Rare cause of sciatic neuropathy: persistent sciatic artery pseudoaneurysm managed by endovascular stent graft placement

Persistent sciatic artery is an uncommon congenital lower limb vascular variant resulting from persistent embryonic vasculature. While up to 20% of individuals remain asymptomatic, the most frequently seen complication associated with this artery is the development of a pseudoaneurysm in the gluteal region (48%). Pseudoaneurysms may result in thrombosis, embolisation into distal vessels and radicular pain due to compression of the adjacent sciatic nerve.We present the case of a gentleman in his mid-50s with complaints of neuropathic lower limb pain secondary to sciatic nerve compression by a pseudoaneurysm of persistent sciatic artery, which was excluded from circulation using an endovascularly placed stent graft. Follow-up ultrasound (US) on post-op day 1 revealed thrombosis of the pseudoaneurysm with complete resolution of neuropathic pain, and the patient remaining pain-free at 1 year. Knowledge of this uncommon variant, with its varied presentations, can aid early diagnosis and planning of effective, minimally invasive endovascular management techniques.