Type of publication:
Ultrasound; 2020; vol. 28 (no. 2)
Peripheral vascular disease (PVD) affects 13% of the population aged over 50 in the western world and can be divided into two main groups: organic and functional. Other less common causes to include in the differential diagnosis in younger patients are Buerger's disease and anatomical variants such as duplication of the superficial femoral artery and persistent sciatic arteries (PSAs). PVD is a major cause of morbidity and mortality globally. Symptoms vary from cold extremities, intermittent claudication, to acute and critical ischaemia. All of these have a significant financial burden on critical healthcare resources. This case report evaluates the role of ultrasound in the diagnosis of bilateral PSAs. A 16-year-old female was referred by her GP to the vascular clinic presenting with bilateral intermittent claudication. On examination, missing dorsals pedis pulses were noted bilaterally. No previous imaging was available and the patient was referred for a lower limb Doppler ultrasound. Initial ultrasound scanning demonstrated no evidence of diseased vessels causing the patient's pain, but unusual arterial anatomy. Both superficial femoral arteries tapered to the distal thigh, where collaterals were demonstrated. Following the scan a diagnosis of persistent bilateral sciatic arteries was made. Ultrasound, due to its many advantages, is usually the first line imaging investigation to assess the peripheral arteries. In this case ultrasound was able to demonstrate that there was no evidence of any organically diseased vessels, but an anatomical variant causing the patient's symptoms. However, it was unable to demonstrate the overall view of the lower limb vasculature, the origin of the PSA, or provide all information to classify the sub type in view of any potential treatment or surgery. Although ultrasound is useful in the diagnosis of PSA, it lacks the ability to assess the whole of the peripheral circulation.