A case of persistent sciatic artery aneurysm with recurrent embolism

Mutsuo Tanaka; Minoru Okamoto; Ken Okamoto; Toshihiro Fukui

doi:10.1016/j.ijscr.2019.06.017

A case of persistent sciatic artery aneurysm with recurrent embolism

Int J Surg Case Rep. 2019:60:156-160. doi: 10.1016/j.ijscr.2019.06.017. Epub 2019 Jun 13.

Authors

Mutsuo Tanaka¹, Minoru Okamoto², Ken Okamoto³, Toshihiro Fukui⁴

Affiliations

¹ National Hospital Organization Kumamoto Medical Center, Department of Cardiovascular Surgery, 1-5 Ninomaru, Chuo-ku, Kumamoto-shi, Kumamoto Prefecture, 860-0008, Japan. Electronic address: mutsuoman620@gmail.com.
² National Hospital Organization Kumamoto Medical Center, Department of Cardiovascular Surgery, 1-5 Ninomaru, Chuo-ku, Kumamoto-shi, Kumamoto Prefecture, 860-0008, Japan. Electronic address: okamoto.minoru.he@mail.hosp.go.jp.
³ Kumamoto University Hospital, Department of Cardiovascular Surgery, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto Prefecture, 860-8556, Japan. Electronic address: okaken1967cmk@kuh.kumamoto-u.ac.jp.
⁴ Kumamoto University Hospital, Department of Cardiovascular Surgery, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto Prefecture, 860-8556, Japan. Electronic address: tfukui.cvs@gmail.com.

Abstract

Introduction: Persistent sciatic artery (PSA) is a rare congenital vascular anomaly. It has several clinical features with the formation of aneurysms. Among the complications, leg ischemia is severe problem and the management involves revascularization and prevention of recurrence. We herein describe an anatomically annoying case of PSA aneurysm with recurrent embolism that necessitated thrombectomy and bypass surgery. And this work has been reported in line with the SCARE criteria.

Case presentation: A 76-year-old woman developed leg embolism twice from PSA aneurysm. PSA was complete type and the popliteal artery ran on the lateral side, which was difficult to approach from the standard medial side. Based on these anatomical conditions, thrombectomy of the posterior-tibial artery (PTA) and femoral-PTA bypass were performed. Additionally, the proximal side of PTA from the anastomosis site was ligated to avoid the recurrence of embolism. Residual PSA aneurysm has not yet been treated, but neither clinical complications nor dilatation have occurred.

Discussion: PSA is a rare disease, but should be remember in acute limb ischemia. Clear treatments have not yet been established; therefore, its plans need to be considered based on clinical symptoms and anatomical conditions.

Conclusion: Although there were anatomical issues in the present case, thrombectomy and bypass surgery were successful and no complications have occurred one year after surgery.

Keywords: Limb ischemia; Peripheral vascular surgery; Persistent sciatic artery aneurysm.