Endovascular Treatment of a Persistent Sciatic Artery Aneurysm Complicated by Lower Extremity Arterial Embolism

Persistent sciatic artery (PSA) is a rare congenital vascular abnormality associated with the embryonic development of the iliac, common femoral, and superficial femoral arteries. Most cases of PSA are incidentally detected and are generally asymptomatic. However, PSA can present as chronic pain, such as neuralgia from aneurysmal dilatation compressing the sciatic nerve, or ischemic pain due to thrombus embolization from the aneurysm. In severe cases, aneurysm rupture poses a significant threat to both limb and life. Timely detection and appropriate intervention are therefore crucial. This article explores the clinical characteristics and treatment strategies of PSA, exemplified through the management of a patient with PSA complicated by distal embolization. Clinical Impact This study underscores the importance of simultaneously addressing both the aneurysm and distal thromboembolism in symptomatic persistent sciatic artery (PSA) cases, rather than treating embolic events alone. It reinforces endovascular repair as a preferred, minimally invasive strategy, reducing surgical trauma and nerve injury risk. For clinicians, this highlights the need for vigilant follow-up and consideration of early combined intervention to prevent recurrence. The innovation lies in demonstrating the efficacy of a staged, hybrid endovascular approach and proposing postural modification as a potential adjunct to slow aneurysm progression, offering a refined management paradigm for this rare condition.