Gabelmann A, Krämer S C, Wisianowski C, Tomczak R, Pamler R, Görich J
Department of Diagnostic Radiology, University Clinics of Ulm, Germany.
J Endovasc Ther. 2001 Dec;8(6):622-8. doi: 10.1177/152660280100800616.
To report our experience with interventional procedures used to treat complete and incomplete persistent sciatic arteries (PSA).
Three female patients with PSAs displayed varying symptoms referable to this rare anatomical variant. In the first woman, a 1-year history of intermittent lower limb ischemia and an acute event prompted angiography, which demonstrated proximal occlusion of 2 crural vessels and a partially thrombosed sciatic artery aneurysm. To prevent further embolism, the aneurysm was excluded with a stent-graft. Endograft patency and aneurysm exclusion have been maintained up to 22 months. In a 41-year-old diabetic with chronic limb ischemia and digital gangrene, a flow-limiting stenosis of the sciatic artery was stented, restoring adequate pedal perfusion. The stent remained patent at the 18-month follow-up. The third patient suffered from a tumor-related pelvic hemorrhage originating from retrograde perfusion through the PSA, which had been ligated during previous surgery. Attempted embolization via a collateral connection between the incomplete PSA and the popliteal artery failed, and the patient died.
Vasculopathies involving the sciatic artery are uncommon but may be amenable to interventional techniques, such as coil embolization and stent implantation. PSA aneurysm exclusion with a stent-graft may represent a new therapeutic alternative to standard surgery that obviates potential sciatic nerve damage, but the durability of the repair remains to be determined.
报告我们使用介入手术治疗完全性和不完全性持续性坐骨动脉（PSA）的经验。
3例患有PSA的女性患者表现出与这种罕见解剖变异相关的不同症状。首例女性患者，有1年间歇性下肢缺血病史及1次急性发作，促使其接受血管造影，结果显示2条小腿血管近端闭塞及1个部分血栓形成的坐骨动脉瘤。为防止进一步栓塞，使用覆膜支架隔绝动脉瘤。覆膜支架通畅及动脉瘤隔绝情况维持达22个月。1例41岁患有慢性肢体缺血和指端坏疽的糖尿病患者，对其坐骨动脉的限流性狭窄进行了支架置入，恢复了足部充足的灌注。在18个月的随访中支架仍保持通畅。第3例患者因通过PSA逆行灌注导致与肿瘤相关的盆腔出血，该PSA在先前手术中已被结扎。试图通过不完全PSA与腘动脉之间的侧支连接进行栓塞失败，患者死亡。
累及坐骨动脉的血管病变并不常见，但可能适合采用介入技术，如弹簧圈栓塞和支架植入。使用覆膜支架隔绝PSA动脉瘤可能是一种替代标准手术的新治疗方法，可避免潜在的坐骨神经损伤，但修复的耐久性仍有待确定。
