An Effective Hybrid Treatment for Persistent Sciatic Artery Aneurysm

TL;DR

A 61-year-old man with bilateral persistent sciatic artery aneurysms was successfully treated with a hybrid surgical and percutaneous approach.

Contribution

This case report presents a novel hybrid treatment approach for persistent sciatic artery aneurysms.

Findings

A hybrid treatment combining surgical bypass and aneurysm embolization successfully managed right-sided persistent sciatic artery aneurysm.

The patient remained free of ischemic symptoms with a patent graft at 12 months follow-up.

The left aneurysm remained asymptomatic, suggesting monitoring may be sufficient for unilateral cases.

Abstract

Persistent sciatic artery (PSA) is a rare congenital vascular anomaly that is often asymptomatic; however, it can be associated with aneurysm formation and potential complications. Here, the case of a 61 year old man presenting with bilateral persistent sciatic artery aneurysms (PSAAs) who underwent right sided hybrid treatment for rest pain and aneurysm thrombosis is reported.

Hybrid treatment of the right PSAA was performed by surgical bypass using the in situ great saphenous vein, from the common femoral artery to the posterior tibial artery and staged percutaneous aneurysm embolisation with controlled release coils and a vascular plug. The post-operative course was uneventful, and computed tomography angiography at six months confirmed right PSAA exclusion and graft patency. At 12 months follow up, the bypass was patent, and the patient remained free of ischaemic symptoms. The left PSAA remained asymptomatic.

PSAAs can be associated with chronic limb threatening ischaemia due to complications such as thrombosis, and a hybrid approach can treat this successfully.

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