Persistent sciatic artery in association with varicosities and limb length discrepancy: an unrecognized entity?

The persistence of the sciatic artery is an unusual occurrence, with an angiographically demonstrated incidence of 0.06%. There have been 71 cases previously reported. We report an additional case in a 14-year-old boy who presented with a chief complaint of unsightly varices. The involved right limb was notably shorter than the uninvolved left lower extremity. Work-up included physical examination, duplex studies, venography, and angiography. Our patient was found to have a patent deep venous anatomy with valvular incompetency associated with complete persistence of the sciatic artery and a foreshortened right leg. He has done well with conservative treatment. The persistence of a sciatic artery has occasionally been associated with other anomalies including Mullerian and left renal agenesis, A-V fistula formation, hypertrophy or hypotrophy, multiple hemangiomata, neurofibromatosis, or anomalies of leg arteries. The literature describes three previous case reports in which patients presented with gross varicosities and were incidentally found to have persistent sciatic arteries as well as limb length discrepancies. Our patient is a fourth example of this syndrome. This pattern of physical attributes has not been previously described as a distinct entity. The association of venous incompetency, limb discrepancies, and persistence of the sciatic artery may be an incidental finding or may represent a related embryologic event. This relationship merits consideration in a young patient presenting with severe venous varicosities.