Intermittent claudication associated with persistent sciatic artery: Report of two cases

Two elderly women complaining of intermittent claudication complicated with persistent sciatic artery are herein reported. A direct femoral arteriogram showed hypoplasty of the superficial femoral artery and an unnatural anatomical relationship between the distal superficial femoral artery and the proximal popliteal artery, thus suggesting the presence of persistent sciatic artery. The diagnosis of persistent sciatic artery was finally made based on the aortography findings including the iliac arterial system and computed tomography (CT) scan. Magnetic resonance imaging (MRI) was helpful to demonstrate the entire image of this anomaly in cases with non-thrombolized sciatic artery. These diagnostic methods were useful in designing the optimal surgical strategy. The first case with a gluteal pulsating mass underwent exclusion of the persistent sciatic artery including the aneurysm through a retroperitoneal approach with a combination of femorotibial bypass, while the second case with thrombosed persistent sciatic artery only underwent femoropopliteal bypass. To recognize such a rare lesion, awareness of the differential diagnosis is important, and to provide appropriate treatment, an accurate whole image including adequate angiography, a CT scan, and magnetic resonance imaging is necessary.     

Persistent sciatic artery aneurysm with limb-threatening ischemia

A 50 year old lady with bilateral persistent sciatic artery aneurysm presented with severe limb ischemia due to distal embolization from a thrombus filled persistent sciatic artery aneurysm on one side. Persistent sciatic artery is a rare embryological anomaly which results due to the failure of development of the femoral system. Its complete variant can be clinically recognised by the presence of a weak femoral pulse with a normal popliteal pulse. The diagnostic and treatment considerations of this rare anomaly are described.     

Role of computed tomographic angiography in the detection and comprehensive evaluation of persistent sciatic artery

PURPOSE: To define the role of computed tomographic (CT) angiography in the evaluation of persistent sciatic artery and to identify its potential advantages as a diagnostic modality. METHODS: Between July 2002 and August 2004, 307 consecutive patients underwent CT angiography for suspected lower-extremity arterial insufficiency. All CT angiograms were retrospectively reviewed to determine the presence and laterality of persistent sciatic artery and its associated vascular abnormalities, such as aneurysm, thrombus, distal thromboembolism, and atherosclerotic change. The relationship of persistent sciatic artery with adjacent structures, such as sciatic nerve, muscle, accompanying vein, and femoral artery, as well as the presence of other anomalies, was analyzed. Clinical data regarding the presenting symptoms and hospital course were obtained from patient charts. RESULTS: Six persistent sciatic arteries, with or without occlusion, were identified in five female patients (age range, 54 to 80 years). CT angiography revealed unilateral persistent sciatic artery in four patients (left, 3; right, 1) and bilateral persistent sciatic artery in one patient. Aneurysm was present in two (mean size, 26 mm x 20 mm), thrombosis in three, and distal thromboembolism in all six persistent sciatic arteries. All persistent sciatic arteries coursed along the sciatic nerve and continued as popliteal artery. Characteristically, in all these instances, the superficial femoral arteries were hypoplastic and tapered smoothly. Anomalous popliteal venous drainage was noted in all ipsilateral limbs with persistent sciatic artery and even in contralateral limbs with normal superficial femoral artery in all but one. CONCLUSION: CT angiography enables the detection of persistent sciatic artery even in the presence of complete occlusion and is useful in the comprehensive evaluation of various complications and associated venous anomalies. It can potentially be used as the sole imaging modality for persistent sciatic artery.     

Persistent sciatic artery aneurysm: a case report

In early embryologic development the sciatic artery provides the blood supply to the lower limb bud. When the femoral artery develops, the sciatic artery involutes. However, in rare cases, the sciatic artery persists. It can be visualised as a prolongation of the inferior gluteal artery (branch of the internal iliac artery) and it accompanies the sciatic nerve at the posterior side of the hip. We present the case of a 47-year old woman who consulted because of a numb right foot which presented colder and paler than the left foot. She also had a right painful calf, especially after exercise. Upon physical examination and doppler ultrasound there were no popliteal nor pedal artery pulses in the right leg. CT angiography showed bilateral persistent sciatic arteries with aneurysm formation and the presence of an embolus in the popliteal artery at the right side. Treatment involved thrombolysis of the popliteal occlusion, followed by intra-aneurysmatic stent placement and embolectomy of the popliteal artery and its distal branches. Postoperative clinical results were remarkably good and the patients symptoms dissolved. CONCLUSION: A persistent sciatic artery is a rare vascular anomaly. It is more prone to vasculopathies such as aneurysm formation. In cases of acute ischemia, correct diagnosis and treatment of this anomaly can avoid serious medical consequences.     

Double popliteal artery of congenital origin

An exceptional unilateral right double popliteal artery was discovered by chance. After a review of the possible causes of embryological developmental abnormalities, the most likely hypothesis is that of persistent sciatic artery.     

Occluded persistent sciatic artery

The case of a patient with ischemic symptoms due to occlusion of a persistent left sciatic artery is presented. Femoral arteriography revealed a tapering hypoplastic superficial femoral artery terminating as small branches in the distal thigh and a hyperplastic profunda femoris artery. Also, translumbar aortography demonstrated an abrupt occlusion of a hyperplastic left hypogastric artery just distal to the inferior gluteal artery. The popliteal artery was found to be patent and perfused by collaterals. A bypass graft using a composite E-PTFE prosthesis and an autogenous vein graft was successfully performed.     

A surgical case of aneurysm of the persistent sciatic artery

Seventy two-year-old woman was admitted in September, 1985 to our hospital with complaints of painful mass in the right buttock and ischias. Aorto-peripheral arteriogram showed that enlarged right internal iliac and inferior gluteal arteries passed posteriorly to cross the right hip and down the posterior aspect of the femur to supply the popliteal artery. A saccular aneurysm was seen immediately posterior to the right femoral head. The femoral artery was small in size, but connecting to the popliteal artery. Delayed flow to the popliteal artery through the sciatic artery was noted in contrast to the femoral system. With Osborne's right buttock approach, the gluteus maximus muscle was divided in the direction of its fibers, exposing a 3.5 by 5 cm aneurysm which was located above, the sciatic nerve and adherent to it. The proximal sciatic artery and the trunk of the sciatic nerve passed beneath the piriformis muscle. The pressure of the dorsalis pedis artery decreased from 156/77 to 117/72 mmHg after ligation of the proximal sciatic artery. The aneurysm was dissected free from the sciatic nerve. Postoperatively she had no more gluteal discomfort, nor did she have any ischemic symptoms by walking.     

Persistent sciatic artery. Case report

In a man with ischemia of the right leg due to embolism of popliteal artery, arteriography following failure of embolectomy via the common femoral artery revealed the internal iliac artery continuing as an aneurysmally dilated sciatic artery distally to the popliteal artery. The aneurysm was ligated and bypass established from the common femoral to the popliteal artery.     

Persistent sciatic artery: Case report,anatomy, and review of the literature

We report the case of a 64-year-old woman with an aneurysm of a left persistent sciatic artery presenting with arterial insufficiency from distal embolization. Treatment was exclusion of the aneurysm and femoropopliteal bypass after distal embolectomy with a Fogarty balloon catheter. We reviewed 71 cases in the literature to define characteristics of this anomaly which has many synonyms: including persistent sciatic artery, persistent axial artery, ischiopopliteal trunk. The persistence of the sciatic portion of the embryonic dorsal axial artery and failure of development of anastomoses with the ventral femoral network results in the anomaly. The persistent sciatic artery was "complete" in 75% of cases. In this configuration, it arises from the internal iliac artery, leaves the pelvic cavity through the lower part of the greater sciatic foramen caudad to the pyriformis muscle, reaches the posterior compartment of the thigh and continues as the popliteal artery. In 35% of cases, the artery is aneurysmal with a pulsatile mass in the buttock or a complication of the aneurysm. Arteriography required for diagnosis of the mass leads to discovery of the anomaly in many cases. The treatment of choice is exclusion followed by femoropopliteal vein bypass.     

Replacement of in situ saphenous venous aneurysms with arterial autografts

BACKGROUND: Aneurysm formation in arterialized autologous saphenous veins is an unusual complication of in situ femoral popliteal bypass procedures. METHODS: In a personal series of 207 in situ saphenous femoral popliteal bypass operations, three nonanastomatic venous aneurysms occurred. All three venous aneurysms occurred in male patients who had no adequate autologous vein available as an interposition graft. The use of eversion endarterectomized superficial femoral artery is reported as a substitute interposition graft with long-term results. RESULTS: In the 3 male patients in this series, nonanastomatic aneurysms developed in their in situ saphenous femoral popliteal bypass grafts. The venous aneurysms developed between 5 and 8 years after the original surgical procedure. No adequate vein was available as a replacement for the excised venous aneurysm. Prosthetic conduit was not used owing to the remote possibility of a subclinical infection. A segment of eversion thromboendarectomized superficial femoral artery removed from the same leg was used as a replacement interposition graft in each patient. The in situ venous graft with the autologous interposition thromboendarterectomized superficial femoral artery remained patent until each patient's death 4 to 7 years after the venous aneurysm replacement. CONCLUSIONS: A short segment of endarectomized superficial femoral artery has been found to be a novel solution for the treatment of isolated saphenous vein graft aneurysms when no suitable vein is available. These patients should be maintained on lifelong aspirin therapy owing to the thrombogenic potential of endarectomized artery.     

Angioplasty via retrograde popliteal approach in a stenosed persistent sciatic artery.

Persistent sciatic arteries are a rare developmental anomaly prone to aneurysm formation and atherosclerotic disease. We present a case of a patient with bilateral persistent sciatic arteries presenting with unilateral claudication due to a symptomatic stenosis. The stenosis (just above knee) was treated with angioplasty via popliteal puncture. The puncture was complicated by pseudoaneurysm formation. Persistent sciatic arteries can cause diagnostic difficulties as Duplex ultrasound can give the impression of an occluded superficial femoral artery. Angiographic techniques are the mainstay of diagnosis and we demonstrate both conventional and CT angiographic appearances.     

Symptomatic persistent sciatic artery in a newborn

Persistent sciatic artery is an unusual anatomical anomaly first noted in 1832. Approximately 60 to 70 cases have been documented in the literature, but none described symptomatic persistent sciatic artery presenting in the neonate. We report a case of a newborn infant who presented after birth with an atrophic right lower extremity and ischemia. Ultrasound with Doppler and magnetic resonance angiography revealed a right persistent sciatic artery with hypoplastic external iliac artery. The common femoral artery was reconstituted above the bifurcation into the superficial femoral and profunda femoral artery via collaterals from the internal iliac and the persistent sciatic artery. The infant's blood flow to the right extremity gradually improved for the next 4 days without treatment and continues to have adequate blood flow.     

Aneurysm of lateral circumflex femoral artery in association with multiple atherosclerotic aneurysms

Femoral aneurysms are uncommon and are frequently associated with other aneurysms, particularly those of the aorta and popliteal arteries. Other peripheral aneurysms are even more rare. As far as we are aware, only one aneurysm of the lateral circumflex artery has been previously described. We describe such an aneurysm in association with a common femoral aneurysm on the same side, an abdominal aortic aneurysm and an iliac aneurysm on the contralateral side.     

带血管蒂股骨外侧髁骨膜(骨)瓣移位术的应用解剖

目的　为修复股骨中、下段提供一新的骨膜（ 骨）供区。方法　在４０ 侧成人下肢标本上,解剖观测股骨外侧髁和股骨下段前面的血管来源、走行、分支和吻合情况。结果　膝外上动脉起自月国动脉,经外侧髁上方穿股二头肌腱与股外侧肌间隔至骨面发骨膜支分布于外侧髁的外侧面并参与股骨前面骨膜血管网。股动脉直接骨膜支约在股骨中下１／３ 交界处,发自股动脉,斜向外下行分布于股骨下段前面。结论　以膝外上动脉为蒂的股骨外髁骨膜（ 骨） 瓣移位可修复股骨髁上部;以股动脉直接骨膜支为蒂可修复股骨中段。     

腘窝直接动脉穿支蒂股后皮神经营养血管皮瓣的解剖基础

目的探讨腘窝直接动脉穿支蒂股后皮神经营养血管皮瓣的解剖学基础。方法于30侧动脉内灌注红色乳胶的成人下肢标本上解剖观测:股后皮神经走行与分布;腘窝直接动脉穿支与股后皮神经营养血管间吻合关系。另在1侧新鲜成人下肢标本上进行摹拟手术设计。结果股后皮神经主干由臀大肌下缘中点穿出入股后部,主干沿股后正中线下行,终支伴小隐静脉下降,达小腿后面中部。其在穿臀大肌下缘和腘窝上角处横径分别为(3.0±0.6)mm和(2.0±0.7)mm。其营养血管为多节段、多源性,其中腘窝直接动脉穿支的位置相对恒定,于膝关节平面上7～11cm处,起于腘动脉上段后壁,起点外径(0.8±0.2)mm,伴行静脉1～2条。该动脉为股后皮神经下段主要血供来源,上行过程中发出5～8支皮支与股深动脉(第1～3穿动脉)皮穿支、闭孔动脉穿支和旋股外侧动脉皮穿支吻合,在股后形成顺沿中线和股后皮神经纵轴的血管丛。摹拟手术结果显示可形成腘窝直接穿支蒂股后皮神经营养血管皮瓣。结论腘窝直接动脉穿支蒂股后皮神经营养血管皮瓣血供相对恒定、手术操作简便,移位后可用于修复腘窝及膝周软组织缺损。     

Giant true aneurysm of superficial femoral artery in patient with multiple atherosclerotic aneurysms: A case report

True atherosclerotic aneurysms of superficial femoral artery (SFA) are rare and often associated with other peripheral or aortic aneurysms.We report the case of a 84-year-old patient presenting a giant degenerative ruptured aneurysm of the superficial femoral artery. The patient underwent successful aneurysm resection and bypass grafting, with a satisfying long-term follow-up and patency of the graft. The patient was also operated one year before, for a ruptured aneurysm of the abdominal aorta.This case report is rare, because we described a case of patient with multiple atherosclerotic aneurysms, who present, for the second time, a life threating ruptured aneurysm. In this report, we see extreme and rapid evolution of SFA Aneurysm before being symptomatic.Degenerative aneurysms of the lower extremity most commonly involve the popliteal artery, while they are rarely detected in the femoral region (Leon et al., 2008). In this region, aneurysms most frequently involve the common femoral artery (CFA), whereas true aneurysms of the superficial femoral artery (SFA) represent only 15% to 25% of femoral arterial aneurysms [1], [2], [3], [4], [5].Degenerative aneurysms of the SFA display peculiar characteristics (in terms of clinical onset, diagnostic timing, and clinical behavior) so that they differ from other peripheral aneurysms. Because the relative rarity of this location, our case report can be useful to participate to increase the number of reported cases, and define the therapeutic approach for this rare location.     

药物涂层球囊与普通球囊治疗股腘动脉闭塞性疾病:Meta分析

目的采用Meta分析对比药物涂层球囊(DCB)与普通球囊成形术(POBA)治疗股腘动脉闭塞性疾病效果差异。方法检索中国知网、Pubmed、EMBASE、the Cochrane Central Register of Controlled Trials和ISI Web of Knowledge数据库自建库至今DCB与POBA治疗股腘动脉闭塞性疾病的随机对照研究。以R软件对结局指标进行Meta分析,包括晚期管腔丢失(LLL)、再狭窄、靶病变血运重建(TLR)、截肢和死亡。结果共入选18篇文献,DCB组1400例,POBA组1002例;组间LLL[MD=-0.98,95%CI(-1.11,-0.86),P<0.001]、再狭窄[RR=0.33,95%CI(0.27,0.42),P<0.001]和TLR[RR=0.44,95%CI(0.36,0.55),P<0.001]差异均有统计学意义,截肢[RR=0.57,95%CI(0.30,1.09),P=0.091]和死亡[RR=0.70,95%CI(0.39,1.23),P=0.210]差异无统计学意义。结论DCB用于治疗股腘动脉闭塞性疾病整体效果优于POBA。     

Persistent sciatic artery and vein: an unusual case

Persistent sciatic artery is a rare anomaly that has been reported in 48 patients in the North American literature. No report has contained more than two cases. This article discusses the first reported case of bilateral persistent sciatic arteries in a patient who also has normally developed superficial femoral arteries. This unique situation allowed removal of the superficial femoral artery for a malignant femoral nerve schwannoma without a concomitant reconstructive arterial procedure. A similar anomaly of the venous system permitted the operation to be done without compromising venous outflow.     

Anatomical Variations of the Profunda Femoris Artery and Its Branches—A Cadaveric Study in South Indian Population

The variations of the profunda and its branches are numerous, and, to a considerable extent, largely associated with one another. In occlusion of the Superficial femoral artery, the profunda femoris artery forms an effective collateral bed between the ileo-femoral segment and the popliteal artery and its branches. This study based on dissections performed on 40 properly embalmed human cadaver specimens. The position, source and the point of origin of the profunda and its circumflex branches were studied and compared with earlier literature. We found that profunda femoris was originated from the posterolateral surface of the common femoral artery with a mean distance of 3.56 cms from the midinguinal point. An absence of profunda femoris was noted in one (5 %) case. Medial circumflex femoral artery (in 40 % on right side and 60 % on left side) originated from the profunda femoris; whereas in 50 % on right and 35 % on left side, it begins from the femoral artery. On the otherhand, the lateral circumflex femoral in 80 % on right and 70 % on left sides sprungs from profunda femoris with 20 % and 25 % from common femoral arteries of right and left limb specimens respectively. Knowledge of variations in profunda femoris and its branches helps surgeons during preoperative clinical evaluation for surgical and interventional revascularization of the ileo-femoral and femoro-popliteal segments, in open canulation of femoral artery for cardiopulmonary bypasss, in radiological interventions for A-V malformations, and in salvage operations for traumatic limb ischemia.     

Collateral artery bypass in buerger's disease: Report of a novel procedure

A 25-year-old man was admitted to our hospital for treatment of a painful ulcer on his left fourth toe, 9 years after undergoing lumbar sympathectomy and 4 years after undergoing bypass, both of which had been unsuccessful. Angiography demonstrated diffuse arterial occlusion in the lower extremities except for a persistent sciatic artery and a sural artery, which was the main collateral. Thus, reversed bifurcated saphenous vein bypass from the sciatic artery to the sural artery and the posterior tibial artery was performed utilizing Esmarch's rubber bandage as a substitute for a vascular clamp to control bleeding intraoperatively. The ulcer healed promptly and the patient was discharged symptom-free 1 month postoperatively. This case report dmonstrates the advantage of performing collateral arterial bypass and illustrates some of the technical challenges associated with this procedure.