Persistent Sciatic Vein Research Articles

Sciatica secondary to deep venous thrombosis of the persistent sciatic vein: the first case in the literature. Illustrative case.

Sciatica usually results from lumbar nerve compression due to factors like disc herniations or lumbar canal stenosis. Despite its common causes, sciatic pain in a 52-year-old man following a coronavirus disease 2019 infection highlighted the importance of considering less common factors. Initially, minor disc protrusions were suspected as the cause of the symptoms, leading to the offer of surgery at another facility. The patient sought a second opinion, and our evaluation revealed a unique finding. Pelvic magnetic resonance imaging uncovered varicose structures displacing the left sciatic nerve. Subsequent pelvic computed tomography angiography identified a remarkable finding-the lack of opacification in a left persistent sciatic vein ascending toward a left internal iliac vein, originating from a common internal iliac venous trunk-confirming a suspicion for deep venous thrombosis. These findings represented not 1, but 2, extremely rare and distinct variants in the venous anatomy. The authors promptly initiated anticoagulant therapy and tailored pain management strategies, observing progressive thrombosis resolution on follow-up imaging. This report highlights the need for comprehensive diagnostics when symptoms and imaging differ. Misdiagnosis could lead to unnecessary surgeries and potential risks for the patient. https://thejns.org/doi/10.3171/CASE23652.

Beyond The Ordinary: A Case of a Unilateral Persistent Sciatic Vein

Uncommon anatomical variations in venous structures continue to intrigue anatomists and clinicians alike. Here, we present a rare case of a unilateral persistent sciatic vein observed in the right thigh of an adult male cadaver. Unlike the commonly associated Klippel-Trenaunay-Weber syndrome, this finding emerged as an isolated phenomenon. During routine dissection, a conspicuous enlarged sciatic vein of lower type morphology was discovered in the right lower limb. This prominent vein, comparable in size to the sciatic nerve, originated from the confluence of posterior tibial, central soleal and peroneal veins at the distal end of the popliteal fossa. It ran a short course along the posterior thigh medial to the sciatic nerve, before terminating into the profunda femoris vein. This case underscores the importance of recognizing rare venous anatomical occurrences such as a persistent sciatic vein which predisposes one to deep vein thrombosis.

Persistent Sciatic Veins

Persistence of the sciatic vein is a venous anomaly located in the lower limbs. Accounts in the literature rarely include patients who do not have the Klippel-Trenaunay-Weber syndrome. We present a case of a woman with bilateral persistent sciatic veins and no Klippel-Trenaunay-Weber syndrome, first suspected on a duplex ultrasound examination and then confirmed by computed tomography angiography. Persistent sciatic vein is a rare venous anomaly. Although the prevalence of persistent sciatic veins is possibly underestimated, we should be aware of its presence, considering its relevance in contributing to venous disease.

Is it popliteal artery? Is it popliteal vein? No it is persistent sciatic vein

Is it popliteal artery? Is it popliteal vein? No it is persistent sciatic vein

Klippel-Trenaunay Syndrome of the Extremities- A Report of Two Cases

Klippel-Trenaunay Syndrome (KTS) is a rare disorder, with an incidence of 1 in 100,000 people worldwide. The hallmark features of this syndrome include venous malformations, capillary malformations, and soft tissue hypertrophy. There is no gender or racial predilection and it manifests in childhood. It usually involves one limb, predominantly the lower limb. But, in rare incidences, upper limb involvement is also reported. The common presentation of KTS is pain with spontaneous cutaneous haemorrhage, soft tissue enlargement, venous thrombosis, leg length discrepancy, cortical thickening, macular patches and phleboliths. The present case report described two patients (both females) with KTS, who visited the hospital. One of them was an adult female, presented with left lower limb swelling. Computed Tomography (CT) showed, multiple dilated lower limb veins, draining into the internal iliac and deep femoral veins. Following this, the patient had undergone one cycle of Ultrasound Guided Sclerotherapy (UGS) and was advised to follow-up. The patient underwent subsequent two cycles of UGS at an interval of three months. Another patient was of the paediatric age group, presented with swelling and pain in the left lower limb. Magnetic Resonance Imaging (MRI) revealed, multiple veno-capillary malformations with a Persistent Sciatic Vein (PSV). Liposuction of the bilateral gluteal region was performed with the application of topical Neosporin and was advised to follow-up. After five months, Ultrasonography (USG) of the bilateral gluteal region was done, which was normal with no obvious residual disease.

Persistent sciatic vein.

Venous anomalies of the lower extremity are a challenge when found as rare variations. Physicians should be aware of morphological variations in this region for correct diagnosis and management of diseases such as deep vein thrombosis. During the routine dissection of the lower extremities of a Caucasian male cadaver, a case of persistent sciatic vein was found. A persistent sciatic vein originating from the saphenopopliteal junction coursed proximally and laterally to enter into the adductor magnus muscle, at the right side. Running through the fibres of the adductor magnus anteriorly, the variant vein drained into the deep femoral vein just medial to the vastus medialis muscle. As being a rare congenital vascular anomaly, the persistent sciatic vein should be correctly diagnosed and defined during the radiologic assessments, surgical interventions and blockades for better outcomes and lesser complications.

A large unilateral persistent sciatic vein: a case report

Persistent sciatic vein is considered a relatively rare anatomical finding, commonly associated with the Klippel-Trenaunay-Weber syndrome. We report a case of a large unilateral persistent sciatic vein in the right lower limb of an adult male cadaver, identified during routine dissection. The size of the vein was comparable to the sciatic nerve and it was originated from the union of posterior tibial veins at the distal end of the popliteal fossa. It was ascending in the posterior part of the thigh, medial to the sciatic nerve, before coursing through the infrapiriform foramen of the greater sciatic foramen and terminating by draining into the internal iliac vein. Further dissection revealed conventional anatomy of the femoral venous system. The epidemiology, anatomy, diagnosis and management a persistent sciatic vein are also discussed.

CT Angiographic Evaluation of Congenital Anastomoses between Femoropopliteal Vein and Deep Femoral Vein: Types and Incidence.

To evaluate congenital anastomotic channels between femoropopliteal veins and deep femoral veins with the use of computed tomographic (CT) venography. CT venography of 488 limbs in 244 patients (105 men; mean age, 61 y; age range, 18-96 y) performed between January 2016 and December 2016 was retrospectively evaluated. The presence or absence of anastomotic channels (> 3 mm in diameter) connecting a femoropopliteal vein to a deep femoral vein was determined, and the observed channels were classified based on their location and course. Two types of anastomotic channels were observed in 32 patients (13%): a persistent sciatic vein (PSV) in 24 limbs of 15 patients (6%) and a retrofemoral channel (RFC) in 22 limbs of 19 patients (8%). A PSV anastomosed with the popliteal vein in the popliteal fossa, coursed posterior to the adductor magnus muscle, and drained into the deep femoral vein. An RFC anastomosed with the femoral vein at the level of the adductor hiatus, coursed posterior to the femoral shaft, and drained into the deep femoral vein. PSVs and RFCs were of similar size or larger than adjacent femoropopliteal veins in 50% (12 of 24) and 22% of limbs (4 of 22), respectively. Anastomotic channels connecting a femoropopliteal vein to a deep femoral vein are not a rare variation and may have an important role in collateral venous drainage of the lower extremities.

The Significance of Doppler Ultrasound in the Causes of Varicose Veins

Varicose veins could be clinically diagnosed with visual inspection but the use of Doppler ultrasound (US) in varicose veins is to identify the cause of varicose veins. Need for an extensive systematic review is therefore felt to itemize different causes of varicose veins. Relevant literature was searched and systematic analysis was performed with the aim to show the significance of US in the diagnosis of various causes of varicose veins. Various causes can be diagnosed with color and spectral Doppler US which can be usual causes and unusual causes as well including neovascularization, chronic venous ulceration, obesity, incompetency of the perforating veins, deep vein thrombosis, saphenofemoral junction incompetence, recurrence of the varicose veins after surgical treatment, vulvoperineal varicosities, intraosceous perforating vein incompetence, round ligament varicosity, persistent sciatic vein incompetence, congenital venous malformation and Klippel– Trenaunay syndrome, portosystemic collateral–related varicose veins, and pelvic congestion syndrome. It is concluded that duplex ultrasonography plays an important role in the diagnosis of the various causes of varicose veins.

Case Series of Isolated Primary Persistent Sciatic Vein

Our study aimed to present a short series on the persistent sciatic vein, a rare venous variation, without Klippel-Trenaunay-Weber syndrome and to review the anatomical consideration of deep venous systems. Four cases of lower-type persistent sciatic vein were found. A combination of May-Thurner syndrome and persistent sciatic vein was found in 2 cases. Non-hypoplastic femoral veins, normal and duplicated, were found in 3 cases. This study concluded that in this persistent sciatic vein, the associated non-hypoplastic femoral vein is not uncommon, and care must be taken about this condition during ultrasonographic examination. Unusual causes of chronic venous insufficiency and other venous anomalies should not be overlooked.

The persistent embryonic vein in Klippel–Trenaunay syndrome

Klippel-Trenaunay syndrome (KTS) is a congenital malformation syndrome with prominent vascular anomalies. A persistent embryonic vein (PEV) may be located on the affected leg(s) of patients with KTS. Our understanding of PEVs of the legs is limited and their nomenclature is confusing. The objective of this study was to obtain further insight in the prevalence, nomenclature and etiology of PEVs of the legs in KTS and to propose a standardized description of anomalous leg veins in KTS. We investigated 70 KTS patients for the presence of PEVs (lateral marginal vein, LMV) of the legs by duplex ultrasonography. We performed histopathological analysis of a surgically excised PEV (LMV) of a typical KTS patient, and we conducted an extensive literature study. Duplex ultrasonography showed LMVs in 12/70 (17.1%) patients. The terms used to describe PEVs in the leg are quite variable, while indicating only two types: lateral marginal vein (LMV) and persistent sciatic vein (PSV). The histology of the excised LMV showed remarkable similarity with that of varicose veins found in the general population. In conclusion, the prevalence of LMVs in our KTS cohort is 17.1%. Two PEVs can be found in the legs and we propose nomenclature based on anatomical criteria, thereby using only the terms persistent lateral marginal vein and persistent sciatic vein, combined with the patency of the deep venous system. We hypothesize that PEVs are most likely caused by a genetic defect leading to abnormal venous pattern formation, which is further supported by our histopathological findings.

Bilateral persistent sciatic vein: report of a case with developmental, histological and clinical aspects

Bilateral large variant veins were encountered in the lower extremity. It was aimed to identify the structural characteristics of this rare case and then, regarding the structural features, to overview its formation process and denomination. During the routine dissection of a 93-year-old male cadaver, bilateral large variant veins were found at the thigh. Valves of the veins were examined and evaluated together with the vascular wall histology. The variant vein was loosely attached to the sciatic nerve by fibrous tissue and had anastomoses with the popliteal vein in the popliteal fossa on each side. The popliteal veins were hypoplastic on both sides. The right variant vein was passing through the fibers of the adductor magnus muscle 56.2 mm above the adductor hiatus, which corresponds to the third perforating branch of deep femoral vein. The left one was turning to the front over the adductor magnus muscle, at the lower border of quadratus femoris muscle. The left variant vein was corresponding to the descending branch of the medial circumflex femoral vein. Both variant veins had one incomplete and three well-developed valves. In accordance with the findings, the variant vein was concluded to be an embryonic remnant, rather than an acquired one subsequent to any obstruction of the femoral vein. Regarding their connection with the popliteal vein but not with the internal iliac vein, both variant veins were denominated as "lower type persistent sciatic vein". Such a variation would be important with respect to the risk of complication during popliteal sciatic nerve blockade.

Abstract No. 387 - Importance of early closure of the marginal venous system in Klippel-Trenauny and CLOVES syndromes: anatomical and technical considerations

Purpose To describe i.various configurations of the marginal venous system (MVS) in Klippel-Trenauny (KTS) and CLOVES syndromes, ii.the importance of early intervention and iii.report technical considerations. Materials and Methods Patients with KTS and CLOVES underwent venous mapping using direct and diversion venographyfollowed by embolization of anomalous veins. Results In KTS, a persistent sciatic vein was the most consistent and largest part of the MVS. Networks of veins, multiple perforators and communicators were common. In CLOVES, the leg marginal veins communicated with a truncal vein draining into the axillary/subclavian vein. Embolization and endovenous laser caudal to the communication with the iliac veins were performed. Use of “stopper wire/needle,” coil scaffolding or anchoring techniques, pull-back glue, Amplatzer obstructive device, and various combinations were utilized. Prior to implementing this approach, several patients had pulmonary embolism (1 fatality). Conclusion The marginal venous systems in KTS and CLOVES syndromes should be mapped and closed early in life.

Variations in popliteal fossa venous anatomy: implications for diagnosis of deep-vein thrombosis

To retrospectively review the bilateral venous system within the popliteal fossa to evaluate the types of variations and their frequency seen in venous anatomy. During routine dissection of formalin-fixed cadavers, a retrospective review of 32 bilateral (64 limbs) lower limbs obtained from adult donors was performed. Deep veins present in the popliteal fossa were evaluated according to predetermined criteria for the presence of duplication of vessels and interindividual variations in venous anatomy. More than one deep venous vessel was seen in the popliteal fossa in 20 (31.3%) of 64 limbs. In 12 (18.7%) cases there was a high (just below the level of the adductor hiatus) origin of the popliteal vein: from 2 tributaries in 10 (15.6%) and 3 tributaries in 2 (3.1%). In 5 (7.8%) cases true duplicated popliteal veins were observed. There were also 3 (4.7%) cases, including one bilateral, of persistent sciatic vein. Variations in popliteal fossa venous anatomy are common and have important implications for the diagnosis of deep vein thrombosis.

A Case of Sciatic Arterio-venous Malformation

A persistent sciatic artery is a rare congenital anomaly. On the other hand, a persistent sciatic vein is frequently associated with Klippel–Trenaunay syndrome. However, co-existence of both conditions is extremely rare. An 84-year-old woman was referred to our department for swelling of the unilateral lower extremity. Her internal iliac artery angiogram revealed persistence of both sciatic artery and dilated meandered sciatic vein. Furthermore, the sciatic artery connected with the dilated meandered sciatic vein directly through ‘nidus’ without a capillary connection. This is the first case of sciatic arterio-venous malformation.

Persistência da veia ciática

CONTEXTO: Durante um período da vida embrionária, a veia ciática é a principal coletora do membro inferior. Na embriogênese vascular, há diferenciação dos angioblastos em um plexo vascular primitivo, com posterior remodelagem e expansão. Consequentemente, durante esse processo, podem ocorrer anomalias. Quando ocorre persistência da veia ciática, esta pode se comunicar com a veia safena parva ou com a veia poplítea durante seu percurso, anastomosando-se com a veia perfurante superior e com a veia circunflexa medial do fêmur. OBJETIVO: Relatar o caso da persistência bilateral de veia ciática nos membros inferiores, comparando à literatura. MÉTODOS: Foram dissecados 32 membros inferiores de 16 cadáveres formolizados no Laboratório de Anatomia pela Disciplina de Anatomia Topográfica da Faculdade de Medicina da Universidade de Santo Amaro (Unisa), durante 2006 e 2007, observando-se em 2 membros inferiores de um único cadáver, a presença de veia ciática. RESULTADOS: No membro inferior esquerdo de um cadáver que apresentou a anomalia bilateralmente, a veia media 37 cm, tinha origem na região da veia poplítea, acompanhava o nervo ciático, perfurava o músculo adutor magno e desembocava na veia femoral profunda. No membro inferior direito, ela media 36 cm, originava-se recebendo as veias do compartimento tibial anterior, acompanhava o nervo ciático, perfurava o músculo adutor magno e desembocava na veia ilíaca interna. CONCLUSÃO: As variações anatômicas do sistema venoso do membro inferior são as mais prevalentes. A persistência da veia ciática pode causar insuficiência venosa crônica no membro inferior e, dessa forma, deve ser investigada para uma melhor conduta clínica ou cirúrgica.

A case of persistent sciatic artery aneurysm accompanied by a persistent sciatic vein.

A persistent sciatic artery is a rare anomaly. On the other hand, a persistent sciatic vein is frequently associated with Klippel-Trenaunay syndrome. In a 71-year-old female with a complete-type persistent sciatic artery aneurysm, we performed aneurysmectomy and right femoropopliteal bypass surgery. The right popliteal vein drained into the femoral vein via a lower-type persistent sciatic vein and the deep femoral vein. The superficial femoral artery and vein were hypoplastic. Since only 4 cases of a coexisting persistent sciatic artery and vein have been reported, we report this extremely rare case.

Unusual Causes of Varicose Veins in the Lower Extremities: CT Venographic and Doppler US Findings

There are various causes of varicose veins in the lower extremities. Among the causes are venous insufficiency of the saphenofemoral junction, saphenopopliteal junction, or usual perforating veins. Traditionally, Doppler ultrasonography (US) has been used for evaluation of varicose veins. Sometimes, varicose veins arise from an unexpected anatomic source; in these cases, computed tomographic (CT) venography can provide an overview of the varicose veins. Doppler US with complementary CT venography is useful for determining the precise cause of varicose veins. Between November 2003 and March 2008, the authors evaluated 1350 cases of varicose veins in the lower extremities with both CT venography and Doppler US. The varicose veins were classified according to their causes; unusual causes were studied and included vulvoperineal varicosity, intraosseous perforating vein incompetence, round ligament varicosity, persistent sciatic vein incompetence, Klippel-Trenaunay syndrome, and portosystemic collateral pathways. Radiologists should be familiar with the complete range of primary causes of varicose veins in the lower extremities and with their radiologic manifestations and should recognize the complementary role of CT venography in their evaluation.

Veins along the course of the sciatic nerve

To describe the anatomic variations, symptomatology, and pathophysiology associated with the sciatic nerve (SN), and report the results after treatment of the incompetent veins. Retrospective analysis of prospectively collected data from patients with signs and symptoms of chronic venous disease that had superficial varicosities associated with incompetent veins along the SN. Patients were evaluated with duplex ultrasound scans. In patients with enlarged veins along the SN, the anatomy of the incompetent veins, their size and association with superficial varicosities, and the severity of insufficiency were analyzed. The symptoms associated with their presence and the treatment results were also noted. Patients were re-evaluated following treatment for recurrence of varicosities and symptoms. We identified 24 limbs in 21 patients with varicosities along the SN and its branches. The duration of signs and symptoms was 4.5 years ranging from 1 to 14. Reflux was detected in 18 veins of the SN, in three persistent sciatic veins and in three veins of the tibial nerve. All limbs with sciatic and tibial nerve veins had varicosities in the lateral and posterior aspect of thigh and calf and were symptomatic. Ten limbs presented with CEAP class 2, 5 with class 3, 2 with class 4, and 1 with class 1. Pain or tingling was reported in 15 limbs, itching in 8, and heaviness in 7. The distribution of pain and tingling was present along the nerves in 19 limbs. One patient had acute thrombosis in a persistent sciatic vein and died from pulmonary embolism. Of the 21 limbs with SN veins, 16 were treated with subfascial vein ligation and phlebectomies. Three patients had sclerotherapy, 1 refused treatment, and 1 had mild symptoms not requiring treatment. Of the 19 treated limbs, in 11 there was relief of their symptoms, 6 had significant improvement, and 2 had no change. Within a year, 4 patients required additional treatment for veins along the same area. Eleven limbs had a follow-up duplex scan 3 to 19 months after their treatment. All limbs showed significant diameter reduction in the nerve veins while mild reflux was present in 3 (4.1 mm vs 2.1 mm, P < .001). Reflux is the most common pathology of the sciatic and tibial nerve veins which produces significant symptoms along the distribution of the nerves. Treatment of the varicosities offers significant relief while recurrence or residual varicosities are easily managed.

Catheter-directed Thrombolysis and Mechanical Thrombectomy of a Thrombosed Persistent Sciatic Vein in a Patient with Klippel-Trénaunay Syndrome

The authors report a case of a thrombosed persistent sciatic vein in a patient with Klippel-Trénaunay syndrome diagnosed at magnetic resonance (MR) venography and its treatment with endovascular interventional techniques.