Persistent sciatic artery aneurysm: case report of endovascular treatment

A persistent sciatic artery is a rare congenital vascular anomaly. The most common complication is aneurysm. Clinical presentation may include symptoms resulting from arterial dilatation and ischemia caused by thrombosis or embolization. There are diverse options for treatment of this rare condition, ranging from ligature of the aneurism to endovascular repair. This report describes the case of a female patient complaining of a pulsating mass in the left buttock. She was referred to a Vascular Service where an angiotomography showed complete bilateral persistence of the sciatic artery, with an aneurysm of the left sciatic artery. The aneurysm was treated with endovascular techniques, via a contralateral approach, with placement of two stent grafts and preservation of distal patency. Patency is particularly important in cases of this anatomical variation in which the persistent sciatic artery is complete. This patient recovered well.

Keywords:
aneurysm; endovascular procedures; persistent sciatic artery; lower extremity

Authorship

Dominique Rodas Costa

Universidade Federal da Bahia – UFBA, Serviço de Cirurgia Vascular do Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, BA, Brasil.Universidade Federal da BahiaBrasilSalvador, BA, BrasilUniversidade Federal da Bahia – UFBA, Serviço de Cirurgia Vascular do Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, BA, Brasil.

Ronald José Ribeiro Fidelis

Vanessa Prado dos Santos ^**Correspondence Vanessa Prado dos Santos Universidade Federal da Bahia – UFBA, Instituto de Humanidades, Artes e Ciências Professor Milton Santos – IHAC Rua Barão de Jeremoabo, s/n, PAF IV, Campus Universitário de Ondina CEP 40170-115 - Salvador (BA) - Brasil Tel.: +55 (71) 3283-6799 E-mail: vansanbr@hotmail.com

Universidade Federal da Bahia – UFBA, Instituto de Humanidades, Artes e Ciências Professor Milton Santos – IHAC, Salvador, BA, Brasil.Universidade Federal da BahiaBrasilSalvador, BA, BrasilUniversidade Federal da Bahia – UFBA, Instituto de Humanidades, Artes e Ciências Professor Milton Santos – IHAC, Salvador, BA, Brasil.

Cícero Fidelis

Universidade Federal da Bahia – UFBA, Faculdade de Medicina da Bahia, Departamento de Cirurgia, Salvador, BA, Brasil.Universidade Federal da BahiaBrasilSalvador, BA, BrasilUniversidade Federal da Bahia – UFBA, Faculdade de Medicina da Bahia, Departamento de Cirurgia, Salvador, BA, Brasil.

Carlos Alberto Silveira Alves

José Siqueira de Araújo Filho

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

*Correspondence Vanessa Prado dos Santos Universidade Federal da Bahia – UFBA, Instituto de Humanidades, Artes e Ciências Professor Milton Santos – IHAC Rua Barão de Jeremoabo, s/n, PAF IV, Campus Universitário de Ondina CEP 40170-115 - Salvador (BA) - Brasil Tel.: +55 (71) 3283-6799 E-mail: vansanbr@hotmail.com

Author information DRC - MD, vascular surgeon, former resident physician at Serviço de Cirurgia Vascular, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA). RJRF - PhD in Surgery from Universidade de São Paulo (USP), Preceptor, Programa de Residência Médica em Cirurgia Vascular, Complexo Hospitalar Universitário Professor Edgard Santos/Hospital Ana Nery, Universidade Federal da Bahia (UFBA). VPS - MSc and PhD in Surgery from Faculdade de Ciências Médicas, Santa Casa de São Paulo; Professor, Instituto de Humanidades, Artes e Ciências, Universidade Federal da Bahia (UFBA); Supervisor, Programa de Residência Médica em Cirurgia Vascular, Complexo Hospitalar Universitário Professor Edgard Santos, UFBA. CF - MSc in Medicine from Faculdade de Medicina da Bahia (FMB); Professor at FMB/UFBA; Preceptor, Programa de Residência Médica em Cirurgia Vascular, Complexo Hospitalar Universitário Professor Edgard Santos/Hospital Ana Nery, UFBA. CASA - Chief, Serviço de Cirurgia Vascular, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA); Preceptor, Programa de Residência Médica em Cirurgia Vascular, Complexo Hospitalar Universitário Professor Edgard Santos, UFBA. JSAF - MD, vascular surgeon; Professor, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA); Preceptor, Programa de Residência Médica em Cirurgia Vascular, Complexo Hospitalar Universitário Professor Edgard Santos/Hospital Ana Nery, UFBA.

Author contributions Conception and design: DRC, RJRF Analysis and interpretation: DRC, RJRF Data collection: DRC, VPS Writing the article: DRC, VPS, RJRF Critical revision of the article: DRC, VPS, CF, CASA, RJRF, JSAF Final approval of the article*: DRC, CF, VPS, CASA, RJRF, JSAF Statistical analysis: N/A. Overall responsibility: DRC, RJRF, CF, VPS, CASA, JSAF *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (6)

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Figure 1
Axial angiotomography showing the diameter (37.9 x 33.6 mm) of the persistent sciatic artery aneurysm.

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Figure 2
Angiotomography showing bilateral persistent sciatic arteries with aneurysmal formation involving the left sciatic artery: reconstructed images from anterior (A), posterior (B) and lateral views (C).

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Figure 3
Magnetic resonance angiography: hypoplasia of superficial and deep femoral arteries (A) sciatic arteries giving origin to popliteal arteries, characterizing the complete form of sciatic artery persistence bilaterally. Fusiform aneurysmal dilatation involving the left persistent sciatic artery (B).

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Figure 4
Endovascular treatment of the aneurysm of the left persistent sciatic artery: (A) angiography via a contralateral access through the right common femoral artery; (B) and (C) placement of first (distal) covered stent, 13 x 10 mm, (D) placement of second (proximal) covered stent, 11 x 10 mm.

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Figure 5
Endovascular treatment of the persistent sciatic artery aneurysm: (E) ballooning of proximal and distal covered stents and at connection using a 12 x 60 mm balloon; (F) and (G) control angiography showing exclusion of the aneurysm and absence of leaks; (H) angiography of the sciatic artery distal of the aneurysm repair, showing patency.

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Figure 6
(A) Angiotomography performed after endovascular treatment, with anteroposterior three-dimensional reconstruction, showing covered stents in the persistent sciatic artery, patent and free from leaks; (B) axial angiotomography showing complete regression of the aneurysmal dilatation of the left persistent sciatic artery.

Figure 1 Axial angiotomography showing the diameter (37.9 x 33.6 mm) of the persistent sciatic artery aneurysm.

Figure 2 Angiotomography showing bilateral persistent sciatic arteries with aneurysmal formation involving the left sciatic artery: reconstructed images from anterior (A), posterior (B) and lateral views (C).

Figure 3 Magnetic resonance angiography: hypoplasia of superficial and deep femoral arteries (A) sciatic arteries giving origin to popliteal arteries, characterizing the complete form of sciatic artery persistence bilaterally. Fusiform aneurysmal dilatation involving the left persistent sciatic artery (B).

Figure 4 Endovascular treatment of the aneurysm of the left persistent sciatic artery: (A) angiography via a contralateral access through the right common femoral artery; (B) and (C) placement of first (distal) covered stent, 13 x 10 mm, (D) placement of second (proximal) covered stent, 11 x 10 mm.

Figure 5 Endovascular treatment of the persistent sciatic artery aneurysm: (E) ballooning of proximal and distal covered stents and at connection using a 12 x 60 mm balloon; (F) and (G) control angiography showing exclusion of the aneurysm and absence of leaks; (H) angiography of the sciatic artery distal of the aneurysm repair, showing patency.

Figure 6 (A) Angiotomography performed after endovascular treatment, with anteroposterior three-dimensional reconstruction, showing covered stents in the persistent sciatic artery, patent and free from leaks; (B) axial angiotomography showing complete regression of the aneurysmal dilatation of the left persistent sciatic artery.

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Persistent sciatic artery aneurysm: case report of endovascular treatment

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[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.