Nishizawa T, Suzuki I, Shiramatsu K, Kobyashi J, Terajima M
Department of Cardiovascular Surgery, National Chiba Hospital, Japan.
Nihon Geka Gakkai Zasshi. 1987 Oct;88(10):1509-12.
Seventy two-year-old woman was admitted in September, 1985 to our hospital with complaints of painful mass in the right buttock and ischias. Aorto-peripheral arteriogram showed that enlarged right internal iliac and inferior gluteal arteries passed posteriorly to cross the right hip and down the posterior aspect of the femur to supply the popliteal artery. A saccular aneurysm was seen immediately posterior to the right femoral head. The femoral artery was small in size, but connecting to the popliteal artery. Delayed flow to the popliteal artery through the sciatic artery was noted in contrast to the femoral system. With Osborne's right buttock approach, the gluteus maximus muscle was divided in the direction of its fibers, exposing a 3.5 by 5 cm aneurysm which was located above, the sciatic nerve and adherent to it. The proximal sciatic artery and the trunk of the sciatic nerve passed beneath the piriformis muscle. The pressure of the dorsalis pedis artery decreased from 156/77 to 117/72 mmHg after ligation of the proximal sciatic artery. The aneurysm was dissected free from the sciatic nerve. Postoperatively she had no more gluteal discomfort, nor did she have any ischemic symptoms by walking.
1985年9月，一名72岁女性因右臀部疼痛性肿块和坐骨神经痛入住我院。腹主动脉周围动脉造影显示，右侧髂内动脉和臀下动脉增粗，向后穿过右髋关节，沿股骨后侧下行，为腘动脉供血。在右股骨头后方立即可见一个囊状动脉瘤。股动脉细小，但与腘动脉相连。与股动脉系统相比，通过坐骨动脉向腘动脉的血流延迟。采用奥斯本右臀部入路，沿臀大肌纤维方向切开，暴露一个3.5×5cm的动脉瘤，位于坐骨神经上方并与之粘连。坐骨神经近端和主干从梨状肌下方穿过。结扎坐骨神经近端后，足背动脉压力从156/77mmHg降至117/72mmHg。将动脉瘤从坐骨神经上分离出来。术后她不再有臀部不适，行走时也没有任何缺血症状。
