Persistence of the Ischiadic Artery
Persistence of the primitive ischiadic artery is reported with a prevalence of 0.6–0.8%. The artery may be complete (continuing with the popliteal artery) or not. Aneurysmal degeneration is frequent, representing the cause of compression syndromes or of p
- PDF / 660,138 Bytes
- 12 Pages / 504.567 x 720 pts Page_size
- 81 Downloads / 213 Views
Persistence of the Ischiadic Artery Antonino Cavallaro
Normally [1], in the adult, the internal iliac artery divides into two main trunks, the posterior continuing as the superior gluteal artery and the anterior. The latter gives off several important branches supplying the pelvic organs and divides into the internal pudendal artery and the ischiadic artery; this appears as its terminal branch or continuation. The ischiadic artery (or inferior gluteal artery) leaves the pelvis through the lower part of the greater sciatic foramen, passing under the pyriformis muscle, and then courses medial to the sciatic nerve, covered by the gluteus maximus muscle, dividing after 3–6 cm into two branches: the inferomedial branch descends between the cutaneous posterior nerve of femur and the sciatic nerve, supplying this through a small branch (the satellite artery or arteria comitans of the sciatic nerve). In 1832, Green [2] described an anomaly of the femoral artery that he believed to be unique “….the external iliac artery passed under Poupart’s ligament and immediately divided into three or four branches, which seemed to supply the place of the profunda; no superficial femoral artery could be found in the thigh;….dissecting the lower back of the thigh and leg, it was discovered that the artery, which became the popliteal…..was a branch of the internal iliac; a large artery, of the same calibre as the femoral itself usually is, passed out through the sciatic notch with the sciatic nerve….” A. Cavallaro (*) Past Professor of General Surgery, “Sapienza” University, Rome, Italy © Springer Nature Switzerland AG 2021 A. Cavallaro (ed.), Aneurysms of the popliteal artery, https://doi.org/10.1007/978-3-030-49687-6_5
This is commonly quoted as the first report of a persisting primitive ischiadic artery, later called simply as persisting sciatic artery (PSA). Green made a warning about the pitfalls offered to surgeons by such anatomical variant especially when undertaking the treatment of a popliteal aneurysm by ligature of the superficial femoral artery. Almost two centuries elapsed and a case of popliteal aneurysm in a limb with a PSA was reported [3]. In 1847, Dubrueil [4] published a beautiful drawing of a PSA continuing with the popliteal artery (Fig. 5.1). Other scanty reports appeared in the literature [5, 6], and in 1928 Adachi [7] was able to collect 15 cases (including two personal cases resulting from 1200 dissections). Reports on the finding of a PSA during dissections continued to be published, also in recent years [8–11]. The PSA has been the object of several case reports and reviews, owing to the intriguing problems posed by its presence and mainly by its pathology. The largest collected series was published by Ikezawa [12] (Table 5.1); taking into account the reports appeared successively, it is probable that more than 200 cases are currently present in the world literature. PSA is a rare anomaly: Adachi [7] found two cases out of 1200 dissections (0.16%). From the retrospective inquiry into large angiographic serie
Data Loading...
