Endovascular treatment of acute limb ischemia for persistent sciatic artery aneurysms: a report of 2 cases.

Background: Persistent sciatic artery (PSA) is a rare congenital anomaly associated with various complications, including atherosclerotic changes and aneurysms. These changes can cause limb ischemia, thrombosis, distal embolization of the PSA, rupture of aneurysms, buttock pain, and sciatica due to compression of adjacent tissues. Acute limb ischemia (ALI) is a life-threatening condition. Treatment of ALI includes surgical and endovascular treatments (EVT); EVT includes catheter-directed thrombolysis (CDT) and angioplasty, with thrombolysis being highly effective. In Japan, urokinase is the only insurance-covered thrombolytic agent approved for ALI treatment; however, it is currently unavailable due to manufacturing issues.

Case presentation: This case report details the treatment of two women (aged 89 and 82 years) with ALI associated with PSA. In both cases, reperfusion was achieved without CDT and stent grafts were deployed across the PSA aneurysm. The final angiogram showed that the PSA aneurysms had disappeared, and the vessel runoff was maintained. Both patients were successfully discharged from the hospital and experienced no complications over the next 6 months.

Conclusions: Two patients with ALI with PSA were treated with EVT without CDT. These cases suggest that EVT without CDT may rescue ALI caused by PSA. Moreover, no standard treatment for sciatic artery remnants has been established. Endovascular treatment with stent grafts may be an option for older patients.