Case of persistent sciatic artery in a dialysis patient with critical limb ischemia

Persistent sciatic artery is a rare congenital malformation (incidence rate, 0.03%–0.06%). We report the case of a 72-year-old male patient with persistent sciatic artery suffering from pain at rest and an ulcer on the left first toe. Angiography findings showed 90% stenosis in the distal persistent sciatic artery. Endovascular therapy was considered difficult because of a long stenotic lesion from the persistent sciatic artery to the popliteal artery and extremely high calcification of the whole body. Because of poor blood flow to the lower leg, vascular prosthesis would have increased the risk of thrombotic occlusion. Therefore, below-knee femoropopliteal bypass using the great saphenous vein graft was performed, which led to the healing of the ulcer on the left first toe. Contrast-enhanced computed tomography of the lower limbs was performed to confirm that the bypass blood flow was good. The patient was discharged on postoperative day 5.

Arteries of the Lower Limb—Embryology, Variations, and Clinical Significance

Objectives: The purpose of this article is to review the embryology of the lower limb arterial anatomy along with common variants and their clinical relevance. Design: Embryologic variations of the lower limb arterial system may be explained by i.) persistence of primordial arterial segments, ii.) abnormal fusion, iii.) segmental hypoplasia/absence, or a combination of both. Persistent sciatic artery, corona mortis, and popliteal entrapment syndrome will also be discussed with associated symptoms, and potential complications. Conclusion: Knowledge of these variations is essential for surgical and endovascular management as failure to recognize them can result in complications.