Persistent Sciatic Artery Aneurysm with Lower Limb Ischemia

Abstract

Persistent sciatic artery is a very rare clinical entity. Those of us who have not seen the lesion regard this as a condition which is described in the literature through less than 200 cases. We report, here, a case of a 60-year-old female who presented to the surgical outdoor with complaints of a pulsatile gluteal swelling associated with ischemic changes in the ipsilateral lower limb. On Doppler and CT angiographic analysis, the patient was determined as having persistent sciatic artery aneurysm which was then managed by a combined surgical and endovascular approach. Ours is probably the first such case to be reported from India. The objective of this case report is to highlight the relevant embryology, the pathognomonic presenting features, the diagnostic dilemma, management, and complications associated with a case of persistent sciatic artery (PSA).

A Case Report of Patients with Persistence of Sciatic Artery

“…The incomplete type is the existence of a hypoplastic persistent sciatic artery along with the dominant superficial femoral vessel. The complete type entails the existence of a dominant persistent sciatic artery along with a hypoplastic superficial femoral system, which only provides collateral supply to the lower limb [7][8][9].…”

“…Fifty percent of the cases are bilateral. The presenting symptoms are pain, numbness, and motor impairment that result from compression of the sciatic nerve that lie adjacent to the persistent aberrant vessel [2,7,9]. The most common complication of persistence of sciatic artery is formation of aneurysm, occurring in 48% of cases [6].…”

Nonatherosclerotic limb ischemia: Prompt evaluation and diagnosis

“…13,14 ■ PERSISTENT SCIATIC ARTERY Persistent sciatic artery is a rare developmental abnormality. [15][16][17] Normally, as the femoral artery develops in the embryo, the sciatic artery involutes to form the inferior gluteal artery. But if the femoral system fails to mature, the sciatic artery, which is adjacent to the sci-Popliteal artery aneurysm is associated with abdominal aortic aneurysm in 50% of patients Asymptomatic, persistent sciatic artery found incidentally does not require repair, but it should be followed atic nerve posteriorly as it goes through the sciatic foramen, persists and functions as the major artery supplying the lower extremity, continuing to the posterior thigh and joining the popliteal artery (Figure 3).…”

“…15,17 Persistent sciatic artery has an incidence of 2.5 to 4 per 10,000 per year 15 and is bilateral in almost half of cases. 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.…”

“…15,17 Other signs and symptoms include a pulsatile mass in the buttock, lower extremity numbness, motor weakness, and radicular pain along the sciatic nerve distribution from nerve compression. [15][16][17] Physical findings vary but are distinguished by the lack of femoral pulses in the presence of pedal pulses. A pulsatile buttock mass with evidence of lower extremity nerve compression or limb ischemia or both is pathognomonic of a persistent sciatic artery aneurysm.…”