Brantley S K, Rigdon E E, Raju S
Department of Surgery, University of Mississippi Medical Center, Jackson 39216.
J Vasc Surg. 1993 Aug;18(2):242-8.
The purpose of this article is to describe the embryologic development and anomalous persistence of the sciatic artery, pathologic changes that may occur in the persistent sciatic artery, and management of complications related to these pathologic changes.
Two patients with persistence of the sciatic artery treated in the authors' experience are reported. In addition, the computerized data base of the University of Mississippi Medical Center was searched for patients with other lower extremity arterial aneurysms, and their records were reviewed for possible aneurysm of a persistent sciatic artery. A review of the literature was undertaken to determine the embryologic development of the persistent sciatic artery, the pathologic changes that have been observed in the sciatic artery, clinical findings associated with these pathologic changes, and methods of treatment.
Two patients with persistence of the sciatic artery were treated by the authors. No other cases were identified in 43 patients with 66 lower extremity aneurysms treated at our institution. The first patient presented with acute lower extremity ischemia caused by thrombosis of a sciatic artery aneurysm and was treated successfully with intraarterial thrombolytic therapy followed by interposition graft repair. In the second case an incidental unilateral persistent sciatic artery was identified in a patient with bilateral Buerger's disease presenting with digital gangrene of the contralateral extremity in whom below-knee amputation was eventually required. Bilateral tibial artery occlusion was observed on arteriography. Histologic examination of the amputated limb confirmed findings typical of Buerger's disease, and no microemboli were seen.
The sciatic artery is a continuation of the internal iliac artery and is the primary blood supply to the lower limb bud during early fetal development. The sciatic artery normally involutes during fetal development, but remnants persist as the popliteal and peroneal arteries after the superficial femoral artery develops and establishes continuity with the popliteal artery. Persistence of the sciatic artery as the major blood supply to the lower extremity in adults is a rare vascular anomaly that may be of surgical significance. Failure to appreciate the persistent sciatic artery as the major inflow into the lower extremity may lead to inappropriate bypass of apparent occlusive disease of the superficial femoral artery. The persistent sciatic artery is also frequently aneurysmal, which may cause critical limb ischemia resulting from thrombosis or embolization of aneurysm thrombus. Options for vascular reconstruction include interposition graft replacement and standard femoropopliteal bypass grafting if the common femoral artery is sufficiently developed to provide adequate inflow. As with other peripheral arterial aneurysms resulting in thrombosis and extensive distal arterial embolization and thrombosis, intraarterial thrombolytic therapy may be useful in selected cases before definitive surgical revascularization.
本文旨在描述坐骨动脉的胚胎发育及异常持续存在情况、持续存在的坐骨动脉可能发生的病理变化以及与这些病理变化相关的并发症的处理。
报告了作者经验中治疗的2例坐骨动脉持续存在的患者。此外，检索了密西西比大学医学中心的计算机数据库，查找患有其他下肢动脉瘤的患者，并查阅其记录以寻找可能存在的持续坐骨动脉动脉瘤。对文献进行综述，以确定持续坐骨动脉的胚胎发育、在坐骨动脉中观察到的病理变化、与这些病理变化相关的临床发现以及治疗方法。
作者治疗了2例坐骨动脉持续存在的患者。在我院治疗的43例患有66个下肢动脉瘤的患者中未发现其他病例。第一例患者因坐骨动脉动脉瘤血栓形成导致急性下肢缺血，经动脉内溶栓治疗后成功进行了间置移植修复。第二例患者为双侧血栓闭塞性脉管炎，对侧肢体出现手指坏疽，在其患侧偶然发现单侧持续性坐骨动脉，最终需要进行膝下截肢。动脉造影显示双侧胫动脉闭塞。截肢肢体的组织学检查证实为典型的血栓闭塞性脉管炎表现，未见微栓子。
坐骨动脉是髂内动脉的延续，在胎儿早期发育过程中是下肢芽的主要血液供应。坐骨动脉在胎儿发育过程中通常会退化，但在股浅动脉发育并与腘动脉建立连续性后，其残余部分会持续存在为腘动脉和腓动脉。成人中坐骨动脉作为下肢主要血液供应持续存在是一种罕见的血管异常，可能具有手术意义。未能认识到持续存在的坐骨动脉是下肢的主要流入血管可能会导致对股浅动脉明显闭塞性疾病进行不适当的旁路手术。持续存在的坐骨动脉也常形成动脉瘤，这可能会因动脉瘤血栓形成或栓塞导致严重肢体缺血。血管重建的选择包括间置移植置换，如果股总动脉发育充分能够提供足够的流入量，则可进行标准的股腘旁路移植术。与其他导致血栓形成及广泛远端动脉栓塞和血栓形成的周围动脉瘤一样，在进行确定性手术血管重建之前，动脉内溶栓治疗在某些病例中可能有用。
