959 A Double Case Review: Arteria Comitans Nervi Ischiadici, Two Rare Presentations of Persistent Sciatic Artery Aneurysm

Abstract

Abstract Background In the embryo, the blood flow of the lower limb bud originates from the umbilical artery and becomes the sciatic artery following the course of the sciatic nerve. By the 12th week, the sciatic will involute, in rare instances that this fails it is referred to as ‘arteria comitans nervi ischiadici’. This variant is rare with an incidence of 0.01%-0.05% is of the utmost surgical significance as failure to accurately diagnose and treat can ultimately threaten limb loss. Cases 1. A middle aged gentleman who presented with a 9-month history of posterior thigh pain with sensations of pressure related to posture and back pain following heavy lifting. Initially this patient was managed conservatively for claudication symptoms until they represented to clinic 4 years later with a 5month history of left buttock discomfort when sitting in the absence of claudication. An endovascular intervention with coil embolisation was undertaken reasons with a satisfactory outcome. 2. A young female with AVM to the left thigh and bilateral PSA's, presented with a painful swelling of the upper inner aspect of the mid-thigh, with a normal venous examination. On representing, despite repeated sclerotherapy, the patient had developed increasingly severe discomfort at the site of the thigh malformation, posterior aspect of the left leg. The patient was referred to a tertiary centre for reassessment. Conclusion Due to the variety and evolving nature of clinical presentations, a high degree of clinical suspicion is an important factor in providing a diagnosis. We also highlight the advantages of endovascular intervention.