Popliteal Artery Occlusion in a Sole Sciatic Arterial System Requiring Complex Repair

Objective: Persistence of the sciatic artery is a rare phenomenon in vascular surgery. It results from abnormal embryologic development, and where present in the absence of a femoral arterial system, it can have significant clinical implications for patients and can even be limb threatening. We present the case of a 69-year-old man with left-sided, short-distance claudication and rest pain, which caused concern for critical limb ischaemia. Methods: Computed tomography angiography revealed a persistent sciatic artery arising from the common iliac artery and resulting in an occluded popliteal artery. The patient underwent a double-bypass procedure to restore the arterial supply to the symptomatic limb. A left iliopopliteal Dacron graft bypass was performed, followed by a left iliopopliteal Dacron to posterior tibial bypass using the patient's great saphenous vein. The left sciatic artery was ligated proximally. Results:This allowed for restoration of arterial supply to the patient's left lower limb, relieving his claudication and rest pain. Conclusion: The key finding was the aneurysmal nature of the sciatic artery, reflecting the likely thromboembolic nature of the distal popliteal disease. Thus, our patient required not only a bypass procedure but also ligation of the native sciatic artery. Timely management is critical due to severity of consequences.