Persistent sciatic artery (PSA) is a very uncommon congenital malformation. Its incidence is estimated to be 0.025-0.04%. If it is accompanied by hypoplasia of the femoral artery system, its presence is essential for perfusion of the limbs. The usual form of presentation is as an aneurysm (25-58%) and/or its complications (thrombosis, distal remobilization, local compression). A 66-year-old woman presented with a painful mass of several months' progression. After performing angio-computed tomography, a fusiform aneurysmal dilation was observed in the left gluteal mass dependent on the left obturator artery, which was identified as the left lower gluteal artery. For this reason, we decided to perform therapeutic embolization. During the angiogram, a left aneurysmal PSA with distal thrombosis was observed. In view of these findings, a bypass from the superficial femoral artery to the tibioperoneal trunk was performed, with a contralateral inverted saphenous vein. The PSA was subsequently embolized with an occluder (AGA Medical IZASA, Plymouth, MN). The patient was discharged after checking complete exclusion of the aneurysm by ultrasound, with distal pulses during follow-up. Combined treatment using embolization, before surgical revascularization of the limb, markedly decreases the morbidity and mortality by avoiding the pelvic approach by the posterior route.
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