Hybrid Approach in a Case of Persistent Sciatic Artery Aneurysm

A hybrid approach for the treatment of persistent sciatic artery aneurysms

“…Endovascular exclusion has been achieved using Amplatzer plugs, 5-7 stent grafts, [8][9][10][11][12][13][14] and coiling. 15,16 Open aneurysmorrhaphy and excision with interposition grafting have also been described. 1 Bypass methods after PSA aneurysm exclusion previously performed include common femoral-to-popliteal, internal iliac-to-popliteal, common iliac-to-profunda femoris artery, internal iliac-to-distal PSA, femorotibial trunk, common femoral-to-PSA, common femoral-toposterior tibial, and popliteal-to-posterior tibial bypasses 3 with autologous vein.…”

Nonatherosclerotic limb ischemia: Prompt evaluation and diagnosis

“…16 Up to 40% of patients have no symptoms, but symptoms may develop by age 40 to 50. Because of repeated trauma to the vessel as it passes through the sciatic foramen, 18 the persistent sciatic artery typically sustains accelerated atherosclerotic changes that make it susceptible to aneurysm formation, 15 and up to 46% of patients present with aneurysmal degeneration. 17 Classically, patients present with lower extremity ischemia from atherosclerotic changes in the persistent sciatic artery or aneurysmal degeneration and thromboembolism.…”

“…A pulsatile buttock mass with evidence of lower extremity nerve compression or limb ischemia or both is pathognomonic of a persistent sciatic artery aneurysm. 16,18 Diagnosing persistent sciatic artery Diagnostic angiography is the gold standard imaging test, 15,19 although CTA is starting to replace it. 16,18 Treating persistent sciatic artery Persistent sciatic artery that is asymptomatic and is found incidentally does not require repair; however, it should be followed with duplex ultrasonography to look for evidence of aneurysm degeneration.…”

“…Degeneration requires repair in most cases. 15,16,18,19 When the persistent sciatic artery is the only blood supply to the distal extremity, open aneurysm excision and bypass is the treatment of choice. 15,16,19 If collateral flow is adequate, endovascular coil embolization is an option.…”

Commentary: Endovascular Treatment of Persistent Sciatic Artery Aneurysm With the Multilayer Stent: Is It a Miraculous Solution for All Complex Conditions?

“…Today, the management of PSA aneurysm can be either endovascular or surgical treatment, with good results in either scenario. [4][5][6][7][8][9][10][11][12][13] Excluding the surgical option, the flow-modulating MARS is an alternative treatment for aneurysmal arteries in cases where the conventional endovascular techniques are not suitable or when it is necessary to maintain patency of collateral branches of the target artery. The literature contains many cases in which the MARS was used in selected cases for arterial aneurysm with initial enthusiastic results.…”