Pulseless Right Groin… Bounding Distal Pulses

Unusual anatomic variants are rare and can sometimes mimic atherosclerotic peripheral vascular disease. In the case described, physical examination revealed a pulseless right groin yet palpable dorsalis pedis and posterior tibial pulses. During peripheral angiography, numerous attempts at gaining right common femoral arterial access were unsuccessful. A persistent sciatic artery was identified.

Persistence of the embryonic sciatic or axial artery is a rare but clinically important anomaly.¹ It is essentially a continuation of the internal iliac artery. In the adult, the popliteal and peroneal arteries as well as the inferior gluteal arteries are remnants of this embryologic structure.^1,2

Recent angiographic series have shown significant variability as to its prevalence varying from 0.025–0.05%.^3,4 Aneurysm formation occurs in between 15–40% of the cases.³

This vessel follows the course of the inferior gluteal artery and traverses the greater sciatic foramen below the piriformis muscle when entering the thigh. In the thigh, its course may parallel that of the posterior cutaneous nerve or the sciatic nerve. There is a propensity for early atheromatous degeneration, aneurysmal dilation, occlusive thrombosis, or thromboembolism due to repetitive trauma from its anomalous location and a variable course.^1,3

It may be an incidental diagnosis at the time of arteriography, or present as a pulsatile mass in the buttock, or with symptoms of nerve compression.³ The rarest presentation is that of a pulseless groin.³

It is important to keep in mind that hip surgery in the affected patient can be hazardous as inadvertent interruption of the arterial supply to the involved limb can result.³

References

1. Mandell VS, Jaques PF, Delaney DJ, Oberheu V. Persistent sciatic artery: Clinical, embryologic, and angiographic features. Am J Roentgenol 1985;144:245–249.
2. Mayschak DT, Flye MW. Treatment of the persistent sciatic artery. Ann Surg 1984;199:69–74.
3. Bower EB, Smullens SN, Parke WW. Clinical aspects of persistent sciatic artery: Report of two cases and review of the literature. Surgery 81:588–595.

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From the Heart and Vascular Center of Arizona, Banner Good Samaritan Medical Center Interventional Fellowship Program, Phoenix, Arizona.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted February 11, 2011, provisional acceptance given February 18, 2011, final version accepted March 7, 2011.
Address for correspondence: Dr. Ashish Pershad, MD, Heart and Vascular Center of Arizona, Division of Interventional Cardiology, 1331 N. 7th Street, #375, Phoenix, AZ 85006. Email: asper1971@cox.net