Persistent sciatic artery (PSA) is a rare congenital vascular anomaly resulting from embryologic axial artery malformation in the lower limb. This case report presents three patients aged 45-60, each with bilateral PSA presenting with symptoms indicative of PSA complications, including aneurysmal degeneration, limb ischemia, thromboembolism, or neuralgia from nerve compression. It highlights the diagnostic process, management strategies, and clinical outcomes observed at a tertiary referral hospital. Treatment involved a collaborative, multidisciplinary approach with vascular surgeons, internists, and radiologists tailoring interventions to individual patient findings and disease progression. This report aims to provide insights into the diverse presentations and management of PSA in a resource limited setting, encouraging further reporting and case studies to enhance understanding of therapeutic outcomes.

OBJECTIVE: To evaluate the safety and effectiveness of endovascular therapy with stent grafts (SGs) to treat complications associated with persistent sciatic artery (PSA) by conducting a systematic review.
METHODS: The MEDLINE, Web of Science, Scopus, and Ichushi Web databases were searched to identify articles focusing on endovascular treatment with SGs for complications associated with PSA published from inception to September 15, 2023. The review included 31 case reports, 2 case series, and 7 conference proceedings. Forty patients (median age, 67 years [range, 22-88 years]; 25 women) with 41 limbs underwent endovascular treatment with 65 SGs for ischemia (n = 26), aneurysm (n = 13), and trauma (n = 2). Prior treatments were systemic anticoagulation (n = 7), thrombolysis (n = 5), thrombectomy (n = 3), and amputation (n = 1), whereas concurrent treatments were thrombolysis (n = 6) and thrombectomy (n = 2). The median number of SGs implanted was 2 (range, 1-4). Early outcomes were technical success and adverse events (AEs). Late outcomes were primary patency, secondary patency, freedom from reintervention, and clinical success.
RESULTS: The technical success rate was 100%. Intervention-specific AEs were reported in 4 cases; however, there were no severe AEs. The clinical success rates at 1 and 2 years were 100% and 95.7%, respectively. The primary patency rates at 1 and 2 years were 81.5% and 67.6%, respectively, and the secondary patency rates at 1 and 2 years were 94.5% and 81.6%, respectively.
CONCLUSIONS: Endovascular treatment with SGs for complications associated with PSA is safe and effective with acceptable midterm patency and durability, and is supportable as the first-choice treatment.

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.

暂无摘要。

OBJECTIVE: The persistent sciatic artery (PSA) is a rare congenital anomaly with a high rate of aneurysm formation, occlusion and stenosis. It may lead to severe complications including thrombosis, distal embolisation, or aneurysm rupture. We reported herein our experience in the management of PSA and its complications, and discuss the therapeutic options.
METHODS: Eight patients with 10 PSA were managed in our institutions between 1985 and 2017. An analysis was done for the clinical data, surgical technique, and results.
RESULTS: The series included six women and two men. The median age of the patients was 66,5 years (37-80 years). Physical examination found a pulsatile gluteal mass in five patients, sciatic neuropathy in two cases. Four patients had an acute ischemia of the lower limb. Cowie\'s sign was described in only two patients (diminished or absent femoral pulse but presence of popliteal pulse). Digital subtraction angiography was performed in all patients, and was completed with a computed tomography angiography (CTA) with a diagnosis of PSA, associated with a symptomatic aneurysmal lesion in seven cases and with an occlusion in one case. The treatment was surgical in all cases: bipolar exclusion of the aneurysm and bypass between the iliac artery and the PSA distal to the aneurysm was performed in four cases, only proximal and distal ligation was done in 2 other cases. A Chopart amputation was necessary in 2 cases.
CONCLUSIONS: We consider that the treatment of PSA is usually surgical in symptomatic cases. Surgical techniques depend on symptoms and classification describing anatomy of the PSA. However, future studies should compare the open versus the endovascular approach to optimize patient selection criteria and identify the most safe and effective strategy. In an asymptomatic patient, PSA does not require any intervention; continued follow-up is required because of the high incidence of aneurysmal formation and the risk of thromboembolic events.

The Persistent Sciatic Artery (PSA) is an unusual anatomical variation due to the persistence of an embryological artery, which should disappear before the 3rd month of intrauterine life. The reported case is that of a woman who developed an acute ischemia of the right lower limb, revealing the presence of persistent sciatic artery. Diagnosis was made only belatedly by means of angio-CT. The amputation was the inevitable choice of treatment.

BACKGROUND: Popliteal fossa, also known as the popliteal space, is located behind the knee joint. This region can develop many clinical complications in the vascular, nervous, lymphatics, adipose, as well as swelling and masses.
OBJECTIVE: The objective of this review article is to give a detailed understanding of the popliteal fossa and the clinical pathology that may present itself.
METHODS: MEDLINE® searches were conducted of literature published since 1950s for \"popliteal fossa,\" \"diseases,\" \"anatomy,\" \"arterial,\" \"venous,\" \"nerves,\" \"entrapment syndrome,\" \"aneurysms,\" \"cysts,\" \"lymphatics,\" \"solid masses,\" \"tumors,\" \"inflammatory lesions,\" and \"swellings.\" The references provide up-to-date literature for all the pathologies discussed.
RESULTS: This review articles discusses the anatomy, clinical examination, including history, physical, and imaging modalities, and various diseases that present themselves in patients. Diseases relating to the arterial and venous systems, nervous system, musculature, adipose, lymphatics, cysts and other solid masses, including neoplasms, and abscesses. The differential diagnosis and symptoms of certain conditions are addressed to isolate the root of the manifestation.
CONCLUSIONS: Diseases of the popliteal fossa can use histology and electrophysiology to aid in diagnosis, as well as instrumentation. Surgical approaches are uses to treat varying pathologies as they are the best means of therapy.

Persistent sciatic artery (PSA) is a relatively rare congenital variant of the lower limb vasculature and can have highly variable clinical presentations. The purpose of this study was to analyze the relationship between PSA anatomy and clinical presentation, and to suggest an optimal management strategy.
Between 2001 and 2014, 24 PSAs in 19 patients were diagnosed by computed tomography and referred to the vascular surgery department. Patient demographics, types of PSA and femoral artery, aneurysmal changes, symptoms, and treatment methods were assessed. Additionally, all English literature from 1964 to 2014 was reviewed and compared using the PubMed database (224 PSAs in 171 patients).
PSA was diagnosed in 10 men (52.6%) and nine women (47.4%). PSAs were bilateral in five patients (26.3%) and symptomatic in 12 patients, while in seven patients PSA was found incidentally. According to the Pillet-Gauffre classification, Type 2a was the most common variant (n = 15/24, 62.5%), with unclassifiable types in two limbs. Compared with cases in the literature, the PSA occlusion rate in this study was higher (n = 10/24, 41.7% vs. n = 54/224, 27.5%), but aneurysm incidence was higher in the literature cases (n = 5/24, 20.8% vs. n = 112/224; 50.7%). In this study, 16 limbs (66.6%) were treated conservatively, and six limbs were treated by open surgery, including four bypasses, one amputation, and one thrombo-embolectomy. Endovascular coil embolization was performed in one limb, and a hybrid procedure with stent graft was performed in one limb with PSA aneurysm. Based on the present series and the literature review, a new classification system and treatment option is proposed according to the anatomic status and the presence of aneurysm. According to the new classification, class III was the most common in both the present study (18/24; 75%) and the literature review, and the presence of aneurysm was the most important determinant of surgical treatment.
The new classification system is simple and provides guidance for management. Limb anatomy of the femoral artery system and the presence of PSA aneurysm should be considered when selecting the optimal treatment. The risk of embolism from the presence of aneurysm is an important factor for treatment, and bypass surgery is mostly required in classes III and IV.

Persistent sciatic artery (PSA) is a rare anatomic variant and is normally clinically silent. It can be found occasionally during uterine arteries embolization (UAE) and can lead to technical failure or complications. The authors present a patient with bilateral PSAs who was referred for emergency UAE because of uncontrollable postabortion hemorrhage. Inadvertent embolization of the right PSA led to unsalvageable ischemia and amputation of the right lower limb 12 days later.

A persistent sciatic artery is a very rare vascular anomaly with an estimated incidence of 0.025-0.06% and with less than 200 described cases in the literature. During early embryonic development, the sciatic artery delivers the major blood supply to the lower limb and usually disappears when the superficial femoral artery has developed properly. The usual form of presentation in adults is the aneurysmal degeneration of the sciatic artery or less frequently with another complication (thrombosis, embolism, neuralgia). We describe three cases of a complete sciatic artery (two cases are bilateral and one is unilateral) associated with lower limb ischemia caused by embolism from the aneurysmal degeneration of the sciatic artery at the buttock level in two cases and atherosclerotic degeneration of the lower limb arteries in the third case. We also describe two combined therapy methods consisted of limb revascularization with vein-graft bypass and endovascular embolization of the aneurysm with vascular plug in the first case, in the second case combination of localized thrombolysis therapy followed by a bypass and an ilio-pedal vein bypass in the third one. And we discuss later the reported clinical outcome after surgical and endovascular treatment of this anomaly in the literature.