Anemia, Coagulopathy, and Acute Leg Ischemia: Unusual Complications of a Persistent Sciatic Artery Aneurysm

Abstract

In the event of a developmental abnormality of the vascular system of the lower limb in which the femoral system fails to develop or the axial artery fails to involute, the main vascular supply to the leg will be through a persistent sciatic artery (PSA). With an incidence of less than 0.04%, PSA can be asymptomatic, but in about half the cases an aneurysmal dilatation can ensue, and its symptomatology may include a painful gluteal mass. Cases have been reported of coagulopathy, anemia, or acute ischemia complicating PSA aneurysm. The case presented here is a clinical constellation of all three components appearing together in a patient who had long been investigated for anemia and had been operated on for a bleeding duodenal ulcer (as a consequence of coagulopathy) in a different center. At hospitalization, the gluteal mass was noted on examination, and angiography showed a huge PSA aneurysm. The clinical presentation and management of this case are discussed in light of the current literature.

Popliteal artery acute thromboembolic ischemia from a persistent sciatic artery

“…In most cases, the diagnosis is made incidentally during physical examination for lower extremity symptoms such as claudication, rest pain, or acute thromboembolism 5 . Our patient presented with sudden acute leg pain due to acute embolism.…”