A Case of Leriche Syndrome with Persistent Sciatic Artery as Collateral Pathway

Abstract

We report an extremely rare case of Leriche syndrome with persistent sciatic artery (PSA) as collateral pathway to the lower limb. A 60-year-old woman was referred with chronic bilateral leg claudication. The ankle brachial pressure index (ABI) was reduced to 0.49 on the right side and 0.48 on the left side. Preoperative angiography and computed tomography (CT) revealed arterial occlusion extending from the infra renal aorta to the both common iliac arteries. CT also showed left PSA connecting to the popliteal artery. Although various collateral pathways maintained blood flow to the lower extremities, the left lower thigh was only collateralized by the PSA. The left superficial femoral artery and the deep femoral artery were atretic at distal portion and not connected to the popliteal artery. Aorto-bilateral femoral artery bypass grafting with Y-shaped graft and Left femoro-popliteal artery bypass grafting with the saphenous vein graft was performed. Her symptoms were disappeared postoperatively. ABI was improved to 0.98 on the left side and 0.97 on the right side. CT showed all grafts patent.