LETTERS TO EDITOR Year : 2023  |  Volume : 24  |  Issue : 1  |  Page : 81-82  

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

Vinod Krishnagopal1, Raj Murugan1, Krishnakumar Sharanya2, Raghuraman M Sethuraman1
1 Department of Anaesthesiology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
2 Department of Microbiology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India

Date of Submission03-Nov-2022Date of Decision05-Dec-2022Date of Acceptance02-May-2023Date of Web Publication24-May-2023

Correspondence Address:
prof. Vinod Krishnagopal
Sree Balaji Medical College and Hospital, Chrompet, Chennai - 600 044, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/TheIAForum.TheIAForum_102_22

How to cite this article:
Krishnagopal V, Murugan R, Sharanya K, Sethuraman RM. Is it popliteal artery? Is it popliteal vein? No it is persistent sciatic vein. Indian Anaesth Forum 2023;24:81-2
How to cite this URL:
Krishnagopal V, Murugan R, Sharanya K, Sethuraman RM. Is it popliteal artery? Is it popliteal vein? No it is persistent sciatic vein. Indian Anaesth Forum [serial online] 2023 [cited 2023 May 27];24:81-2. Available from: http://www.theiaforum.org/text.asp?2023/24/1/81/377545

Sir,

We would like to share our experience about the presence of persistent sciatic vein (PSV) while scanning for the sciatic nerve in the popliteal fossa. We encountered a 65-year-old diabetic patient posted for emergency debridement of the right foot ulcer. The laboratory investigations of the patient revealed elevated blood glucose (378 mg/dl). We planned to take up the patient for surgery under ultrasound-guided popliteal nerve block. She was placed in the prone position and a scout scanning was performed in the right popliteal fossa. The ultrasound examination of the fossa revealed an aberrant vessel between the two components of the popliteal nerve below which the popliteal vein and artery were clearly visualized [Figure 1]. The aberrant vessel was compressible and nonpulsatile, probably a vein. We were able to trace the vessel upward up to the back of the upper thigh [Figure 2] and downward till the middle third of the calf. With due precautions not to injure the vessel, the popliteal nerve was blocked under ultrasound guidance with 15 ml of 0.5% ropivacaine. The patient was placed in the supine position and a femoral nerve block was performed under ultrasound guidance with 10 ml of 0.5% ropivacaine. On ultrasound examination, the femoral vasculature appeared normal. The block was adequate and following the completion of the debridement, she recovered from the nerve block without any complications.

Figure 1: Ultrasonogram of the popliteal fossa depicting CP nerve, PT nerve, PSV, PA, popliteal vein (PV) and femur. Turban head appearance (persistent sciatic vein along with the sciatic nerve). PSV: Persistent sciatic vein, PA: Popliteal artery, PV: Popliteal vein, CP: Common peroneal, PT: Posterior tibial

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Figure 2: Ultrasonsogram of the back of thigh showing PSV, sciatic nerve and GM. PSV: Persistent sciatic vein, GM: Gluteus maximus

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The aberrant vein visualized with the sciatic nerve was probably PSV. During embryological development, the vessels of the lower limb are divided into axial (Sciatic vessels) and preaxial (femoral vessels and great saphenous vein).[1] Gradually, the axial system regresses and the preaxial vessels emerge as the main vascular system after birth.[2] Persistence of the axial vasculature after birth results in persistent sciatic vessels. The PSV observed by us would probably belong to complete PSV according to Cherry et al., as it extended along the entire length of the thigh and buttock.[3] PSV is a rare anatomical variant which is seen in 1% of general population and 48.8% in Klippel–Trenaunay syndrome (KTS).[3] Apart from PSV, our patient lacked other features of KTS. A persistent sciatic artery enclosed within the paraneural sheath of the sciatic nerve has been reported in the popliteal fossa.[4]

The presence of PSV is mostly asymptomatic, but it rarely presents with lower limb pain, pulmonary embolism, and arteriovenous malformations.[3] From the anesthetist's point of view, the anatomical variation can result in a higher incidence of vessel injury when blind/nerve locator-guided blocks are attempted. Furthermore, even in an ultrasound-guided approach, aberrant vessels could prevent the spread of local anesthetic resulting in failure as reported for brachial plexus block.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Gillot C. Le prolongement post-axial de la petite veine saphène. Étude anatomique. Considérations fonctionnelles. Intérêt pathologique. Phlébologie 2000;53:295-325.  
    2.Arey LB. Developmental Anatomy. 7th ed. Philadelphia: WB Saunders Company; 1974. p. 357-60.  
    3.Cherry KJ, Gloviczki P, Stanson AW. Persistent sciatic vein: Diagnosis and treatment of a rare condition. J Vasc Surg 1996;23:490-7.  
    4.Ogami-Takamura K, Murata H, Hara T. Persistent sciatic artery within the paraneural sheath of the sciatic nerve at the popliteal fossa. JA Clin Rep 2021;7:74.  
    5.Kinjo S, Frankel A. Failure of supraclavicular block under ultrasound guidance: Clinical relevance of anatomical variation of cervical vessels. J Anesth 2012;26:100-2.  
    
  [Figure 1], [Figure 2]