Endovascular treatment of Persistent Sciatic Artery Aneurysms using covered stents : a Systematic Review of the Literature
George J. Koullias, MD, PhD1, Nektarios Charisis, MD1, Stefanos Giannopoulos, MD2, Apostolos Tassiopoulos, MD1.
1SUNY Stony Brook University Hospital, Stony Brook, NY, USA, 2251 HAF and VA Hospital, Athens, Greece.
OBJECTIVES: Persistent Sciatic Artery (PSA) is a rare vascular anomaly and is an embryologic remnant of the internal iliac artery. PSA has aneurysmal degeneration in 60% of the cases. Although open repair of this aneurysm is rarely performed today, the results between open and endovascular repair are still debatable. In this study, we evaluated the presenting symptoms, safety, efficacy and outcomes of the endovascular treatment of a persistent sciatic artery aneurysm (PSAA).
METHODS: This systematic review was conducted according to the PRISMA guidelines and eligible studies were identified through search of the PubMed, Scopus and Cochrane Central databases. We used descriptive statistics with the help of STATA 13 to analyze our data.
RESULTS: Sixteen studies, all of them case reports (total of 16 patients), were included in this systematic review. The mean age of the patients included in these studies was 59 years old and half of the patients (50%) were women. The persistent sciatic artery aneurysm was located at the left in 60% of the reported cases, right in 33% and bilaterally in 7%. The majority of patients were admitted to the hospital with recent worsening limb claudication, palpable and pulsatile buttock mass. The onset of symptoms was sudden in 78% of the reported cases. Additionally, in 92% of the patients, their distal pulses on PSAA side were diminished or absent. Acute limb ischemia was the primary diagnosis in 78% of the cases. All patients underwent endovascular repair of the PSAA with a covered stent. The mean number of stents used for this procedure was N=1.5. Procedural outcome was favorable in all patients. Periprocedural imaging evaluation was determined either with CT angiography (CTA) or Duplex Ultrasound (DUS). Periprocedural complications included only one endoleak with distal dissection. This endoleak was identified after stent deployment and dissection distal to the aneurysm. Mean follow up (with CTA and/or DUS) was 22 months, with all patients being asymptomatic with no symptoms recurrence.
CONCLUSIONS: The endovascular treatment of PSAA with covered stent is safe and effective. This treatment is associated with high procedural success, low periprocedural complications and favorable mid-term follow up.
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