Symptomatic persistent sciatic artery

Abstract

A 69-year-old man with no previous history of peripheral arterial disease was admitted for evaluation of acute left leg ischemia. Physical examination revealed normal pulses on the right leg; on the left the femoral pulse was reduced; popliteal and pedal pulses were undetectable. Angiography showed a unilateral persistent sciatic artery on the left (Fig A. PSA, persistent sciatic artery; PFA, profunda femoris artery; SFA, superficial femoral artery), continuous with the popliteal artery, which was occluded at its origin (Fig B. PA, popliteal artery). The distal superficial femoral artery appeared hypoplastic and did not supply significant flow to the lower extremity. Thrombolytic therapy with selective intra-PSA urokinase infusion was followed by normalization of leg perfusion (C). Femoral left artery showed unchanged reduced pulsation with normal popliteal and pedal pulses (Cowie’s sign).