PMC6457022_01
(a) Computed tomography angiography (CTA) revealing a complete persistent
sciatic artery (PSA) branching off from the right common iliac artery and
the hypoplastic superficial femoral artery terminated in the mid-thigh. (b)
The complete PSA formed a partially thrombosed aneurysm (36 mm in diameter)
in the right gluteal region. (c) Intraoperative angiogram revealed occlusion
of distal arteries below the knee (BTK).
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Computed tomographic angiography (CTA) revealed a complete PSA extending from the right internal iliac artery to the popliteal artery and forming a partially thrombosed fusiform aneurysm (36 mm in diameter) in the right gluteal region, causing embolization of distal arteries (Figure 1(a) and (b)). The superficial femoral artery (SFA) was hypoplastic and terminated in the mid-thigh (Figure 1(a)). Intraoperative angiogram revealed occlusion of distal arteries below the knee (BTK; Figure 1(c)).
(a) Postoperative CTA at 10 days showing a patent PSA, popliteal artery, and
arteries BTK. (b) CTA after 2 months revealed that there was a large
collateral from the femoral artery to the popliteal artery and (c) the PSA
was totally occluded from the pelvic level. (d) Angiogram showing the PSA
totally occluded and the guide wire, and catheter was unable to pass through
via a contralateral femoral approach.
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Postoperative CTA, at 10 days, showed patent PSA, popliteal artery, and arteries BTK (Figure 2(a)). CTA revealed that the PSA was totally occluded from the pelvic level, and there was a large collateral from the common femoral artery to the popliteal artery (Figure 2(b) and (c)). The guide wire and catheter was unable to pass through the occluded PSA via the contralateral femoral approach (CFA; Figure 2(d)).
(a, b) The occluded PSA underwent percutaneous transluminal angiography with
balloon over a V-18 control wire, (c) we performed catheter-directed
thrombolysis using an infusion catheter, (d) and the PSA was patent after
CDT.
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We performed PTA of the PSA using a 4 x 150 mm balloon (BIOTRONIK AG, Bulach, Switzerland) over a V-18 control wire (Boston Scientific, Marlborough, MA, USA; Figure 3(a) and (b)) and CDT through a 4-F sheath by retrograde puncture of the anterior tibial artery (Figure 3(c) and (d)).
(a) The PSA aneurysm was excluded by deployment of a 10 x 150 mm Viabahn
stent graft. (b, c) Postdilation was performed after stent graft and
self-expanding bare stent implantation. (d-f) Final angiogram revealed
exclusion of the aneurysm and patent stent, popliteal artery, and distal
arteries of BTK.
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Jude Medical, MN, USA; Figure 4(a)). PSA aneurysm. Postdilation was performed using an 8 x 80 mm balloon (Invatec, BS, Italy; Figure 4(b) and (c)). Completion angiogram revealed the excluded aneurysm and the patent stent, popliteal artery and distal arteries of BTK (Figure 4(d)-(f)).
CTA at 6 months of follow-up revealing a patent stent graft, popliteal artery
and arteries of BTK without fracture of the stent.
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CTA at 6 months of follow-up after re-intervention revealed patent stent graft, popliteal artery, and arteries of BTK (Figure 5).