Taking the Scenic Route: A Peripheral Intervention Complicated by a Persistent Sciatic Artery
Journal of the American College of Cardiology
Vascular congenital anomalies are frequently encountered and can complicate the treatment of peripheral arterial disease (PAD).
A 54 year old woman presented with bilateral claudication and rest pain. Arterial duplex showed an occluded right superficial femoral artery (SFA) and reduced distal blood flow. Angiography revealed what appeared to be a large internal iliac artery (IIA) and small external iliac artery (EIA) (Figure 1A). Attempts to wire the EIA were unsuccessful.
Selective angiography of the IIA revealed a large calcified vessel that coursed laterally along the thigh to form the popliteal artery, consistent with a persistent sciatic artery (PSA) (Figures 1B, 1C). The sciatic artery usually disappears in utero but rarely can persist in place of the SFA. Due to its course along the sciatic nerve, it causes increased risk of limb ischemia and aneurysm formation from prolonged sitting. It may present as a pulsatile mass in the gluteal region. Once the anatomy was defined, atherectomy and angioplasty of the stenotic popliteal and posterior tibial arteries was performed without complication (Figures 1D, 1E). In this case, the anomaly resulted in prolonged procedure time with increased dye and radiation exposure.
PSA is a rare vascular anomaly with less than 200 reported cases. Knowledge of this anomaly is necessary to appropriately monitor for aneurysm formation and to efficiently treat PAD while reducing procedural risks to patients and operators.
Lynch S, AlSahli A, Elder M. Taking the scenic route: a Peripheral intervention complicated by a persistent sciatic artery. J Am Coll Cardiol 2021 May;77(18):2916.