Veins along the course of the sciatic nerve

Abstract

Objective: To describe the anatomic variations, symptomatology, and pathophysiology associated with the sciatic nerve (SN), and report the results after treatment of the incompetent veins.

Patients and methods: 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.

Results: 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).

Conclusion: 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.