Persistent sciatic artery presenting with limb ischemia

Abstract

The persistent sciatic artery (PSA) is a rare but clinically significant congenital vascular anomaly. Clinical presentation varies and PSA can cause a number of complications, including limb loss. We describe the presenting features and treatments in two patients. The former was found to have thrombosis of a PSA with distal thromboemboli and was treated with a bypass graft. The latter was treated for an ischemic foot following successful ruptured aortic aneurysm repair and was found incidentally to have patent PSA with concomitant stenosis of the common iliac artery, which was successfully treated with stent grafting.

Angioplasty of the anterior tibial artery through an incidentally discovered persistent sciatic artery

“…PSA is a rare arterial embryologic anomaly reported in 0.025–0.04% of the population on angiography; 50% of cases are discovered incidentally . A PSA results when the femoral system fails to develop or the sciatic artery fails to regress . Thus, it arises from the internal iliac artery (IIA) and connects to the popliteal artery .…”

“…A PSA results when the femoral system fails to develop or the sciatic artery fails to regress . Thus, it arises from the internal iliac artery (IIA) and connects to the popliteal artery . It is unilateral in 70% of cases .…”

“…PSAs may undergo atherosclerosis resulting in stenosis or occlusion (<10%) . However, pseudoaneurysm formation is the most common complication (44–61%) and tends to be secondary to trauma from adjacent structures (accounting for its common occurrence near the greater trochanter) . Aneurysms manifest as a pulsatile buttock mass or result in thrombosis or distal embolisation .…”

“…However, pseudoaneurysm formation is the most common complication (44–61%) and tends to be secondary to trauma from adjacent structures (accounting for its common occurrence near the greater trochanter) . Aneurysms manifest as a pulsatile buttock mass or result in thrombosis or distal embolisation . Thromboembolic complications can lead to lower limb ischaemia (31–63%) and amputations (<10%) .…”

Mycotic Aneurysm of a Persistent Sciatic Artery

“…Oral antibiotics were unavailable, so she remains under close observation after 12 weeks of treatment. Aneurysmal enlargement and thromboembolism of a PSA may bring about complications such as limb ischemia and neuralgia (1). The development of a mycotic aneurysm of the type we encountered is notably rare (2).…”