Persistent sciatic artery aneurysm complicated by acute arterial occlusion successfully treated with surgical thrombectomy and femoro–popliteal bypass

Persistent sciatic artery (PSA) is a rare congenital vascular anomaly that may be complicated by aneurysm formation and acute arterial occlusion. Optimal management remains controversial and depends on anatomical features and limb ischemia. A 74-year-old woman presented with acute left lower limb pain and sensory disturbance. Contrast-enhanced computed tomography revealed a complete-type persistent sciatic artery aneurysm (PSAA) with thrombotic occlusion extending to the infrapopliteal arteries. Emergency surgery was performed for limb salvage. Surgical thrombectomy was carried out via an above-knee popliteal artery approach, followed by femoro–popliteal bypass because residual severe stenosis distal to the aneurysm resulted in insufficient flow after thrombectomy. The PSA proximal to the bypass anastomosis was ligated, and the aneurysm was excluded without resection. Postoperative imaging demonstrated good graft patency and complete thrombosis of the PSAA. The patient recovered uneventfully with restoration of limb perfusion. Combined surgical thrombectomy and femoro–popliteal bypass with aneurysm exclusion was effective for limb salvage in this case and may represent a useful treatment option for PSAA complicated by acute arterial occlusion. Structured abstract Persistent sciatic artery (PSA) is an extremely rare congenital vascular anomaly, with a reported prevalence of 0.03–0.06%. Treatment strategies remain controversial and depend on anatomical configuration, collateral circulation, and the severity of lower limb ischemia. Here, we report a case of acute lower limb ischemia caused by thrombotic occlusion of arteries distal to a persistent sciatic artery aneurysm (PSAA), which was successfully treated with emergency thrombectomy, femoro–popliteal bypass, and exclusion of the aneurysm, resulting in a favorable outcome.