永存坐骨动脉的临床及CT血管成像影像特点分析

Analysis of clinical and CT angiography imaging characteristics of persistent sciatic artery

目的探讨永存坐骨动脉(PSA)的临床特点及CT血管成像(CTA)影像特点。方法横断面研究。纳入西安交通大学第一附属医院2017年6月—2022年12月行双下肢动脉CTA检查的患者3 120例。其中, 2 995例(96.00%)患者被检出为外周动脉疾病、48例(1.53%)急性动脉栓塞、43例(1.38%)血栓闭塞性脉管炎、9例(0.29%)腘动脉陷迫综合征、7例(0.22%)检出PSA, 18例患者(0.58%)未见明显异常。对7例PSA患者的临床及影像学资料进行系统分析。结果 (1)临床特点:7例PSA患者中, 男4例、女3例, 年龄30~84(59.5±15.9)岁;均累及单侧肢体, 左侧5例、右侧2例;Pillet-Gauffre分型为2A型6例、3型1例。其中, 1例患者表现为左臀部搏动性包块1年余, 突发左下肢疼痛4 d;4例患者表现为下肢疼痛、发凉;1例下肢肿胀;1例无明显临床症状, 因膝关节外伤行双下肢动脉CTA检查时偶然发现;2例合并左侧坐骨动脉动脉瘤, 动脉瘤均位于左侧臀大肌前内侧, 且合并附壁血栓及远端栓塞;1例合并腘动脉血栓形成;2例合并下肢动脉硬化。(2)CTA影像特点:7例患者中, 6例2A型患者表现为增粗的髂内动脉发出粗大分支并走行至臀大肌前内侧, 最终延续为腘动脉, 其股浅动脉发育纤细, 较腘动脉内径明显变小, 并未与腘动脉延续;另1例3型患者表现为髂内动脉分支止于大腿上部, 较为纤细, 股浅动脉发育正常并延续为腘动脉。6例2A型PSA患者患侧髂内动脉直径为(9.7±1.9)mm, 大于健侧髂内动脉直径的(5.9±1.3)mm;患侧股浅动脉直径为(2.4±0.3)mm, 小于健侧的(4.9±0.2)mm:两侧比较差异均有统计学意义(t=8.63、36.60, P值均<0.001)。1例3型PSA患者患侧髂内动脉直径为6.7 mm、健侧为6.4 mm, 患侧股浅动脉直径为4.3 mm、健侧为4.6 mm, 患、健两侧基本一致。结论 PSA发病率极低, Pillet-Gauffre分型中以2A型常见, 并发症以坐骨动脉瘤和动脉栓塞常见。不同分型PSA的CTA表现不同, 典型(即2A型)表现为髂内动脉增粗, 发出坐骨动脉走行至臀大肌前内侧并延续为腘动脉, 股浅动脉纤细, 不与腘动脉延续。

Objective To investigate the clinical and computed tomography angiography(CTA)imaging characteristics of persistent sciatic artery.Methods This was a cross-sectional study.A total of 3120 patients who underwent CTA examination of both lower extremity arteries in the First Affiliated Hospital of Xi'an Jiaotong University from June 2017 to December 2022 were included.Among them,peripheral artery disease was detected in 2995 patients(96.00%),acute arterial embolism in 48 patients(1.58%),thromboangiitis obliterans in 43 patients(1.38%),popliteal artery occlusion syndrome in 9 patients(0.29%),PSA in 7 patients(0.22%),and no significant abnormality was detected in 18 patients(0.58%).The clinical and imaging data of 7 patients with PSA were systematically analyzed.The clinical characteristics and CTA imaging characteristics of patients with PSA were summarized and analyzed.Results(1)Clinical characteristics:Among the 7 PSA patients,there were three females and four males,aged 30-84(59.5±15.9)years.The unilateral limb was involved in all seven patients(five cases of the left limb and two cases of the right limb).In accordance with the Pillet-Gauffre classification,six cases were categorized as type 2A,and one case was type 3.Among them,1 patient presented with throbbing mass in the left hip for more than 1 year and sudden pain in the left lower limb for 4 days;4 patients presented with pain and chiller in the lower limb,1 patient had swelling in the lower limb,and 1 patient had no obvious abnormal clinical symptoms,which was accidentally found during CTA examination of lower limb arteries due to knee trauma.Two patients with PSA were combined with left sciatic artery aneurysms,which were located anterometrically in the left gluteus maximus and were combined with mural thrombosis and distal embolism.One patient had popliteal artery thrombosis and two patients had lower extremity arteriosclerosis.(2)CTA imaging characteristics:Among the 7 patients,CTA images of 6 patients with type 2A showed that the thickened internal iliac artery sent out a thick branch and ran to the anterior and medial gluteus maximus,and finally continued into the popliteal artery.The superficial femoral artery was thin and significantly smaller than the internal diameter of the popliteal artery,and did not continue with the popliteal artery.In one type 3 patient,the internal iliac artery branched off to the upper thigh and was thin.The superficial femoral artery developed normally and continued into the popliteal artery.In patients with type 2A PSA,the diameter of the internal iliac artery on the affected side was(9.7±1.9)mm,which was larger than that on the healthy side at(5.9±1.3)mm.The superficial femoral artery diameter on the affected side was(2.4±0.3)mm,smaller than that on the healthy side at(4.9±0.2)mm.The difference between the two sides was statistically significant(t=8.63,36.60,all P values<0.001).In patients with type 3 PSA,the diameter of the internal iliac artery was 6.7 mm on the affected side and 6.4 mm on the healthy side,and that of the superficial femoral artery on the affected side was 4.3 mm on the healthy side and was basically identical with the healthy side of 4.6 mm.Conclusion The incidence of PSA is extremely low,with type 2A being the most common in accordance with the Pillet-Gauffre classification.Sciatic aneurysm and arterial embolism are the most common complications.The manifestations of CTA differ among various types of PSA.The typical(type 2A)manifestation is thickened internal iliac artery,which branches into the sciatic artery to the anterior medial gluteus maximus and continues into the popliteal artery.The superficial femoral artery is thin and does not continue with the popliteal artery.