A 79 year-old female with left buttock and thigh pain was diagnosed as persistent sciatic artery aneurysm (PSAA) by CT. On the following day she had her left lower limb pain caused by embolic ischemia. Distal embolization was treated by transcatheter thrombus suction and thrombolytic therapy. A Viabahn (W.L. Gore, AZ, USA) was deployed to exclude the PSAA. Although the lower limb pain was alleviated, the stent graft occluded in the early postoperative period and caused intermittent claudication. As the long term results of stent graft placement for persistent sciatic artery is unknown, the indication should be carefully considered.

A 48-year-old man who had intermittent claudication 3 years ago experienced a recurrence of symptoms 3 months prior and was referred to our hospital with suspected arteriosclerosis obliterans. His right ankle-brachial index was 0.67; contrast-enhanced computed tomography and magnetic resonance imaging showed a stenotic lesion in the popliteal artery above the knee due to cystic tumors. Cystic adventitial disease was diagnosed. We performed popliteal artery resection and anatomical reconstruction with an autologous vein graft. There has been no recurrence of symptoms 1 year postoperatively. Appropriate graft selection considering the location of the stenotic region and patient background is crucial.