Endovascular stent graft repair of complete persistent sciatic artery aneurysm with lower limb ischemia: A case report and review of the literature

Abstract

Background: Persistent sciatic artery is a rare embryological vascular anomaly, with an incidence of 0.01%–0.05%. Up to 60% of persistent sciatic artery patients will develop aneurysms that can subsequently lead to distal embolization and a high risk of limb loss. Method: Here we report a case with acute limb ischemia caused by thrombus in a right persistent sciatic artery aneurysm. The patient underwent endovascular treatment by deploying a 10 × 150 mm stent graft (Viabahn) in the persistent sciatic artery and two self-expanding bare stents (10 × 40 mm, 10 × 60 mm, SMART) in the stent graft to reinforce the radial resistive force. In addition, we conducted a literature review of articles published in PubMed from 2001 to 2018 regarding stent graft repair of complete persistent sciatic artery aneurysms. A total of 13 articles reported 13 patients with complete persistent sciatic artery aneurysms who underwent endovascular stent graft repair. Result: A favorable result was obtained for this patient, and computed tomographic angiography at 6 months of follow-up revealed patent stent graft. Most articles reported favorable results. Conclusion: Favorable results can be achieved with endovascular stent graft repair and anticoagulation therapy for complete persistent sciatic artery aneurysms.

Total endovascular repair for a persistent sciatic artery aneurysm with widespread limb-threatening arterial occlusion

“…The literature was searched and revealed no previously reported cases of continuous thrombotic lesions that extended from the IIA orifice to the below-knee arteries. [2][3][4][5][6][7][8][9][10][11][12][13][14] In such cases, the EIA running to the deep femoral artery, could develop as a collateral pathway into the J o u r n a l P r e -p r o o f popliteal artery. However, the EIA in the present case was also thrombosed, and a potential risk of limb loss was high.…”

“…[1][2][3][4][5][6] Along with surgical bypass and/or resection, endovascular treatment (EVT), including stent-grafting deployment, thrombolysis, and/or embolization, has recently emerged as a key treatment option. 2,[6][7][8][9][10][11][12] This report describes a successful management of a case of a PSAA with thrombotic occlusion extending from the orifice of the IIA and EIA to the below-knee popliteal artery. This was repaired only with EVT using stent-grafts, a bare-metal stent (BMS), and thrombolytics via a bidirectional percutaneous approach.…”

Endovascular Treatment of Persistent Sciatic Artery Aneurysms With Primary Stenting: A Systematic Review of the Literature

“…1,28 Although surgical repair of PSAAs is considered a well-established treatment approach, there is no evidence of superiority of surgery to endovascular therapy due to sparse data and low prevalence of the disease. 1 Although open repair is more invasive and challenging than endovascular therapy, it has been associated with increased risk of sciatic nerve injury and a slower recovery of functional status 3 due to the narrow and deep surgical field in the thigh 6,20,29 as well as the presence of the sciatic nerve close to PSA. In addition, the technical burden of a failed bypass procedure, especially in the cases with a complete type PSA, could have dramatic sequela and even lead to major amputation.…”

“…Up to 60% of the PSA cases will eventually develop aneurysmal degeneration 1,2 and as such is placed at a higher risk for acute or chronic lower limb ischemia and limb loss. 1,3 Persistent sciatic artery aneurysms (PSAAs), due to its complications, can potentially be a highly morbid condition with poor limb salvage in most cases, requiring immediate aneurysm exclusion and revascularization when diagnosed. 1,3 Repair of PSAA has most commonly been achieved by femoropopliteal bypass and aneurysm resection.…”

Therapie primärer Aneurysmen der Extremitätenarterien

“…Eine vergleichende Evidenz existiert nicht, jedoch wird für das offen chirurgische Vorgehen ein hohes Risiko einer Verletzung des N. ischiadicus beschrieben. Endovaskuläre Versorgungen lieferten in Einzelfallberichten gute Ergebnisse [38,39].…”