Arteriography of a Persistent Primitive Left Sciatic Artery with Aneurysm: A Case Report

Persistence of the primitive sciatic artery appears to be an extremely rare anomaly of development. In spite of the present-day widespread use of peripheral arteriography, the demonstration of such a vessel is infrequent. To the best of our knowledge, only 13 cases have appeared in the world literature, and only 3 of these have been documented by arteriography (1–7). We therefore feel that a fourth such case, of unusual interest, is worthy of a report. Case Report A 65-year-old Negro woman was referred to the hospital in April 1906 with complaints of pain in the left foot for six years, with gradual worsening over the three months prior to admission. A swelling had been noted in the left buttock for several months. Progressive trophic changes had been observed in the toes, most marked at the distal end of the first digit. She gave no history of intermittent claudication or of diabetes mellitus. Past history and personal history were significant in that a hysterectomy had been performed in 1946 for pelvic inflammatory disease and the patient smoked one package of cigarettes daily. Physical examination revealed a well developed, well nourished Negro female with a blood pressure of 140/80, a regular pulse of 100, and a respiratory rate of 20 per minute. The abdomen displayed a 9 cm infraumbilical midline scar. A deeply situated pulsatile mass with a systolic bruit was present in the left gluteal region. Pulses in the lower extremities were as follows: on the left: femoral +1, popliteal +1, posterior tibial 0, dorsalis pedis 0; on the right: femoral +3, popliteal +2, posterior tibial +1, dorsalis pedis +1. In the left leg there was painful pitting edema below the level of the distal tibia with swelling and dry gangrene of the tips of the first, second, fourth, and fifth toes. Leg measurements and oscillometrics were not recorded in the chart. Laboratory Findings: The hemogram and urogram were normal; the erythrocyte sedimentation rate was 19 mm in one hour; the serologic tests for syphilis were positive. The fasting blood sugar was 94 mg per 100 ml. Roentgen Examination: A right transfemoral approach was used for antegrade arteriography of the left lower limb. The catheter was placed in the left common iliac artery. Following injection of 40 cc of meglumine diatrizoate 76 per cent, serial filming was carried out. Figures 1 to 5 demonstrate the progressive filling of an enlarged left hypogastric artery which, instead of terminating as the inferior gluteal as on the right, passes posteriorly to cross the left hip and proceeds distally along the medial aspect of the femoral shaft to join the popliteal. A saccular aneurysm arises from the persistent primitive sciatic artery as it courses posterior to the femoral head (Fig. 2). Discussion This case demonstrates the persistence of the primitive blood supply to the lower limb.