title: Ruptured persistent sciatic artery aneurysm managed by endovascular embolization.
abstract: Persistent sciatic artery (PSA) is a rare vascular anomaly present in 0.025% to 0.05% of the population. They are particularly prone to aneurysmal degeneration, potentially leading to distal ischemia, sciatic neuropathy, or rarely rupture. Here, we describe a case of a ruptured PSA aneurysm managed by endovascular embolization. A 70-year-old man initially presented with acute left lower extremity ischemia. He was found to have a popliteal embolus originating from a complete persistent sciatic artery aneurysm. He underwent thrombolysis followed by a femoropopliteal bypass and ligation of the proximal popliteal artery to exclude the PSA. Four weeks later he re-presented with severe pain, a pulsatile buttock mass, and anemia in the setting of hemodynamic instability. A ruptured PSA aneurysm was confirmed by computed tomography angiography (CTA). This was managed emergently by endovascular exclusion of the inflow and outflow vessels using Amplatzer vascular plugs. His postoperative course was complicated by both a foot drop, likely secondary to sciatic nerve ischemia, and a buttock abscess. To our knowledge, this is the first report detailing the endovascular management of a ruptured PSA aneurysm. The etiology, management, and complications associated with the treatment of this rare vascular entity are discussed.
authors.affiliation: Division of Vascular Surgery, New York Presbyterian, New York, NY, USA.
authors.forename: Combiz
authors.initials: C
authors.lastname: Rezayat
authors.forename: Elliot
authors.initials: E
authors.lastname: Sambol
authors.forename: Lee
authors.initials: L
authors.lastname: Goldstein
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Broderick
authors.forename: John K
authors.initials: JK
authors.lastname: Karwowski
authors.forename: James F
authors.initials: JF
authors.lastname: McKinsey
authors.forename: Ageliki G
authors.initials: AG
authors.lastname: Vouyouka
mesh_terms: D000038:Abscess / Q000209:etiology; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D001158:Arteries / Q000002:abnormalities; D002081:Buttocks; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005263:Femoral Artery / Q000601:surgery; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D012501:Saphenous Vein / Q000637:transplantation; D020426:Sciatic Neuropathy / Q000209:etiology; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications*