Presentation
Diabetic, noncompliant. Cutaneous ulcers with gangrene in right calf.
Patient Data
On both sides, the internal iliac artery (IIA) continues as a persistent sciatic artery (PSA), which continues in turn as the popliteal artery (PopA). The superficial femoral artery (SFA) is hypoplastic.
Both PSAs show concentric atheromatous plaque along their walls, with numerous focal stenoses, mild to moderate.
Right:
Tibioperoneal trunk (TPT) occluded. Peroneal artery (PA) fills from collateral at origin. Anterior tibial artery (ATA) and rest of PA patent. Posterior tibial artery (PTA) occluded at origin, no collateral filling.
Areas of skin loss around calf and posterior part of ankle. Gas bubbles in subcutaneous fat in medial aspect of distal shin and ankle and plantar surface of foot, likely representing gangrenous necrosis.
Cortical destruction in posterior aspect of medial malleolus and talus and in medial and posterior calcaneus, representing osteomyelitis
Left:
PTA occluded at origin, no collateral filling. ATA and PA pathological but patent.
Additional findings:
Tiny amount of free intraperitoneal fluid in right paracolic gutter and in lesser pelvis.
Extensive subcutaneous and mild intra-abdominal edema - anasarca.
Case Discussion
Case of bilateral complete persistent sciatic artery incidentally discovered on CTA runoff done due to right calf gangrene in a neglected diabetes patient. Sadly, she had to undergo above-knee amputation (AKA) for her right leg, as the gangrene was spreading upward.