Aneurysm of bilateral persistent sciatic arteries with ischemic complications: case report and review of the world literature

Abstract

A case of bilateral persistent sciatic artery (PSA) aneurysms with thromboembolic complications is presented along with a review of the 167 cases of PSA reported in the world literature. Its embryology, anatomy, clinical features, diagnosis, and treatment are reviewed and provide the following findings: The incidence of PSA is estimated to be from 0.025% to 0.04%, based on angiographic studies. Ages range from 6 months to 89 years, with a mean of 54 years. There is no gender predilection. A PSA was present on the right side in 32%, on the left side in 29%, bilaterally in 22%, and on either side in 18%. The "complete" type of PSA was 69%. Aneurysmal change was present in 46% of all PSAs. Overall, 59% had symptoms, including ischemia in 31% (acute in 14% and chronic in 17%), a gluteal mass in 26% (painful in 10%, painless in 6%, and pulsatile in 13%), gluteal pain in 2%, and ischialgia in 5%. Exclusion of the aneurysm or PSA by surgical or interventional techniques, with a femorodistal bypass as required for the resultant ischemia is currently the treatment of choice.