Endovascular repair of persistent sciatic artery aneurysm: A case report and imaging diagnosis insights

Persistent sciatic artery (PSA) is a rare embryonic vascular remnant, with PSA aneurysms represent an uncommon yet clinically critical complication due to inherent risks of rupture and neurovascular compression. Endovascular therapy has emerged as a preferred minimally invasive management option, though its success hinges on precise anatomical characterization via multimodal imaging. We report a case of an early 60s female with a 6.5 cm Pillet-Gauffre type IIa PSA aneurysm complicated by ipsilateral femoral artery hypoplasia, who presented with a 2-month history of right hip pain and lower limb numbness without ischemic changes. A systematic multimodal imaging workflow (Doppler ultrasound, computed tomographic angiography, digital subtraction angiography) confirmed the PSA aneurysm diagnosis and clarified its anatomical features. Endovascular treatment was performed, involving covered stent-graft deployment for aneurysm exclusion and targeted coil embolization to address an intraoperative minor type III endoleak. Over 1-year clinical and imaging follow-up demonstrated sustained stent patency, near-complete resolution of the aneurysm sac, and complete resolution of the patient's neurological symptoms. This case highlights the value of multimodal imaging for the accurate diagnosis of large PSA aneurysms and validates the safety and efficacy of endovascular intervention for this rare, high-risk condition. Notably, our findings fill a critical gap in the current literature regarding the midterm outcomes of endovascular management for large PSA aneurysms (>5 cm), providing actionable insights for clinicians encountering similar cases.