コイル塞栓術を行い得たDIC合併遺残坐骨動脈瘤の1例

A case of persistent sciatic artery aneurysm with DIC successfully treated by coil embolization

遺残坐骨動脈瘤（persistent sciatic artery：PSA）は胎生期の下肢への血流を担う坐骨動脈が遺残したまれな先天異常で，発症頻度は0.01～0.06％とされている^1）2）。瘤化や閉塞をきたしやすく，瘤の破裂や瘤内血栓に伴う末梢動脈塞栓症による下肢虚血をきたす^2-4）。このような場合，瘤切除術^5）や血行再建術^6）などの外科的治療介入，あるいはコイル塞栓術^7）やステントグラフト留置術^8）などの血管内治療が必要となる。

A woman in her early 80s was admitted to our hospital with whole body hemorrhagic tendency. The hematological examination revealed disseminated intravascular coagulation（DIC）, and three-dimensional CT（3D-CT）showed left persistent sciatic artery aneurysm（SAA）. Digital subtraction angiography（DSA）showed the aneurysm classified as a ‘complete’ type. Although the distal side of the sciatic artery was thrombotic occluded, and collateral arteries arisen from the deep femoral artery were the main vessels feeding blood to the popliteal artery. We assessed that transcatheter arterial coil embolization（TAE）was enforceable as well as ‘incomplete’ type aneurysm. The SAA was successfully treated with TAE alone. Four months after TAE, she was asymptomatic, no significantly abnormal findings were recognized by hematological examination.