Aberrant Anatomy: You See What You Look For and You Look For What You Know

In this issue of the Journal of Invasive Cardiology, Pershad et al describe a case of a persistent sciatic artery.1 This is of course a well-described anomaly with an incidence of 0.025–0.05%.  It is commonly associated with aneurysm formation and can present operative challenges during orthopedic surgery. The authors should be congratulated on their recognition of this arterial anomaly.

To name just a few, other vascular anomalies include the aberrant right subclavian artery (“arteria lusioria”), a bovine aortic arch, the vertebral artery arising directly from the aorta, the replaced hepatic artery, the origin of the SMA below the renal arteries, accessory renal arteries, and the high take-off of the anterior tibial artery. Aberrant radial artery from the axillary artery equals the potential for injury with radial interventions. Venous anomalies are well described as well.

So, why should such a case be published if it is well described? This case highlights the anatomic variations which confront us as imaging specialists. Encountering such anomalies is not unique to the invasive specialties and is more frequently seen by non-invasive imaging. Although easily seen on computed tomography angiography or magnetic resonance angiography, duplex may be more challenging and diagnosis based on physical examination or history is very difficult. However, one must emphasize that without prior knowledge of these anomalies, one will never be able to recognize them. During my radiology rotation in medical school, the professor would say, “You see what you look for and you look for what you know.” As clinicians treating vascular disease, we must be constantly expanding our knowledge and gaining an appreciation for variants. If we don’t, we will never “see them.” My father, Dr. Raymond Dieter Jr, a cardiothoracic and vascular surgeon, has always taught me to “look-see” — in other words, one must not just look, but be very critical in one’s observations and actually see what one is looking at. This case emphasizes the importance of knowledge of anatomy of peripheral vascular structures, especially for invasive vascular specialists.

References

1. Pershad A, Srivastava A, Dima C. Pulseless right groin…Bounding distal pulses. J Invasive Cardiol 2011;23:345–346.

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¹Dr. Dieter is an Associate Professor, Vascular & Endovascular Medicine, Interventional Cardiology, Loyola University Medical Center, Director of Vascular Medicine and Peripheral Vascular Interventions, Medical Director, Cardiovascular Collaborative, Associate Chief of Cardiology at Hines, VA Hospital. ²Dr. Nanjundappa is an Associate Professor of Medicine and General Surgery at West Virginia University School of Medicine in Charleston, West Virginia.
The authors report no conflicts of interest or financial relationships regarding the content herein.
Address for correspondence: Robert S. Dieter, MD, RVT, Assistant Professor, Department of Medicine, Loyola University, Stritch School of Medicine and Hines VA, 2160 S. First Avenue, Bldg. #110, Rm. #6289, Maywood IL 60153. Email: rdieter@lumc.edu