Abstract：Objective To investigate the clinical and computed tomography angiography (CTA) imaging characteristics of persistent sciatic artery. Methods This was a cross-sectional study. A total of 3 120 patients who underwent CTA examination of both lower extremity arteries in the First Affiliated Hospital of Xi'an Jiaotong University from June 2017 to December 2022 were included. Among them, peripheral artery disease was detected in 2 995 patients (96.00%), acute arterial embolism in 48 patients (1.58%), thromboangiitis obliterans in 43 patients (1.38%), popliteal artery occlusion syndrome in 9 patients (0.29%), PSA in 7 patients (0.22%), and no significant abnormality was detected in 18 patients (0.58%). The clinical and imaging data of 7 patients with PSA were systematically analyzed.The clinical characteristics and CTA imaging characteristics of patients with PSA were summarized and analyzed. Results (1) Clinical characteristics: Among the 7 PSA patients, there were three females and four males, aged 30-84(59.5±15.9) years. The unilateral limb was involved in all seven patients (five cases of the left limb and two cases of the right limb). In accordance with the Pillet-Gauffre classification, six cases were categorized as type 2A, and one case was type 3. Among them, 1 patient presented with throbbing mass in the left hip for more than 1 year and sudden pain in the left lower limb for 4 days; 4 patients presented with pain and chiller in the lower limb, 1 patient had swelling in the lower limb, and 1 patient had no obvious abnormal clinical symptoms, which was accidentally found during CTA examination of lower limb arteries due to knee trauma. Two patients with PSA were combined with left sciatic artery aneurysms, which were located anterometrically in the left gluteus maximus and were combined with mural thrombosis and distal embolism. One patient had popliteal artery thrombosis and two patients had lower extremity arteriosclerosis. (2) CTA imaging characteristics: Among the 7 patients, CTA images of 6 patients with type 2A showed that the thickened internal iliac artery sent out a thick branch and ran to the anterior and medial gluteus maximus, and finally continued into the popliteal artery. The superficial femoral artery was thin and significantly smaller than the internal diameter of the popliteal artery, and did not continue with the popliteal artery. In one type 3 patient, the internal iliac artery branched off to the upper thigh and was thin. The superficial femoral artery developed normally and continued into the popliteal artery. In patients with type 2A PSA, the diameter of the internal iliac artery on the affected side was (9.7±1.9) mm, which was larger than that on the healthy side at (5.9±1.3) mm. The superficial femoral artery diameter on the affected side was (2.4±0.3) mm, smaller than that on the healthy side at (4.9±0.2) mm. The difference between the two sides was statistically significant (t=8.63, 36.60, all P values <0.001). In patients with type 3 PSA, the diameter of the internal iliac artery was 6.7 mm on the affected side and 6.4 mm on the healthy side, and that of the superficial femoral artery on the affected side was 4.3 mm on the healthy side and was basically identical with the healthy side of 4.6 mm. Conclusion The incidence of PSA is extremely low, with type 2A being the most common in accordance with the Pillet-Gauffre classification. Sciatic aneurysm and arterial embolism are the most common complications. The manifestations of CTA differ among various types of PSA. The typical (type 2A) manifestation is thickened internal iliac artery, which branches into the sciatic artery to the anterior medial gluteus maximus and continues into the popliteal artery. The superficial femoral artery is thin and does not continue with the popliteal artery.
van Hooft IM, Zeebregts CJ, van Sterkenburg SM, et al. The persistent sciatic artery[J]. Eur J Vasc Endovasc Surg, 2009,37(5):585-591. DOI: 10.1016/j.ejvs.2009.01.014
[2]
Sainz González F, Sánchez GÁ, Lorente A, et al.Persistent sciatic artery: a case report and literature review[J]. Neurocirugia (Astur : Engl Ed), 2022,33(5):254-257. DOI: 10.1016/j.neucie.2022.02.001
[3]
Ahn S, Min SK, Min SI, et al.Treatment strategy for persistent sciatic artery and novel classification reflecting anatomic status[J]. Eur J Vasc Endovasc Surg, 2016,52(3):360-369. DOI: 10.1016/j.ejvs.2016.05.007
倪其泓, 张岚, 薛冠华. 外周动脉疾病的识别与防治[J].中华全科医师杂志,2019,18(10):961-964. DOI: 10.3760/cma.j.issn.1671-7368.2019.010.011.Ni QH, Zhang L, Xue GH.Recognition and prevention of peripheral arterial disease[J].Chin J Gen Pract, 2019,18(10):961-964. DOI: 10.3760/cma.j.issn.2019.010.011
[6]
Belmir H, Hartung O, Azghari A, et al.The persistent sciatic artery: report of ten cases[J]. J Med Vasc, 2020,45(5):241-247. DOI: 10.1016/j.jdmv.2020.06.003
[7]
Wilson JS, Bowser AN, Miranda A, et al.Limb ischemia associated with persistent sciatic artery aneurysms-a report of 2 cases[J]. Vasc Endovascular Surg, 2005,39(1):97-101. DOI: 10.1177/153857440503900109
[8]
卓华威,赵琪,秦怡,等.永存坐骨动脉合并髂动脉瘤一例[J].中华解剖与临床杂志,2018,23(4):359-360.DOI:10.3760/cma.j.issn.2095-7041.2018.04.019.Zhuo HW, Zhao Q, Qin Y, et al.Persistent sciatic artery with iliac artery aneurysm: a case report[J]. Chin J Anat Clin, 2018, 23(4):359-360. DOI:10.3760/cma.j.issn.2095-7041.2018.04.019
[9]
亓恒涛,王锡明,段艳华,等. 永存坐骨动脉的超声诊断价值探讨[J]. 中华超声影像学杂志,2015,24(3):220-222. DOI:10.3760/cma.j.issn.1004-4477.2015.03.013.Qi HT, Wang XM,Duan YH, et al.Value of ultrasonography in the persistent sciatic artery[J]. Chin J Ultrasonogr, 2015, 24(3):220-222. DOI:10.3760/cma.j.issn.1004-4477.2015.03.013
[10]
François CJ.Peripheral vascular imaging focusing on nonatherosclerotic disease[J]. Radiol Clin North Am, 2020,58(4):831-839. DOI: 10.1016/j.rcl.2020.02.007
[11]
中华医学会放射学分会,下肢动脉CTA扫描技术专家共识协作组. 下肢动脉CT血管成像扫描技术专家共识[J]. 中华放射学杂志,2019,53(2):88-92. DOI:10.3760/cma.j.issn.1005-1201.2019.02.002.Chinese Society of Radiology, Chinese Medical Association, Lower Limb Artery CTA Scanning Technology Expert Consensus Collaboration Group. Expert consensus of lower extremity CT angiography[J]. Chin J Radiol, 2019,53(2):88-92. DOI:10.3760/cma.j.issn.1005-1201.2019.02.002.
2024, Vol. 29 
