Case ReportPersistent sciatic artery: A case report and literature reviewCiática extrarraquídea: caso clínico y revisión de la literatura☆
Introduction
During embryonic development in the first weeks of gestation, the sciatic arteries originate from the umbilical artery and become the main source of blood supply to the lower limbs until their cranial or proximal portion atrophies.1, 2 Failure of sciatic arteries to regress is known as persistent sciatic artery (PSA) and is considered a rare congenital vascular malformation, with an incidence of to 3; the lack of regression can coincide with normal development, hypoplasia or agenesis of the iliac, common femoral and superficial femoral arteries.4
PSA can remain asymptomatic throughout life and be detected simply as an incidental finding. It can also manifest as a rare cause of sciatic neuralgia. Most often, however, it degenerates, forming an aneurysmal dilation, which appears as a pulsating mass in the gluteal region, or a thrombosis, which can generate distal embolism with ischaemia.5, 6
We present the clinical case of a young man who went to the Emergency department due to persistent sciatic pain in his right lower limb; he had been doing sports some days before and his pain was not responding to common analgesics.
Section snippets
Case report
This was a 23-year-old male patient with no known allergies and no significant previous medical or family history, who occasionally suffered low-intensity pain in the right inguinal region radiating along the posterior aspect of his right thigh. He consulted at the Emergency Department at "Gómez Ulla" Military Defence Hospital in Madrid, Spain complaining of pain similar to the previous episodes, but more intense in the previous four hours and with a burning sensation in his right gluteal
Discussion
PSA was described in 1832 by Green as an incidental postmortem finding. In 1864, Fagg described the associated aneurysmal degeneration. In 1960, Cowie reviewed the literature after coming across PSA as an incidental finding in an angiographic study, and the clinical sign of the presence of a popliteal pulse with absence of the femoral pulse in these patients is known by his name. PSA is bilateral of cases, and no predominance has been found on the right or left or in terms of gender.7,8
From an
Conclusions
PSA is a rare axial vascular malformation. Clinically it may be asymptomatic, but after reviewing the literature and published cases, these patients usually present with the sensation of a pulsatile mass caused by the aneurysm that develops, or with neuralgic-type pain due to the aneurysm compressing on the surrounding nerve structures, or as in our case, to an abnormally persistent and ectatic artery in contact with the sciatic nerve. The diagnosis is almost always by incidental finding in
Conflicts of interest
The authors declare that they have no conflicts of interest.
References (13)
- et al.
Persistent sciatic artery with monoplegia in right lower leg without vascular complication symptoms in an obese woman
J Emerg Med
(2008) - et al.
Aneurysm of bilateral persistent sciatic arteries with ischemic complications: case report and review of the world literature
J Vasc Surg
(1994) - et al.
The persistent sciatic artery
Eur J Vasc Endovasc Surg
(2009) - et al.
Bilateral persistent sciatic arteries complicated with chronic lower limb ischemia
Int J Surg Case Rep
(2011) - et al.
Bilateral persistent sciatic arteries in a Japanese man
Anat Sci Int
(2002) - et al.
Large-caliber persistent sciatic artery with aneurysm
Anat Sci Int
(2008)
Cited by (0)
- ☆
Please cite this article as: Sainz González F, Sánchez Galán Á, Lorente A, Palacios P. Ciática extrarraquídea: caso clínico y revisión de la literatura. Neurocirugia. 2021. https://doi.org/10.1016/j.neucir.2021.03.006