A Case of Persistent Sciatic Aneurysm with Lower Extremity Acute Arterial Occlusive Disease

Abstract

The symptoms of persistent sciatic artery aneurysm are sciatic nerve compression and lower limb ischemia, but no standard operation method has been established. A 77-year-old female was admitted to our hospital with suspected right lower limb ischemia because she has coldness and pain in her right leg. Pulsatile masses in her right hip and thigh were observed. There was no intermittent claudication, and the ankle brachial index (ABI) was normal. Preoperative contrast enhanced CT angiography revealed a 32 mm diameter persistent sciatic aneurysm with thrombus, and a thoromboembolism in the peripheral artery. The aneurysm terminated at the upper thigh, and blood flow extended to the peripheral artery. She was diagnosed with acute right limb ischemia caused by an embolism from a thrombus in the complete type sciatic artery aneurysm. The sciatic artery aneurysm was ligated at the right pelvis and the upper thigh, and revascularization was performed with a bypass grafting between the common iliac artery and the distal sciatic artery. Postoperative CT indicates that the sciatic artery aneurysm was completely thrombosed, and the bypass graft was patent. The method mentioned above is useful for the treatment of complete type sciatic artery aneurysm, which requires a procedure for the aneurysm, as well as the revascularization.