA aneurysm with recurrent embolism that necessitated thrombectomy and bypass surgery. And this work has been reported in line with the SCARE criteria.

Case presentation: A 76-year-old woman developed leg embolism twice from PSA aneurysm. PSA was complete type and the popliteal artery ran on the lateral side, which was difficult to approach from the standard medial side. Based on these anatomical conditions, thrombectomy of the posterior-tibial artery (PTA) and femoral-PTA bypass were performed. Additionally, the proximal side of PTA from the anastomosis site was ligated to avoid the recurrence of embolism. Residual PSA aneurysm has not yet been treated, but neither clinical complications nor dilatation have occurred.

Discussion: PSA is a rare disease, but should be remember in acute limb ischemia. Clear treatments have not yet been established; therefore, its plans need to be considered based on clinical symptoms and anatomical conditions.

Conclusion: Although there were anatomical issues in the present case, thrombectomy and bypass surgery were successful and no complications have occurred one year after surgery.

Keywords: Limb ischemia; Peripheral vascular surgery; Persistent sciatic artery aneurysm.

Fig. 1

CT images at first admission. a. CT shows a left persistent sciatic artery (PSA) aneurysm (arrow) and the left popliteal artery located more laterally than the normal pattern (arrow head). b. Three-dimensional CT shows complete-type PSA, hypoplastic superficial femoral artery (7 mm), and occlusion in the three artery branches of the lower leg (circle).

Fig. 2

Magnetic resonance angiography during the first hospitalization. Magnetic resonance angiography shows the patency of the posterior-tibial artery (PTA) and peroneal artery (arrow) from the tibio-peroneal trunk (circle). The anterior-tibial artery was not detected.

Fig. 3

Enhanced CT images one year after the surgery. The bypass graft is patient and the artery from sciatic to superficial femoral is occluded at the PSA aneurysm (circle). The dilatation of PSA aneurysm has not been observed, its size is 22 mm in maximum minor-axis diameter (arrow).