Persistent sciatic artery in a patient with unilateral acute lower extremity ischemia

Abstract

We report a rare case of a persistent sciatic artery in a 59-year-old woman who had presented with unilateral acute limb ischemia. A heparin infusion was started. A right lower extremity arterial duplex ultrasound scan showed an occluded superficial femoral artery and underwent catheter-directed thrombolysis of her right popliteal artery, which was fed by a persistent sciatic artery. After recovery, computed tomography angiography was performed, which confirmed a persistent sciatic artery of the right lower extremity. The patient had presented with thrombotic disease secondary to atherosclerosis of popliteal and tibial arteries, in contrast to the more commonly seen aneurysmal disease with thrombosis.

Catheter-Directed Thrombolysis for Persistent Sciatic Artery Presenting with Acute Limb Ischemia

“…Etiology, pathophysiology, and anatomical factors should be considered in the treatment of PSA. The initial evaluation of patients with limb ischemic PSA and decision making in the immediate management period should be discussed and, among those who undergo endovascular and open surgical revascularization, the techniques are often complementary [ 5 - 7 ]. Meghpara et al [ 6 ] successfully performed CDT in a PSA patient with ALI, who was diagnosed with bilateral PSA and a right PSA aneurysm using endovascular procedures concomitant with stent graft placement, bare metal stent implantation, and CDT.…”

“…If blood flow through the sciatic artery persists, the vessel is required to sustain sufficient perfusion of the lower limbs, possibly due to hypoplasia of the femoral artery system [ 1 - 3 ]. Arterial bypass or endovascular intervention often requires immediate treatment for limb-threatening ischemic PSA, thus emphasizing the need for prompt revascularization [ 4 - 8 ]. PSA causes iliac artery aneurysms in 48% of patients and is potentially associated with rest pain, buttock pain, neuropathy, claudication, and acute limb ischemia (ALI) [ 4 , 5 ].…”

Popliteal Artery Occlusion in a Sole Sciatic Arterial System Requiring Complex Repair

“…4,5 In rare cases, through improper embryological development, the sciatic artery persists, typically as a continuation of the internal iliac artery. 6 The majority of reported cases describe unilateral persistent sciatic artery; however, there have been cases describing findings of bilateral sciatic arteries. [4][5][6][7] The persistent sciatic artery can be aneurysmal in up to 60% of cases, leading to distal thromboembolic disease resulting in development of acute or chronic limb ischaemia.…”

“…6 The majority of reported cases describe unilateral persistent sciatic artery; however, there have been cases describing findings of bilateral sciatic arteries. [4][5][6][7] The persistent sciatic artery can be aneurysmal in up to 60% of cases, leading to distal thromboembolic disease resulting in development of acute or chronic limb ischaemia. 1,3,7,8 The persistent sciatic artery is thought to be predisposed to aneurysmal degeneration secondary to accelerated atherosclerotic change or repetitive trauma given its exposed location.…”

“…1,4,9 This can present with regional symptoms secondary to the aneurysmal segment such as a pulsatile mass or buttock pain or may present with secondary symptoms due to embolic disease such as critical limb ischaemia. [1][2][3][4][5][6][7][8] The clinical finding of popliteal and distal pulses in the absence of femoral pulses should alert the examiner to suspect an underlying persistent sciatic artery. 4 The gold standard imaging modality varies by centre but is typically computed tomography angiogram (CTA) or direct angiography.…”