Bilateral Sciatic Nerve Compression Due to Abnormal Termination of the Small Saphenous Vein Into the Popliteal Vein: A Rare Mechanism of Pseudoclaudication of the Lower Extremities

Abstract

Claudication in the young population is a rare condition derived from varied neurogenic and vascular conditions. We report a case of bilateral claudication of the lower extremities in a young athlete after intense training. Apart from tenderness to deep palpation of the popliteal fossa, physical and laboratory examinations did not reveal any abnormal findings. According to the patient's symptoms, sciatic nerve entrapment to the popliteal fossa was suspected and bilateral surgical exploration of the sciatic nerve was performed. The sciatic nerve was found to be entrapped before its division to the tibial and common peroneal nerves from the terminal branch of the small saphenous vein (SSV) into the popliteal vein (PV). The terminal section of SSV was subsequently ligated and resected to relieve the pressure on the sciatic nerve. One year after surgery, the patient was able to run long distances as well as sprint and train without any restriction. Rare conditions may lead to pseudoclaudication in young individuals and athletes during exercise. Normal physical and laboratory tests must raise the suspicion of sciatic nerve compression from fibrous bands or abnormal anastomotic veins that may also exist bilaterally. Surgical exploration along with sciatic nerve release remains the only treatment solution when conservative treatment fails to alleviate the symptoms.