Systemic Review of Persistent Sciatic Artery Management

Safety and Effectiveness of Endovascular Treatment of Complications Associated with Persistent Sciatic Artery: A Qualitative Systematic Review

Clinical question

Is endovascular therapy with stent grafts (SGs) a safe and effective approach to treat complications associated with persistent sciatic artery (PSA)?

Take away point

The current review demonstrated good technical and clinical success rates and a low risk of adverse events with endovascular stent graft management of persistent sciatic artery.

Reference

Koike, Y., Motohashi, K., & Kato, S. (2024). Safety and Effectiveness of Endovascular Treatment of Complications Associated with Persistent Sciatic Artery: A Qualitative Systematic Review. Journal of Vascular and Interventional Radiology.

Click here for abstract

Study design

Systemic review, qualitative

Funding Source

None

Setting

Academic

Figure

Summary

Persistent sciatic artery (PSA) is a rare vascular anomaly occurring in 0.025%–0.040% of the population, where the sciatic artery fails to regress during fetal development and continues to supply the lower limb. This anomaly often results in symptoms, with 80% of patients being symptomatic and 48% developing buttock aneurysms due to repetitive trauma and compression from its anatomical position. These aneurysms can lead to complications such as thrombotic occlusion, distal embolization, and even amputation. The primary treatment goals for symptomatic PSA are to prevent distal embolization and aneurysm rupture, typically through bypass surgery combined with embolization. Recently, stent graft (SG) placement has gained attention as an alternative treatment, although concerns about SG durability, potential fracture, and occlusion remain due to the repetitive trauma in the PSA's location. This systematic review aims to assess the safety and effectiveness of endovascular SG placement for treating PSA complications.

This systematic review, registered with the University Medical Information Network, analyzed existing literature on endovascular treatment of persistent sciatic artery (PSA) complications using stent graft (SG) placement. Following PRISMA guidelines, the study included patients with PSA complications such as aneurysms, rupture, or thrombosis, and excluded those without SG placement or without complications at risk of rupture. The literature search, conducted across multiple databases, identified eligible studies based on a predefined PICOS framework. Two authors independently screened and extracted data, resolving discrepancies by consensus. Outcomes assessed included technical and clinical success, patency, SG-related adverse events, reinterventions, amputations, and mortality. Statistical analyses, including Kaplan-Meier curves and Cox regression, were performed to evaluate the associations between SG characteristics and outcomes, with significance set at a p-value of ≤0.05.

The systematic review included 40 records of patients who underwent endovascular treatment with stent grafts (SGs) for persistent sciatic artery (PSA) complications. The study analyzed 31 case reports, 2 case series, and 7 conference proceedings, with a total of 40 patients (median age 67) treated across 41 limbs. Most patients presented with lower limb ischemia or aneurysm. The technical success rate was 100%, but 9.8% of limbs experienced intervention-specific adverse events, including intraprocedural dissection and thrombotic complications. The study found primary and secondary patency rates of 81.5% and 94.5% at 1 year, respectively, with SG occlusions mainly occurring within 2 years. The clinical success rate remained high at 95.7% over two years. SG fracture was rare, and no endoleaks or infections were reported. Univariate analysis showed no significant association between SG characteristics and primary patency rates.

The discussion highlights that endovascular treatment using stent grafts (SGs) for persistent sciatic artery (PSA) complications is effective, showing high technical and clinical success rates with a low risk of adverse events (AEs). The midterm patency and durability of SGs were found to be acceptable, although factors influencing patency remain unclear. The review supports SG placement as a preferable first-line therapy, especially for PSA aneurysms without occlusion, and suggests that endovascular approaches are increasingly favored due to their minimally invasive nature. The discussion also compares the findings with previous reviews and studies, noting similar success rates but emphasizing the need for more consistent follow-up and reporting to better understand long-term outcomes and the potential impact of anatomical factors on patency. The authors recommend SGs as a first-line treatment while acknowledging the limitations of the current data, including potential selection bias and inconsistencies in study methodologies.