Abstract
A 71-year-old female presenting cyanosis of the left 1st and 2nd toe was admitted to our hospital by diagnosis of left anterior and posterior tibial arterial occlusion. Enhanced CT examination showed that a persistent sciatic artery aneurysm (PSA) with 3 cm of the maximum diameter existed in the left gluteal region, and that popliteal and the distal arteries toward lower limb was enhanced from the internal iliac artery through PSA. Emergent angiographic examination presented that significant stenosis was observed at anterior tibial artery, the proximal site of posterior tibial artery and the ostium of peroneal artery, and that thromboembolic occlusion was also found in the anterior and posterior tibial arteries. Emergent thrombectomy and angioplasty was performed in these 3 vessels. After that, sufficient blood flow was observed through the 3 vessels into lower limb. Thirty seven days after the catheter intervention, the patient underwent left common femoro-popleteal bypass surgery using ePTFE graft, as well as coil embolization for PSA by catheter intervention. Eighteen months after the series of treatments, the patient was asymptomatic, and no abnormal findings were detected by enhanced CT and vascular ultrasonography. In this case of PSA with symptomatic limb ischemia due to arterial occlusion, staged interventional procedure which was reconstructive surgery combined with coil embolization for PSA following release from ischemia by emergent catheter intervention was effective. In addition, for the treatment of PSA, hybrid treatments by surgical and catheter intervention was an efficient and less-invasive procedure.
