Acute limb ischemia after transplantation in a patient with persistent sciatic artery

Background. Improved surgical techniques have contributed to a better outcome in kidney transplantation, and graft failure secondary to technical complications is unusual. Methods. We describe a surgical complication secondary to a rare and unexpected vascular anomaly in a pediatric renal transplant that resulted in considerable morbidity. Results. Our patient had a persistent sciatic artery as a dominant source of blood supply to the lower limb. Ligation of this vessel during anastomosis with the transplant kidney vasculature led to severe ischemic damage to the leg. Conclusion. This vascular malformation, if undetected, can lead to serious complications. We present a review of the literature regarding this malformation and its management with regard to renal transplantation.