In the event of a developmental abnormality of the vascular system of the lower limb in which the femoral system fails to develop or the axial artery fails to involute, the main vascular supply to the leg will be through a persistent sciatic artery (PSA). With an incidence of less than 0.04%, PSA can be asymptomatic, but in about half the cases an aneurysmal dilatation can ensue, and its symptomatology may include a painful gluteal mass. Cases have been reported of coagulopathy, anemia, or acute ischemia complicating PSA aneurysm. The case presented here is a clinical constellation of all three compo nents appearing together in a patient who had long been investigated for anemia and had been operated on for a bleeding duodenal ulcer (as a consequence of coagulopathy) in a different center. At hospitalization, the gluteal mass was noted on examination, and angiography showed a huge PSA aneurysm. The clinical presentation and management of this case are discussed in light of the current literature.