Endovascular management of rare sciatic artery aneurysm

Purpose: To present a rare case of complete persistent sciatic artery aneur ysm successfully treated by coil embolization and to suggest a new classifi cation for this anomaly that encompasses both clinical and pathological fac tors. Methods and Results: A 77-year-old female presented with sudden onset of sh arp, throbbing left thigh and foot pain. A nontender 10.0- x 7.0-cm pulsati le mass was found over the inferolateral aspect of the left buttock on exam ination in the right lateral decubitus position. Angiography demonstrated a 6.9-cm sciatic artery aneurysm with the distal sciatic artery completely t hrombosed. Before planned bypass grafting, the aneurysm and distal segment of the internal iliac artery were successfully embolized with coils through a left percutaneous approach. The patient's symptoms resolved with no dete rioration in limb perfusion, and further revascularization was unnecessary. Postembolization imaging showed complete occlusion of the aneurysm, which has continued for 19 months. Conclusions: The application of endovascular techniques and surgical revasc ularization procedures provides numerous management options for the treatme nt of an aneurysmal persistent sciatic artery. This case demonstrates that clinical evaluation between staged procedures may obviate the need for furt her intervention.