Persistent sciatic artery presenting with limb ischemia

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Presentation transcript:

Persistent sciatic artery presenting with limb ischemia Mikin V. Patel, MD, MBA, Nilesh H. Patel, MD, Joseph R. Schneider, MD, PhD, Stanley Kim, MD, Michael J. Verta, MD Journal of Vascular Surgery Volume 57, Issue 1, Pages 225-229 (January 2013) DOI: 10.1016/j.jvs.2012.06.108 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 Right leg angiography via left transfemoral approach. A, The deep femoral artery (thicker arrow) continues to join a genicular branch, the superficial femoral artery terminates in the distal thigh (thinner arrow). B, The deep femoral artery supplies a genicular artery (thinner black arrow) that communicates with the popliteal artery containing multiple filling defects, including (C) total occlusion of the below-knee popliteal artery (thicker black arrows) and tibioperoneal trunk with reconstitution of the anterior tibial artery (white arrow). D, Selective injection of the internal iliac demonstrates it to be large with an abrupt occlusion (arrow) consistent with thrombosis of the persistent sciatic artery. Journal of Vascular Surgery 2013 57, 225-229DOI: (10.1016/j.jvs.2012.06.108) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Aortogram and left leg angiography via left transfemoral approach. A, High-grade stenosis at the origin of the left common iliac artery (thicker black arrow), the internal iliac artery continues as the persistent sciatic artery (thinner black arrow), and the external iliac artery (white arrow) is small and occluded by the diagnostic catheter. B, The persistent sciatic artery is demonstrated with a small aneurysm in its gluteal portion (thicker arrow), the superficial femoral artery (thinner arrow) is small and occludes in the thigh, (C) the persistent sciatic artery continues as the popliteal artery (arrow), and (D) good technical result after placement of covered stent in the left common iliac artery (arrow). Journal of Vascular Surgery 2013 57, 225-229DOI: (10.1016/j.jvs.2012.06.108) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Persistent sciatic artery (PSA) classification. Type 1: complete PSA and normal superficial femoral artery, both providing flow to the popliteal artery. Type 2a: complete PSA and incomplete superficial femoral artery that does not reach the popliteal artery. Type 2b: complete PSA and absent superficial femoral artery. Type 3: incomplete PSA (upper part persists) and normal superficial femoral artery. Type 4: incomplete PSA (lower part persists) and normal superficial femoral artery. Type 5a: complete PSA originating from the median (middle) sacral artery and incomplete superficial femoral artery. Type 5b: complete PSA originating from the median sacral artery and absent superficial femoral artery. Journal of Vascular Surgery 2013 57, 225-229DOI: (10.1016/j.jvs.2012.06.108) Copyright © 2013 Society for Vascular Surgery Terms and Conditions