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Persistent sciatic artery aneurysm with ruptured internal iliac artery aneurysm

M Kuwabara1, T Onitsuka, K Nakamura

  • 1Second Department of Surgery, Miyazaki Medical College, Japan.

The Journal of Cardiovascular Surgery
|April 1, 1997
PubMed
Summary

This case report details a ruptured internal iliac artery aneurysm in a patient with a persistent sciatic artery. Successful surgical repair involved aortic grafting and ligation of the anomalous artery.

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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Anatomical Variations

Background:

  • Aneurysms, particularly those involving rare anatomical variations like a persistent sciatic artery, pose significant diagnostic and therapeutic challenges.
  • Ruptured internal iliac artery aneurysms are uncommon but life-threatening emergencies requiring prompt surgical intervention.

Observation:

  • A 62-year-old male presented with severe abdominal pain, diagnosed with infrarenal aortic, left internal iliac, and left persistent sciatic artery aneurysms.
  • Preoperative CT and angiography revealed a ruptured left internal iliac artery aneurysm extending into the retroperitoneal space.
  • The persistent sciatic artery aneurysm originated from the internal iliac artery and extended down the left thigh, with normal distal lower extremity perfusion via the superficial femoral artery.

Findings:

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  • Emergency surgical repair was performed using a Y-shaped Dacron graft from the infrarenal aorta to the common iliac and external iliac arteries.
  • The origin of the persistent sciatic artery aneurysm was ligated, preserving distal limb perfusion without requiring additional bypass procedures.
  • Postoperative recovery was excellent, with angiography confirming normal anatomy and perfusion of the left lower extremity.

Implications:

  • This case highlights the critical importance of detailed preoperative imaging (CT and angiography) to identify associated vascular anomalies in patients with abdominal aortic aneurysms.
  • Optimal management necessitates a comprehensive surgical approach addressing both the primary aneurysm and any coexisting rare vascular variations.
  • Early recognition and surgical correction of ruptured internal iliac artery aneurysms, even in the presence of anatomical variations, can lead to excellent patient outcomes.