Symptomatic Growth of a Thrombosed Persistent Sciatic Artery Aneurysm after Bypass and Distal Exclusion

Abstract

A 71-year-old woman presented with an enlarging mass in the right buttock, with pain and tingling sensation in sitting position. Five years ago, she was diagnosed with acute limb ischemia due to acute thrombosis of right persistent sciatic artery (PSA), and she underwent successful thromboembolectomy and femoro-tibioperoneal trunk bypass. Computed tomography angiography revealed a huge PSA aneurysm (PSAA). During the previous bypass, the distal popliteal artery was ligated just above the distal anastomosis to exclude the PSAA, whose proximal end was already thrombosed. However, PSAA has grown to cause compression symptoms, and the mechanism of aneurysm growth can be ascribed to type 1a or type 2 endoleak. In order to relieve the compression symptoms, aneurysm excision was performed without any injury to the sciatic nerve. A postoperative tingling sensation due to sciatic-nerve stimulation in the supine position resolved spontaneously one month after surgery.

Significance of collateral circulation in managing persistent sciatic artery: Two case reports

“…Furthermore, during the follow-up period, the PSAA of the first patient spontaneously occluded, and the aneurysm of the second patient demonstrated a slight increase in diameter without symptom development. Notably, a previous study has reported the growth of thrombosed PSAA with symptom aggravation following bypass surgery for limb ischemia in a patient with PSA ( 8 ). Hence, serial follow-up of PSAA is mandatory and specific guidelines for treating PSAA are warranted.…”

“…In contrast to the management of type 1 PSA with complete PSA and SFA, distal embolization should be managed through the PSA system in the endovascular approach. However, after managing thromboembolic occlusion, PSAA should be accessed as it can cause recurrent embolization or aneurysmal dilatation ( 8 , 9 ). There have been some reports of successful distal embolization management through the PSA using the contralateral femoral or brachial approach ( 10 ).…”

Persistent Sciatic Artery Aneurysm as a Rare Cause of Acute Lower Limb Ischemia

“…Persistent sciatic artery is a rare anomaly of the internal iliac artery during embryogenesis. There is a risk of aneurysmal degeneration in up to 60% of the cases, which may further lead to distal embolization and lower limb ischemia [ 2 ]. Due to its localization and variable femoral and sciatic connections, both open and endovascular management are challenging.…”