Bilateral Persistent Sciatic Arteries (PSA) And Varicose Veins: Mri Demonstration Of An Unusual Association

Persistent sciatic artery (PSA) is an extremely rare anatomical variant of lower limb arterial supply with an incidence of 0.025-0.6 % as estimated on angiographic studies. This vessel is prone for atherosclerosis, aneurysm formation and rupture, sciatic neuropathy, and ischemia of the lower extremities. It is important to diagnose this condition pre operatively especially in renal transplant surgery and in surgeries around the hip joint as trauma to this anomalous vessel can have disastrous consequences. It is associated with other congenital anomalies including Mullerian and left renal agenesis, A-V fistula formation, hypertrophy or hypotrophy, multiple hemangiomata, neurofiomatosis, or anomalies of leg arteries. Association of this anatomical variant with varicose veins is very rare and rarely discussed in literature. We report the youngest patient till date with this unusual association demonstrated on MRI.

Above-Knee Femoropopliteal Arterial Bypass for Lower Limb Ischemia Associated with Bilateral Persistent Sciatic Arteries / 日本心臓血管外科学会雑誌

<p>Persistent sciatic artery (PSA) is a rare congenital vascular anomaly with an incidence ranging from 0.025 to 0.06% of the general population. We report a 65-year-old male patient with bilateral PSA suffering from intermittent right-calf claudication. Peripheral pulsations could be palpated well at the right common femoral artery but not at the right popliteal artery. His ankle brachial index (ABI) was 0.79 on the right and 0.99 on the left. Computed tomographic (CT) angiography demonstrated that the bilateral PSAs were branched from the internal iliac arteries and the right PSA was completely occluded, whereas aneurysmal change was not evident. Both superficial femoral arteries were incompletely developed. Blood flow to the peroneal artery, anterior and posterior tibial arteries were maintained in both lower legs via a network of collateral arteries. Arterial bypass from right common femoral artery to the above-knee popliteal artery using knitted Dacron graft was performed and postoperative ABI of the right lower limb improved to 1.06. Ten months after the intervention, the patient was then suffered from intermittent left-calf claudication caused by complete occlusion of left PSA, therefore, above-knee femoropopliteal arterial bypass using knitted Dacron graft was performed. PSA is often asymptomatic until a complication develops and the careful monitoring to prevent the risk of thromboembolic and aneurysmal events are recommended.</p>

A Case of Persistent Sciatic Artery with Arteriosclerosis Obliterans / 日本心臓血管外科学会雑誌

Persistent sciatic artery (PSA) is a very uncommon congenital malformation. Its incidence is estimated to be 0.01-0.06%. In this article, we have described the case of 59-year-old woman presenting with a left lower limb ischemia. She had a good pulse in her femoral artery. However, no pulsation of her left popliteal, pedal and posterior tibial artery was observed. The ankle brachial index (ABI) was 1.05 on the right side and 0.65 on the left side. Preoperative angiography and CT scan showed that persistent sciatic artery had been branched from left internal iliac artery and the distal side had completely occluded. This persistent sciatic artery had no aneurysmal changes. The left superficial femoral artery was hypoplastic. Blood supply to the left peroneal artery, anterior and posterior tibial arteries by collateral arteries was detected. The left leg ischemia was diagnosed due to chronic occlusion of the persistent sciatic artery. Then, the bypass grafting was performed from the left common femoral artery to the above-knee popliteal artery using an ipsilateral reversed great saphenous vein graft. Postoperatively, ABI improved to 0.89 on the left side.

Treatment of Complete Persistent Sciatic Artery with Distal Thromboembolism by Thromboembolectomy Only

A persistent sciatic artery (PSA) is very rare congenital vascular anomaly which is present in 0.025% to 0.04% of the population by an angiographic study. A PSA is usually combined with aneurismal disease or thromboembolic events because of its arteriosclerosis and vessel wall degeneration. The treatments of symptomatic PSA are comprised of exclusion of PSA from circulation and bypass surgery for the lower limb. However, surgical treatment should be tailored to its anatomy and presentation. We report a successful treatment of PSA with distal thromboembolism by thromboembolectomy without bypass surgery.

Aneurisma verdadero en arteria ciática persistente: caso clínico / Persistent sciatic artery aneurysm: a case report

We report the case of a 71 years old female patient, who had a partially thrombosed true aneurysm in a persistent sciatic artery (PSA), treated in the Surgery Department of Hospital Dr. Eduardo Pereira of Valparaiso. The sciatic artery arises from the umbilical artery and during early embryological state is the main blood supply of the lower limbs. Later, the superficial femoral artery appears with the subsequent progressive involution of the sciatic artery. PSA is a rare congenital vascular anomaly that occurs when sciatic artery fails to regress during fetal development. This is associated with superficial femoral artery hipoplasia and the PSA becomes the dominant arterial inflow to the lower limb. This anatomic abnormality may be bilateral and can remain asymptomatic for many years, however, it has been described aneurysmal degeneration, like in this case, symptoms of sciatic nerve compression, aneurysm thrombosis and distal embolization.

Se reporta el caso de una paciente de 71 años, que presenta un aneurisma verdadero, parcialmente trombosado, en una Arteria Ciática Persistente (ACP), tratada en el Servicio de Cirugía del Hospital Dr. Eduardo Pereira de Valparaíso. La arteria ciática se origina en la arteria umbilical y durante las primeras fases embriológicas es el principal aporte sanguíneo de la extremidad inferior. Posteriormente aparece la arteria femoral superficial y se produce la progresiva involución de la arteria ciática. La ACP constituye una rara anomalía y ocurre por la falta de desarrollo de la arteria femoral superficial. La ACP se origina en el adulto en la arteria hipogástrica, transcurre hacia la región glútea a través de la escotadura ciática y sigue hacia distal por la parte posterior del muslo continuándose después con la arteria poplítea. Se acompaña de un variable menor desarrollo del eje arterial anterior de la arteria ilíaca externa y femoral superficial. Esta anomalía anatómica puede ser bilateral y puede permanecer asintomática durante muchos años, sin embargo, se ha descrito la degeneración aneurismática, como en este caso, y síntomas por compresión del nervio ciático, trombosis del aneurisma y embolización distal.

Bilateral Persistent Sciatic Arteries with Unilateral Complication:a Case Report

The sciatic artery is a major artery of the lower limb bulb during the early embryonic period. Its failure to regress is sometimes associated with femoral artery hypoplasia, and therefore, the dominant inflow to the lower extremity is called a persistent sciatic artery (PSA). This anomaly is often associated with a higher rate of aneurysm formation or thromboembolic complications that cause lower extremity ischemia. A 51-year-old man presented with complaints of right calf pain and a several month history of progressive claudication. CT angiography showed bilateral PSAs originating from hypogastric arteries. A long segment of the right PSA showed aneurysmal dilatation and thrombotic occlusion and the superficial femoral artery showed hypoplastic change. Focal segmental occlusion of the right popliteal artery below the knee was seen. He received a right femoro-posterior tibial bypass with a reversed saphenous vein graft. The patient' s postoperative course was uneventful and no complications were observed at 16 weeks follow-up.

Sciatic Nerve Compression in a Patient with Pesistent Sciatic Artery: A Case Report

The sciatic artery is a major artery of the lower limb during the early embryonic period, which involutes at the third month of embryonic life. The persistent sciatic artery (PSA) is a rare congenital anomaly, which may predispose a subject to atherosclerotic or aneurysmal degeneration. They usually present with leg ischemia or a throbbing buttock mass, but infrequently with a sciatic nerve compression symptom. We report a 56 year- old woman with PSA, who presented with back pain and a sciatic nerve compression symptom, which was erroneously diagnosed as spinal cord compression due to spinal stenosis. She was successfully treated with an above knee femoropopliteal bypass, with a reversed saphenous vein and surgical exclusion of the sciatic artery.

Acute Embolic Attack on Persistent Sciatic Artery: 1 case

Persistent sciatic artery (PSA) is a continuation of the internal iliac artery into the popliteal-tibial vessels and this structure provides the major blood supply to the lower limb bud during early embyrologic development, Its remnants participate in the formation of the inferior gluteal, deep femoral, popliteal, peroneal and pedal vessels. When the femoral artery develops, the PSA then involutes. In rare circumstances it persists and so provides the only major blood supply to the lower limb. The PSA was first reported by Green in 1832 and until now, only about 100 cases have been reported in the world literatures. This rare vascular anomaly is associated with aneurysmal formation in 15% to 46% of cases and it has a bilateral location in 22% of PSA cases. In more than 40% of cases, PSA is asymptomatic. When present, such non-specific symptoms as gluteal pain and painful buttock mass are presented. However, the most frequent clinical finding is lower limb ischemia because in 25% of such cases, the presented symptoms are limb threatening. We describe here the case of a 54 year-old female affected with PSA occlusion, and she was treated with a combination of thrombolysis and thromboembolectomy.