Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case report
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 293 - 295

Persistent Axis Vessels Of The Lower Limb - A Rare Anomaly

Komala Nanjundaiah, Sheshgiri Chowdapurkar, Rahe Rajan

1. Corresponding Author, 2. Senior Professor and Head of the Department, Department of Anatomy, 3. Post Graduate Student, Department of Anatomy, M.S. Ramaiah Medical College, Bangalore. Karnataka, 560054, India.

Correspondence Address :
Komala Nanjundaiah,
Associate Professor, Department of Anatomy,
M.S.Ramaiah Medical College,M.S.R.I.T Post,
Bangalore , Karnataka, India - 560054.
Phone: 9480259177, 080-23421593


Introduction: The persistent axis artery is a rare embryological remnant of the axis artery which supplies the limb bud. It develops as a dorsal root of the umbilical artery and supplies the lower limb. It normally involutes when the femoral artery starts developing.

Observation: We encountered a large, incomplete, persistent axis artery during routine dissection in a male cadaver which was aged approximately 70-years. The artery entered the gluteal region through the greater sciatic notch, below the pyriformis muscle. It gave off the inferior gluteal branches, the branches to the hip joint, the biceps femoris muscle, the sciatic nerve and the tibial nerve (high division of the sciatic nerve was noted). Throughout its course, it was accompanied by a vein which anastomosed with the tributaries of the femoral vein.

Conclusion: Such a persistent axis artery is prone for aneurysm, thrombosis and embolism.


Axis artery, Persistent sciatic artery, neurysm.

The persistent axis artery is a rare embryological abnormality. The first description of a persistent axis artery of the lower limb was published by Green in the Lancet in 1832 (1). This anomaly results from the lack of regression of the embryonic axial artery of the developing lower limb bud. The axis artery is a continuation of the internal iliac artery which communicates with the popliteal artery and the tibial arteries distally (2). The femoral artery is the artery of the ventral aspect of the developing limb. Once the femoral artery starts developing, the axis artery involutes, and this is completed by the third week of gestation, leaving behind the branches which supply the gluteus maximus muscle, which is called the inferior gluteal artery (3). The abnormal persistence of this artery can be accompanied by the hypoplastic femoral artery.

The axis artery is also called the sciatic artery or the ischiopopliteal artery. The incidence of the persistent sciatic artery has been estimated to be 0.025% to 0.04% (4). According to the literature, till 2004, only 88 cases of the persistent sciatic artery had been reported (2). The complete persistence of the axis artery is much more common i.e. 80%, than the incomplete persistent axis artery (2). The literature says that 14.3% to 44% of the patients with the persistent axis artery develop aneurysms by 45 years of age, with an equal sex incidence. We are reporting here, a case of a large incomplete axis artery in a male cadaver, which extended to the back of the thigh.

Case Report

During a routine dissection study in the Anatomy Department, MSRMC, Bangalore, we found a bilateral incomplete persistent axis artery in an adult male formalin preserved cadaver, which was approximately aged 70-years. The artery was as a continuation of the internal iliac artery. It enCasenervetered the gluteal region through the greater sciatic foramen, below the pyriformis muscle, on both the sides. The artery was 4mm thick on both the sides at the point of entry and it gave off the inferiorgluteal artery. Then the artery coursed distally in the thigh for 15 cm on the left and 22cm on the right, giving three branches to the hip joint, and it ended by giving multiple branches to the biceps femoris muscle. On the left side, one branch was given to the gluteus maximus muscle. (Table/Fig 1). Along its course, few small branches to the sciatic and the tibial nerves (high division of the sciatic nerve was observed) were given off. However, the sciatic artery did not continue distally to communicate with the popliteal or the tibial arteries. The femoral artery was normal in calibre and the popliteal artery was found to be a continuation of the femoral artery.

Throughout its course, the artery was accompanied by a vein, which anastomosed with the femoral perforating vein, at the level of the mid thigh. It received tributaries from the inferior gluteal vein, veins draining biceps femoris and the hip joint. Associated variations like the presence of the right rectus sternalis muscle, a bilateral high division of the sciatic nerve, a bilateral origin of the sural nerve from the common peroneal nerve, the bilateral sural communicating nerve from the tibial nerve and the right sural communicating nerve joining with the sural nerve in the popliteal fossa were noted in the same cadaver, (Table/Fig 2).


During the embryological development, the tip of the limb bud has a terminal arterial plexus which constantly gets renewed in thedistal direction as the limb grows. Later, one main vessel supplies the limb and the terminal plexus is called the axis artery. The axis artery of the lower limb arises from the dorsal root of the umbilical artery and courses along the dorsal surface of the thigh, the knee and the leg. The femoral artery courses along the ventral surface (5). (Table/Fig 3).

There have been various reports of the persistent axis artery (1),(2),(3), (4),(6),(7),(8),(9),(10), which may lead to the realisation that the numerous forms of the persistent axis artery correspond to various embryological developments of the lower limb arteries. A male predominance is noted in most of the studies (3). In a majority of cases, the sciatic artery was complete (4).

George Paraskevas et al gave the following classification for the various types of the Persistent axis artery (2) • Type I: A complete axial artery and a normal femoral artery. • Type II: A complete axial artery and an incomplete femoral artery • Type IIa: A superficial femoral artery which does not, however, reach the popliteal artery. • Type IIb: no superficial femoral artery. • Type III: An incomplete axial artery; only the upper half of the artery can be found with a normal femoral network. • Type IV: An incomplete axial artery in which only the lower half can be found, with the co-existence of a normal femoral network. • Type V: A sciatic artery branching from the medial sacral artery, with an existing superficial femoral artery.

The persistent sciatic artery in our cadaver fell into type III.

The axis artery can remain asymptomatic. In around 14.3% to 44% cadavers, it undergoes aneurysmal dilatation. The pre-disposing factors for aneurysm are, a congenital hypoplastic vessel wall with reduced elastic elements and exposure of the artery to repeated trauma in the gluteal region. The aneurysm of the persistent axis artery presents as a pulsating mass in the buttock. Arterial insufficiency as a result of thrombosis of the aneurysm or the distal embolization of the mural thrombus from the aneurysm is also a common clinical presentation, and it is associated with a high incidence of limb loss. Other patients may experience sciatica, which is manifested by pain, numbness or motor impairment as a result of compression of the sciatic nerve by the aneurysm at the level of the sciatic notch (6). Failure to recognize a persistent axis artery as the major blood supply to the lower extremity may lead to an incorrect diagnosis of superficial femoral artery occlusive disease and inappropriate surgical revascularization (8). The persistent axis artery can be diagnosed by using Doppler studies, angiography, computed topography or magnetic resonance imaging of the pelvis and the lower extremities. However, magnetic resonance angiography may be considered as the first line imaging modality due to its non-invasiveness and ability to generate 3- dimensional vascular images without using an iodinated contrast (6). The treatment included aneurysmal exclusion and a femoro-popliteal by-pass with an inverted autologous saphenous vein in the case of a complete persistent sciatic artery, or else, ligature or balloon embolization (2),(10). The persistent axis artery has occasionally been associated with other anomalies which include, mullerian and left renal agenesis,arterio-venous fistula formation, multiple haemangiomas, neurofibromatosis or anomalies of the leg arteries. The persistent axis artery may thus be accompanied by a superficial brachial artery, a right retro-oesophageal subclavian artery, accessory renal arteries, a left accessory hepatic artery branching off from the left gastric artery and an intermesenteric arterial anastomosis (2).


The persistent axis artery can undergo aneurysmal dilatation. Arterial insufficiency as a result of thrombosis of the aneurysm or distal embolization of the mural thrombus from the aneurysm is a common clinical presentation, and it is associated with a high incidence of limb loss. Arterial variations are also important for clinicians for angiographic interpretation and surgical procedures. The abnormal arteries are vulnerable in both orthopaedic and vascular surgeries. Reports of such variations will enhance the anatomical knowledge and remove the ambiguity during diagnostic interventions and surgical procedures.


Green PH. A new variety of the femoral artery. Lancet, 1832; 1:730-31.
Paraskevas G, Papaziogas B, et al, The persistence of the sciatic artery. Folia Morphol, 2004; 63(4): 515-18.
Aziz ME, Yusof NR N, et al, Bilateral persistent sciatic arteries with a unilateral complicating aneurysm. Singapore Med J, 2005; 46(8): 426-28.
David Mayschak T, Flye W. Treatment of the persistent sciatic artery. Ann Surgery, 1984; 199(1): 69-74.
Williams Peter L, Gray’s Anatomy, 39th edition, Embryology and Development, Patricia Collins. Churchill Livingstone, Elsevier. London, UK. 2000; 320.
Sendel T, Yilmaz S, et al. The persistent sciatic artery: radiologic features and patient management. Saudi Med J, 2006; 27(5): 721-24.
Valerie Mandell S, Paul Jaques F, et al. The persistent sciatic artery: clinical, embryologic, and angiographic features. AJR, 1985; 144: 245-49.
Brantley Shelby K, Rigdon Edward E, et al. The persistent sciatic artery: embryology, pathology and treatment. J Vasc Surg, 1993 Aug; 18(2): 242-48.
Jayanthi V, Shashanka MJ. The persistent sciatic artery: clinical and embryologic importance- a case report. Anatomica Karnataka Dec 2011; 5 (3): 57-60.
Mohammad Abdullah DO, et al, Persistent sciatic artery aneurysm presenting with limb threatening ischemia- a case report and review. Vascular Disease management 2010; 7:E82- E85.

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DOI: JCDR/2012/3915:2005

Date Of Submission: Jan 05, 2012
Date Of Peer Review: Jan 27, 2012
Date Of Acceptance: Feb 23, 2012
Date Of Publishing: Apr 15, 2012

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