ABSTRACT
Persistent sciatic artery (PSA) is a very uncommon congenital malformation. Its incidence is estimated to be 0.025-0.04%. If it is accompanied by hypoplasia of the femoral artery system, its presence is essential for perfusion of the limbs. The usual form of presentation is as an aneurysm (25-58%) and/or its complications (thrombosis, distal remobilization, local compression). A 66-year-old woman presented with a painful mass of several months' progression. After performing angio-computed tomography, a fusiform aneurysmal dilation was observed in the left gluteal mass dependent on the left obturator artery, which was identified as the left lower gluteal artery. For this reason, we decided to perform therapeutic embolization. During the angiogram, a left aneurysmal PSA with distal thrombosis was observed. In view of these findings, a bypass from the superficial femoral artery to the tibioperoneal trunk was performed, with a contralateral inverted saphenous vein. The PSA was subsequently embolized with an occluder (AGA Medical IZASA, Plymouth, MN). The patient was discharged after checking complete exclusion of the aneurysm by ultrasound, with distal pulses during follow-up. Combined treatment using embolization, before surgical revascularization of the limb, markedly decreases the morbidity and mortality by avoiding the pelvic approach by the posterior route.
Subject(s)
Aneurysm/etiology , Arteries/abnormalities , Buttocks/blood supply , Lower Extremity/blood supply , Vascular Malformations/complications , Aged , Aneurysm/diagnostic imaging , Aneurysm/therapy , Arteries/surgery , Embolization, Therapeutic/instrumentation , Female , Femoral Artery/abnormalities , Humans , Saphenous Vein/transplantation , Septal Occluder Device , Tomography, X-Ray Computed , Treatment Outcome , Vascular Malformations/diagnostic imaging , Vascular Malformations/therapyABSTRACT
OBJECTIVES: To determine the relationship between endothelial function by means of brachial artery flow-mediated dilation (BAFMD) and the clinical severity of peripheral arterial disease (PAD). METHODS AND RESULTS: We examined the brachial artery diameter by ultrasound, before and after ischemia of the arm in 3 groups of participants- group A: healthy individuals under 30 years, without cardiovascular risk factors (n = 30); group B: patients with PAD and ischemic claudication (n = 30); and group C: patients with critical leg ischemia (n = 20). There were no differences between groups B and C, in regard to age, sex, and main cardiovascular risk factor. The BAFMD was 9.9% in group A compared with 5.5% in the pooled patients group (B + C; P < .001). Significant differences were absent between groups B and C (P > .05). Correlation coefficient of ankle-brachial index/BAFMD was r = .1; P = .49. CONCLUSIONS: Patients with PAD present endothelial dysfunction, but this does not seem to determine the severity of the disease.
