Infected Massive Thrombosed Persistent Sciatic Artery Aneurysm Treated by Small Incision Drainage: A Case Report

Abstract

Introduction Persistent sciatic artery is a rare vascular anomaly. The occurrence of infected persistent sciatic artery aneurysm (PSAA) is extremely rare. Report An 84 year old woman who was under observation for a massive thrombosed right PSAA since the age of 74 presented with severe pain in her right lower limb. The patient was diagnosed with the infected PSAA by computed tomography and laboratory test. The condition was treated with antibiotics as well as drainage and removal of the infected thrombus with a small incision. Subsequently, the patient's symptoms improved, and she was discharged ambulatory. Sixteen months after the surgery, her condition remained good, with no evidence of recurrent infection. Conclusion Extensive debridement requires a large muscle incision and carries with it a risk of sciatic nerve injury. However, a thrombosed aneurysm has little risk of haemorrhage. Therefore, drainage and removal of the thrombus via a small incision, which is less invasive, was considered effective for this infected thrombosed PSAA.

An Infected Massive Persistent Sciatic Artery Aneurysm Treated by an Aneurysmal Incision and Drainage after Angiographic Embolization

“…In the present case, the PSAA likely developed because of repeated compression of the PSA from the patient regularly sitting on it in his daily life. However, reports on PSAA complicated with bacterial infection (infected PSAA) are extremely scarce ( 8 , 10 - 13 ). Furthermore, only two cases of massive infected PSAA that were as large as that reported in the present case have previously been reported ( 10 , 13 ).…”

“…However, reports on PSAA complicated with bacterial infection (infected PSAA) are extremely scarce ( 8 , 10 - 13 ). Furthermore, only two cases of massive infected PSAA that were as large as that reported in the present case have previously been reported ( 10 , 13 ). Because mycotic aneurysms are generally prone to rupture due to their rapid increase in size ( 14 ), the infected PSAA in the present case was naturally considered to be at an extremely high risk of rupture.…”

“…However, adhesion of surrounding tissues, including the sciatic nerve or relatively large blood vessels with infected PSAA, is likely to be present, which could lead to serious complications, such as severe bleeding or sciatic nerve injury, including troublesome neuralgia ( 11 ). One case of infected-PSAA was successfully treated by drainage of infected hematoma through a small incision and this treatment method was reported to be one of the useful and much less invasive treatment strategies without requiring revascularization surgery ( 13 ). Because the infected PSAA of our patient was massive (maximum diameter: 10 cm), gravely invasive surgical resection of the aneurysm and surrounding infected tissues with vascular reconstruction was highly likely to cause serious bleeding or sciatic nerve injury.…”

“…After drainage, the residual infected PSAA gradually decreased in size over time after the consecutive administration of antimicrobial agents, without requiring any additional surgical procedures. Because the control of the infection by drainage of the infected PSAA through an aneurysmal incision may be insufficient without complete aneurysmal resection or resection of the surrounding infected or necrotic tissues, the long-term administration of antimicrobial agents is essential ( 13 ). A case of massive infected PSAA controlled by the long-term administration of antibiotic agents after sufficient drainage of an infected aneurysm through a small incision has been previously reported ( 13 ).…”

“…Furthermore, a previous report has focused on a few cases of a ruptured PSAA with a maximum diameter of ≥5 cm ( 4 ). PSAA complicated with a bacterial infection (infected PSAA), which is extremely rare and has only been reported in a few case reports ( 8 , 10 - 13 ), tends to grow rapidly and rupture more easily due to the fragility of the aneurysm wall caused by bacterial inflammation. Such cases therefore require rapid intervention ( 14 ).…”