Anomalous intraosseous venous drainage of pretibial varices: case report

Anomalous intraosseous venous drainage causing pretibial varices is a rare and little-known cause of varicose veins in the lower limbs (LL). We report the case of a 49-year-old male patient with chronic pain associated with large pretibial varicose veins and mild edema of the left lower limb, with no skin changes or history of previous treatment. Vascular ultrasound identified a dilatated intraosseous vein of the tibia with reflux draining to an incompetent bone perforating vein and subcutaneous varicose veins. Bone perforating veins must be carefully investigated in the presence of atypical non-saphenous and recurrent varicose veins using vascular ultrasound, which demonstrates the periosteal defect in the tibia and presence of reflux that feeds the pretibial subcutaneous varicosities. Recognizing this rare entity avoids diagnostic errors and is essential for the most appropriate treatment.