Abstract：
OBJECTIVE: Persistent sciatic artery (PSA) is a rare congenital anomaly, whereby the embryonic sciatic artery remains patent with associated degrees of femoral axis hypoplasia. Aneurysmal degeneration and distal ischaemia from thromboembolic complications are common. Revascularisation strategies include embolectomy, bypass or interposition grafting and catheter-directed thrombolysis.
METHODS: We describe a sedentary 88-year-old woman with right acute limb ischaemia secondary to a thrombosed PSA aneurysm and concurrent occlusive thrombus at the femoral bifurcation.
RESULTS: The patient presented with a 3-day history of a cold, painful right foot. Examination revealed Rutherford IIb ischaemia. CT-angiography demonstrated no continuity between the hypoplastic superficial femoral and popliteal arteries, complete occlusion of the right PSA distal to the thrombosed aneurysm and occlusive thrombus in the right profunda. As she was too frail for femoral-distal bypass, we restored femoral axis inflow via profunda embolectomy. Her prognosis remained guarded as we deliberately did not reconstruct the PSA. However, she was discharged pain-free and mobilising with aids 2 weeks later.
CONCLUSIONS: Limb ischaemia in frail, high-risk patients is an ever-increasing challenge for vascular surgeons and requires complex decision-making, balancing comorbidities against desired outcomes. This case illustrates that a selective approach can be sufficient to maintain function despite complex anatomy.
METHODS: We describe a sedentary 88-year-old woman with right acute limb ischaemia secondary to a thrombosed PSA aneurysm and concurrent occlusive thrombus at the femoral bifurcation.
RESULTS: The patient presented with a 3-day history of a cold, painful right foot. Examination revealed Rutherford IIb ischaemia. CT-angiography demonstrated no continuity between the hypoplastic superficial femoral and popliteal arteries, complete occlusion of the right PSA distal to the thrombosed aneurysm and occlusive thrombus in the right profunda. As she was too frail for femoral-distal bypass, we restored femoral axis inflow via profunda embolectomy. Her prognosis remained guarded as we deliberately did not reconstruct the PSA. However, she was discharged pain-free and mobilising with aids 2 weeks later.
CONCLUSIONS: Limb ischaemia in frail, high-risk patients is an ever-increasing challenge for vascular surgeons and requires complex decision-making, balancing comorbidities against desired outcomes. This case illustrates that a selective approach can be sufficient to maintain function despite complex anatomy.
摘要：
目的：持续性坐骨动脉（PSA）是一种罕见的先天性异常，因此，胚胎坐骨动脉仍然通畅，并伴有股轴发育不全。血栓栓塞并发症引起的动脉瘤变性和远端缺血很常见。血管重建策略包括栓子切除术，旁路或介入移植和导管溶栓。
方法：我们描述了一位久坐的88岁女性，其右侧急性肢体缺血继发于血栓形成的PSA动脉瘤，并在股分叉处并发闭塞性血栓。
结果：患者有3天的感冒史，痛苦的右脚检查发现卢瑟福IIb缺血。CT血管造影显示在发育不良的股浅动脉和pop动脉之间没有连续性，血栓形成的动脉瘤远端右侧PSA完全闭塞，右侧深部闭塞性血栓。因为她太虚弱了，不能接受股骨远端搭桥手术，我们通过大底栓子切除术恢复股轴流入。由于我们故意不重建PSA，她的预后仍然受到保护。然而,两周后，她无痛出院，并在艾滋病的帮助下动员起来。
结论：肢体缺血，高风险患者对血管外科医生来说是一个越来越大的挑战，需要复杂的决策，平衡合并症与预期结果。这种情况表明，尽管解剖结构复杂，但选择性方法仍足以维持功能。
方法：我们描述了一位久坐的88岁女性，其右侧急性肢体缺血继发于血栓形成的PSA动脉瘤，并在股分叉处并发闭塞性血栓。
结果：患者有3天的感冒史，痛苦的右脚检查发现卢瑟福IIb缺血。CT血管造影显示在发育不良的股浅动脉和pop动脉之间没有连续性，血栓形成的动脉瘤远端右侧PSA完全闭塞，右侧深部闭塞性血栓。因为她太虚弱了，不能接受股骨远端搭桥手术，我们通过大底栓子切除术恢复股轴流入。由于我们故意不重建PSA，她的预后仍然受到保护。然而,两周后，她无痛出院，并在艾滋病的帮助下动员起来。
结论：肢体缺血，高风险患者对血管外科医生来说是一个越来越大的挑战，需要复杂的决策，平衡合并症与预期结果。这种情况表明，尽管解剖结构复杂，但选择性方法仍足以维持功能。
