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.