Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 5237  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (784 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed89    
    Printed8    
    Emailed0    
    PDF Downloaded1    
    Comments [Add]    

Recommend this journal


 


 
  Table of Contents     
CASE SNIPPET
Year : 2019  |  Volume : 65  |  Issue : 4  |  Page : 253-254

Endovascular management of persistent sciatic artery occlusion


Department of Cardiothoracic and Vascular Surgery, JSS Medical College and Hospital, Mysore, Karnataka, India

Date of Web Publication14-Oct-2019

Correspondence Address:
M P Tigga
Department of Cardiothoracic and Vascular Surgery, JSS Medical College and Hospital, Mysore, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_299_19

Rights and Permissions




How to cite this article:
Gowda G G, Kr S, Tigga M P. Endovascular management of persistent sciatic artery occlusion. J Postgrad Med 2019;65:253-4

How to cite this URL:
Gowda G G, Kr S, Tigga M P. Endovascular management of persistent sciatic artery occlusion. J Postgrad Med [serial online] 2019 [cited 2019 Nov 15];65:253-4. Available from: http://www.jpgmonline.com/text.asp?2019/65/4/253/268462




A 64 year old man who was diabetic for the past 11 years presented with a right foot recalcitrant ulcer. Three years prior, he had undergone a right femoropopliteal vein bypass followed by amputation of the second and third toes. On examination, his right lower leg pulses were absent except for femoral. His right distal foot ulcer was covered with necrotic slough. His right ankle brachial index (ABI) was 0.3 indicating severe peripheral artery disease. His right arterial duplex ultrasound showed chronic thrombotic occlusion of distal superficial femoral artery (SFA) and popliteal artery with monophasic flows in pedal vessel. The initial contrast computerized tomography (CT) angiography reported it as distal SFA occlusion. Later, when catheter angiogram was done, it was revealed to be a persistent sciatic artery (PSA) which was occluded starting from its exit from the pelvis at greater sciatic notch reforming in the mid-thigh and continuing as popliteal artery [Figure 1], [Figure 2] and [Figure 3]a. The superficial femoral artery was of low caliber and occluded at adductor hiatus. As the patient was an elderly diabetic with scarred groin and thigh, it was decided to perform right PSA angioplasty.
Figure 1: Axial CT image showing persistent right sciatic artery

Click here to view
Figure 2: Reconstructed CT image showing persistent right sciatic artery

Click here to view
Figure 3: Angiogram images showing: (a) occluded segment of persistent right sciatic artery, (b) a tortuous right internal iliac artery, (c) stent in right PSA, and (d) poststenting distal dye run-off in the right PSA

Click here to view


Through left common femoral artery retrograde approach, a 6Fr Balkan crossover sheath was placed into the right internal iliac artery [Figure 3]b. The right PSA was cannulated and the occlusion crossed with 0.035 Terumo wire and end-on flush catheter [Figure 3]c. Distal angiography runs were taken to confirm the catheter position in true lumen [Figure 3]c. Then the Terumo wire was exchanged with stiff wire. Serial balloon dilatations were done followed by stent placement (6 mm × 150 mm self-expanding). Stent placement was preferred as plain balloon angioplasty is known to yield suboptimal result due to significant residual stenosis. Post stent deployment, there was good contrast runoff seen across the stent distally [Figure 3]d. Post procedure, the patient's popliteal pulse was palpable and ABI increased to 0.8 (normal being 0.90 to 1.30).

Later, the patient underwent foot debridement and was put on dual antiplatelets and statins along with regular wound dressing. At 4 months follow up, the stent was patent and the wound had healed.

Sciatic artery is the principle artery of the lower limb and a branch of umbilical artery during embryonic life.[1] It degenerates and incorporates into the inferior gluteal artery forming its proximal part in the third month of gestation.[1] When it persists as seen in around 0.05% individuals, which is extremely rare, it has a strong predilection for atherosclerosis leading to occlusion or aneurysmal changes.[2],[3],[4] When completely persistent, the sciatic artery becomes tortuous and enlarged, originating from the internal iliac artery and traversing through the greater sciatic foramen in close relation to the sciatic nerve.

Clinical presentation of PSA is usually ischemic or aneurysmal disease. In the present case the diagnosis of PSA was missed initially because of its extreme rarity. The patient had undergone toe amputation 3 years back and again presented with a nonhealing ulcer. Even in the current clinical work up, the initial contrast CT angiography had reported a distal SFA occlusion. It was only on catheter angiogram that PSA with its occlusion was detected. Radiological examinations remain the mainstay for clinching the diagnosis of PSA. It is important that a radiologist is aware of this anomaly to make the diagnosis. CT, magnetic resonance (MR), or catheter angiography can be performed to make the diagnosis, but CT and MR are the preferred modalities as they are noninvasive.

It is important to be aware of PSA while dealing with vascular diseases of the lower limb, as it can save unnecessary procrastination and help in early management. In the present case PSA had gone undetected 3 years ago and the patient had to undergo amputation of his second and third toes. Arteriography is a useful tool in management of PSA, and surgical and endovascular options are available that can be individualized for each case. In our case, endovascular stenting of PSA was done which restored the limb vascularity and abated his symptoms.

Declaration of patient consent

The authors certify that appropriate patient consent was obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 :: References Top

1.
Papon X, Picquet J, Fournier HD, Enon B, Mercier P. Persistent sciatic artery: Report of an original aneurysm-associated case. Surg Radiol Anat 1999;21:151-3.  Back to cited text no. 1
    
2.
Jung AY, Lee W, Chung JW, Song SY, Kim SJ, Ha J, et al. Angiography in the detection and comprehensive evaluation of persistent sciatic artery. J Vasc Surg 2005;42:678-83.  Back to cited text no. 2
    
3.
Cowan MM, Hamweyah KM, Sabbagh MD, Swaid BA, Alkattan AK, Ganguly P. Persistent bilateral sciatic artery: Report of a rare case. Int J Angiol 2010;19:43-4.  Back to cited text no. 3
    
4.
Mascarenhas de Oliveira F, de Souza Mourão G. Endovascular repair of symptomatic sciatic artery aneurysm. Vasc Endovascular Surg 2011;45:165-9.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
 
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow