Orimoto Yuki, Ishibashi Hiroyuki, Sugimoto Ikuo, Yamada Tetsuya, Maruyama Yuki, Hagihara Makiyo, Ishiguchi Tsuneo
Department of Vascular Surgery, Aichi Medical University, Aichi, Japan.
Department of Vascular Surgery, Aichi Medical University, Aichi, Japan.
Ann Vasc Surg. 2019 Apr;56:351.e17-351.e20. doi: 10.1016/j.avsg.2018.07.066. Epub 2018 Oct 19.
A persistent sciatic artery (PSA) is a rare congenital vascular anomaly that occurs in approximately 0.01 to 0.06% of the population. We encountered a patient with aneurysms in the common iliac-internal iliac artery continuous to an occluded right PSA. The patient was an 85-year-old male in whom intermittent claudication of the right lower limb appeared 3 months ago. The right ankle-brachial index (ABI) was 0.48. On contrast computed tomography, the right PSA was present and was occluded over the popliteal artery. The right superficial femoral artery was hypoplastic. Moreover, abdominal aortic (diameter: 42 mm) and right common-internal iliac (diameter: 46 mm) aneurysms continuous to the PSA were present. For the surgical procedure, endovascular aneurysm repair was selected. First, the right internal iliac artery was embolized, an aortouni-iliac stent graft was placed from the infrarenal aorta down to the left common iliac artery, and left common femoral-right deep femoral artery bypass was performed to achieve revascularization of the right lower limb. Postoperatively, the aneurysms were favorably excluded with stent grafts without endoleak. The right ABI markedly improved to 0.83, and claudication was resolved. There are few reports of iliac aneurysm with a concomitant PSA.
持续性坐骨动脉（PSA）是一种罕见的先天性血管异常，在人群中的发生率约为0.01%至0.06%。我们遇到一名患者，其髂总动脉-髂内动脉存在动脉瘤，并与闭塞的右侧PSA相连。该患者为一名85岁男性，3个月前出现右下肢间歇性跛行。右侧踝肱指数（ABI）为0.48。在对比计算机断层扫描中，右侧PSA存在，且在腘动脉处闭塞。右侧股浅动脉发育不全。此外，存在与PSA相连的腹主动脉瘤（直径：42mm）和右侧髂总-髂内动脉瘤（直径：46mm）。对于手术操作，选择了血管腔内动脉瘤修复术。首先，栓塞右侧髂内动脉，从肾下腹主动脉向下至左侧髂总动脉置入主动脉单髂支架移植物，并进行左股总动脉-右股深动脉旁路移植术，以实现右下肢血运重建。术后，动脉瘤被支架移植物良好地排除，无内漏。右侧ABI显著改善至0.83，跛行症状得到缓解。关于合并PSA的髂动脉瘤的报道很少。
