[Ischemia of the lower extremity due to a persistent a. ischiadica--a possible interventional therapeutic approach]

Safety and Effectiveness of Endovascular Treatment of Complications Associated with Persistent Sciatic Artery: A Qualitative Systematic Review

PURPOSE

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.

MATERIALS AND 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.

Surveillance and Conservative Management of a Persistent Sciatic Artery Aneurysm

A persistent sciatic artery aneurysm is a rare congenital vascular anomaly. Surgical intervention is reserved for symptomatic cases. The authors report the case of a 72-year-old woman who presented with thromboembolic occlusion of an aneurysmal persistent sciatic artery. Although initially symptomatic, she was managed expectantly with the aid of serial duplex sonographic imaging. The persistent sciatic artery subsequently thrombosed as a result of hypotension secondary to a myocardial infarction. No surgical intervention was required. The current literature on this condition is reviewed.

Pseudoaneurysm of the superior gluteal artery following polytrauma

Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis.

[Persistent sciatic artery: possible false negative imaging]

Persistent sciatic artery is a rare congenital malformation due to the lack of regression of the dorsal arterial axis of the embryo that can be revealed by serious complications. We report a case of bilateral persistent sciatic artery revealed by subacute distal ischemia. This case illustrates the possibility of false negative imaging and the importance of ruling out this diagnosis in case of recurrent and apparently idiopathic distal embolism.

Pseudoaneurysm of the inferior gluteal artery following polytrauma: diverse presentation of a dangerous complication: a report of two cases

Gluteal artery aneurysms are rare, and the majority of them are pseudoaneurysms secondary to blunt or penetrating trauma. The superior gluteal artery is normally affected. Inferior gluteal artery pseudoaneurysms are uncommon, and review of the literature revealed only 10 cases in the last 30 years. The mainstay of diagnosis is angiography, but these aneurysms may not be visible on an aortic flush angiogram, and super selective angiography may be required to delineate the anatomy. Treatment is either by surgical therapy or minimally invasive techniques, such as embolization, during angiography. We report two cases of pseudoaneurysms of the inferior gluteal artery following pelvic and acetabular trauma, presenting very differently in time and clinical picture. A review of the relevant literature is also presented.