Belmir Hicham, Hartung Olivier, Azghari Amine, S Alimi Yves, Lekehel Brahim
Vascular surgery department, Mohammed VI University of Health Sciences, BP 82403, Hay hassani, Casablanca, Morocco; Vascular surgery department, Mohammed V University, Rabat, Morocco.
Vascular surgery department, University hospital Nord, Marseille, France.
J Med Vasc. 2020 Sep;45(5):241-247. doi: 10.1016/j.jdmv.2020.06.003. Epub 2020 Jul 22.
The persistent sciatic artery (PSA) is a rare congenital anomaly with a high rate of aneurysm formation, occlusion and stenosis. It may lead to severe complications including thrombosis, distal embolisation, or aneurysm rupture. We reported herein our experience in the management of PSA and its complications, and discuss the therapeutic options.
Eight patients with 10 PSA were managed in our institutions between 1985 and 2017. An analysis was done for the clinical data, surgical technique, and results.
The series included six women and two men. The median age of the patients was 66,5 years (37-80 years). Physical examination found a pulsatile gluteal mass in five patients, sciatic neuropathy in two cases. Four patients had an acute ischemia of the lower limb. Cowie's sign was described in only two patients (diminished or absent femoral pulse but presence of popliteal pulse). Digital subtraction angiography was performed in all patients, and was completed with a computed tomography angiography (CTA) with a diagnosis of PSA, associated with a symptomatic aneurysmal lesion in seven cases and with an occlusion in one case. The treatment was surgical in all cases: bipolar exclusion of the aneurysm and bypass between the iliac artery and the PSA distal to the aneurysm was performed in four cases, only proximal and distal ligation was done in 2 other cases. A Chopart amputation was necessary in 2 cases.
We consider that the treatment of PSA is usually surgical in symptomatic cases. Surgical techniques depend on symptoms and classification describing anatomy of the PSA. However, future studies should compare the open versus the endovascular approach to optimize patient selection criteria and identify the most safe and effective strategy. In an asymptomatic patient, PSA does not require any intervention; continued follow-up is required because of the high incidence of aneurysmal formation and the risk of thromboembolic events.
永存坐骨动脉（PSA）是一种罕见的先天性异常，动脉瘤形成、闭塞和狭窄发生率高。它可能导致严重并发症，包括血栓形成、远端栓塞或动脉瘤破裂。我们在此报告我们处理PSA及其并发症的经验，并讨论治疗选择。
1985年至2017年期间，我们机构对8例患有10条PSA的患者进行了治疗。对临床数据、手术技术和结果进行了分析。
该系列包括6名女性和2名男性。患者的中位年龄为66.5岁（37 - 80岁）。体格检查发现5例患者有搏动性臀肿块，2例有坐骨神经病变。4例患者出现下肢急性缺血。仅2例患者出现考伊征（股动脉搏动减弱或消失但腘动脉搏动存在）。所有患者均进行了数字减影血管造影，并通过计算机断层血管造影（CTA）完成检查，诊断为PSA，7例伴有有症状的动脉瘤病变，1例伴有闭塞。所有病例均采用手术治疗：4例患者进行了动脉瘤双极排除术以及在动脉瘤远端的髂动脉和PSA之间进行搭桥，另外2例仅进行了近端和远端结扎。2例患者需要进行Chopart截肢术。
我们认为，有症状的PSA病例通常采用手术治疗。手术技术取决于症状和描述PSA解剖结构的分类。然而，未来的研究应比较开放手术与血管内治疗方法，以优化患者选择标准并确定最安全有效的策略。对于无症状患者，PSA无需任何干预；由于动脉瘤形成的高发生率和血栓栓塞事件的风险，需要持续随访。
