Rare Occurrence of a Symptomatic Persistent Sciatic Artery Aneurysm

Abstract

Persistent sciatic artery (PSA) aneurysms are a rare cause of gluteal or lower extremity pain. The persistent sciatic artery is an uncommon congenital vasculature anomaly that presents with variable clinical presentation and is prone to cause an aneurysm, thrombosis, rupture, and possible amputation. Thus, early diagnosis is imperative to prevent further complications. We present the case of a 75-year-old female who was diagnosed with a persistent sciatic artery aneurysm after presenting with gluteal and lower extremity pain initially thought to be sciatica. Our patient underwent a successful hybrid open and endovascular approach with a femoral to below-knee popliteal artery bypass and the placement of coils at the proximal and distal ends of the aneurysmal segment.

Keywords: endovascular coiling; endovascular technique; ir guided embolization; peripheral vascular surgery; persistent sciatic artery aneurysm; vascular surgery.

Figure 1. A: External iliac artery (black arrow), internal iliac artery (blue arrow), common femoral artery at the level of the femoral head (green arrow) B: Internal iliac artery (orange arrow)

Figure 2. A: Persistent sciatic artery (PSA) posterior to the femur (black arrow), the femoral head (blue arrow) B: Occluded distal PSA above the knee (green arrow), distal femur (orange arrow)

Figure 3. A: Profunda femoris artery (black arrow) B: Superficial femoral artery (blue arrow), C: knee joint (yellow arrow), Popliteal artery (orange arrow)

Figure 4. A: Persistent sciatic artery aneurysm (blue arrow), retrograde ultrasound-guided PSA cannulation (black arrow) B: PSA aneurysm (orange arrow); coil proximal to aneurysm (green arrow); C: Distal coil to PSA aneurysm (yellow arrow).

Figure 5. Normal embryological development of the arterial network of the lower extremity; a persistent sciatic artery may be present due to errors in this process