Persistent Sciatic Artery and Vein with Iliac Vein Fenestration Presenting as Chronic Venous Insufficiency: A Case Report

Persistent sciatic vessels are rare but recognized anatomical variants associated with anomalous mesodermal development. An association between this entity and multiple vascular, visceral, and soft tissue anomalies has been described in the literature. Few reports have described the association of persistent sciatic vessels with lower limb varicosities and limb hypertrophy. Herein, we describe the case of a 24-year-old male who presented with extensive unilateral lower limb varicosities. Diagnostic imaging revealed persistent sciatic vessels with features of chronic venous insufficiency. Further evaluation revealed the coexistence of iliac vein fenestration. The patient underwent endovenous and endovascular management, with improved clinical outcome. In young patients with atypical unilateral varicosities and soft-tissue hypertrophy, comprehensive evaluation of the pelvic venous outflow and deep venous anatomy should precede superficial venous intervention.