Tanaka Mutsuo, Okamoto Minoru, Okamoto Ken, Fukui Toshihiro
National Hospital Organization Kumamoto Medical Center, Department of Cardiovascular Surgery, 1-5 Ninomaru, Chuo-ku, Kumamoto-shi, Kumamoto Prefecture, 860-0008, Japan.
Kumamoto University Hospital, Department of Cardiovascular Surgery, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto Prefecture, 860-8556, Japan.
Int J Surg Case Rep. 2019;60:156-160. doi: 10.1016/j.ijscr.2019.06.017. Epub 2019 Jun 13.
Persistent sciatic artery (PSA) is a rare congenital vascular anomaly. It has several clinical features with the formation of aneurysms. Among the complications, leg ischemia is severe problem and the management involves revascularization and prevention of recurrence. We herein describe an anatomically annoying case of PSA aneurysm with recurrent embolism that necessitated thrombectomy and bypass surgery. And this work has been reported in line with the SCARE criteria.
A 76-year-old woman developed leg embolism twice from PSA aneurysm. PSA was complete type and the popliteal artery ran on the lateral side, which was difficult to approach from the standard medial side. Based on these anatomical conditions, thrombectomy of the posterior-tibial artery (PTA) and femoral-PTA bypass were performed. Additionally, the proximal side of PTA from the anastomosis site was ligated to avoid the recurrence of embolism. Residual PSA aneurysm has not yet been treated, but neither clinical complications nor dilatation have occurred.
PSA is a rare disease, but should be remember in acute limb ischemia. Clear treatments have not yet been established; therefore, its plans need to be considered based on clinical symptoms and anatomical conditions.
Although there were anatomical issues in the present case, thrombectomy and bypass surgery were successful and no complications have occurred one year after surgery.
永存坐骨动脉(PSA)是一种罕见的先天性血管异常。它具有多种临床特征,包括动脉瘤形成。在并发症中,腿部缺血是一个严重问题,治疗方法包括血管重建和预防复发。我们在此描述一例解剖结构复杂的PSA动脉瘤病例,该病例反复发生栓塞,需要进行血栓切除术和搭桥手术。本病例报告符合SCARE标准。
一名76岁女性因PSA动脉瘤两次发生腿部栓塞。PSA为完全型,腘动脉走行于外侧,从标准内侧难以接近。基于这些解剖条件,对胫后动脉(PTA)进行了血栓切除术,并进行了股-腘动脉搭桥术。此外,结扎了吻合部位近端的PTA,以避免栓塞复发。残留的PSA动脉瘤尚未治疗,但未出现临床并发症或扩张。
PSA是一种罕见疾病,但在急性肢体缺血时应予以考虑。目前尚未确立明确的治疗方法;因此,需要根据临床症状和解剖条件来考虑治疗方案。
尽管本病例存在解剖学问题,但血栓切除术和搭桥手术取得了成功,术后一年未出现并发症。