Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland.
National University of Ireland, Galway.
Vascular. 2023 Dec;31(6):1124-1127. doi: 10.1177/17085381221111016. Epub 2022 Jun 23.
Persistent sciatic artery (PSA) is a rare congenital anomaly, whereby the embryonic sciatic artery remains patent with associated degrees of femoral axis hypoplasia. Aneurysmal degeneration and distal ischaemia from thromboembolic complications are common. Revascularisation strategies include embolectomy, bypass or interposition grafting and catheter-directed thrombolysis.
We describe a sedentary 88-year-old woman with right acute limb ischaemia secondary to a thrombosed PSA aneurysm and concurrent occlusive thrombus at the femoral bifurcation.
The patient presented with a 3-day history of a cold, painful right foot. Examination revealed Rutherford IIb ischaemia. CT-angiography demonstrated no continuity between the hypoplastic superficial femoral and popliteal arteries, complete occlusion of the right PSA distal to the thrombosed aneurysm and occlusive thrombus in the right profunda. As she was too frail for femoral-distal bypass, we restored femoral axis inflow via profunda embolectomy. Her prognosis remained guarded as we deliberately did not reconstruct the PSA. However, she was discharged pain-free and mobilising with aids 2 weeks later.
Limb ischaemia in frail, high-risk patients is an ever-increasing challenge for vascular surgeons and requires complex decision-making, balancing comorbidities against desired outcomes. This case illustrates that a selective approach can be sufficient to maintain function despite complex anatomy.
持续性坐骨动脉（PSA）是一种罕见的先天性异常，胚胎坐骨动脉保持开放，伴有股骨轴发育不良。动脉瘤样变性和来自血栓栓塞并发症的远端缺血很常见。血管重建策略包括取栓术、旁路或间置移植术和导管定向溶栓术。
我们描述了一位 88 岁的久坐不动的女性，因 PSA 动脉瘤血栓形成和股分叉处闭塞性血栓导致右急性肢体缺血。
患者出现右足疼痛、发冷 3 天。检查发现存在 Rutherford IIb 期缺血。CT 血管造影显示，发育不良的股浅动脉和腘动脉之间没有连续性，右侧 PSA 在血栓形成的动脉瘤远端完全闭塞，右侧股深动脉有闭塞性血栓。由于患者身体过于虚弱，无法进行股远端旁路术，我们通过股深动脉取栓术恢复了股骨轴的血流。由于我们故意不重建 PSA，因此她的预后仍不容乐观。然而，2 周后她无痛出院并借助辅助工具活动。
对于血管外科医生来说，虚弱、高风险患者的肢体缺血是一个日益增加的挑战，需要进行复杂的决策，权衡合并症与预期结果。本病例表明，尽管解剖结构复杂，但选择性方法足以维持功能。
