Persistent sciatic artery aneurysm presenting with acute limb ischemia: case report and review of the literature

Persistent sciatic artery (PSA) is a rare but clinically relevant congenital anomaly that occurs when the sciatic artery fails to involute during embryonic development. PSAs are prone to aneurysmal degeneration, which can lead to devastating outcomes of limb loss if left untreated. Here, we present a case of a 54-year-old male presenting with a symptomatic left PSA aneurysm (PSAA) who underwent successful repair via hybrid approach of femoral-popliteal bypass and PSAA embolization. A literature review was performed using the PubMed database of all English literature published cases of PSAAs. This yielded 98 case reports that included a total of 102 patients with an average age of 65.8 (SD 12.2). The literature review demonstrated that most patients underwent open surgical repair (n= 47, 46.1%), followed by endovascular repair (n = 24, 23.5%), hybrid approach (n = 18, 17.6%), and nonoperative management (n = 11, 10.8%). Of the patients, 86 (84.3%) recovered without limb loss, while 4 patients underwent major amputation. PSAA remains a rare clinical entity with a paucity of data and no consensus on ideal treatment, minimizing peri-operative morbidity remains a priority which can be achieved via combined open and endovascular repair.