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Singh BM, Galimova I, Singh TM. Double Major for Slashing: Management of Blunt Popliteal Fossa Trauma in Ice Hockey in the Setting of Popliteal Artery Entrapment Syndrome. Clin J Sport Med 2022; 32:e543-e545. [PMID: 34516434 PMCID: PMC9415213 DOI: 10.1097/jsm.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/28/2021] [Indexed: 02/04/2023]
Abstract
ABSTRACT Popliteal artery entrapment syndrome (PAES) is a rare condition that produces calf claudication in young patients. It is most commonly a result of aberrant anatomy of the popliteal fossa. If undiagnosed, PAES can lead to acute ischemia and a threatened limb as a result of complete arterial occlusion or embolism. Ice hockey is a contact sport, and slashing on the covered legs is well described as a strategy and contact point. We present a unique case that highlights a blunt popliteal artery injury in a young player with an underlying type 2 PAES. We discuss the initial diagnosis and endovascular/vascular surgical treatment, followed by the delayed management of the popliteal artery injury. We also provide considerations for popliteal fossa blunt trauma and need for future protection of the popliteal fossa for athletes.
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Affiliation(s)
- Brij M. Singh
- Men's National Team Operations, 10th Brendan Burke Intern, USA Hockey, Plymouth, Michigan; and
| | - Irina Galimova
- Vascular Surgery, Palo Alto Medical Foundation, Mountain View, California
| | - Tej M. Singh
- Vascular Surgery, Palo Alto Medical Foundation, Mountain View, California
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2
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Bradshaw S, Habibollahi P, Soni J, Kolber M, Pillai AK. Popliteal artery entrapment syndrome. Cardiovasc Diagn Ther 2021; 11:1159-1167. [PMID: 34815967 DOI: 10.21037/cdt-20-186] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/29/2020] [Indexed: 12/22/2022]
Abstract
Popliteal artery entrapment syndrome (PAES) is an uncommon cause of lower extremity exertional claudication due to external compression of vascular structures in the popliteal fossa. A developmental anomaly due to an aberrant relationship of the artery with the surrounding myofascial structures contributes to the vascular compromise. PAES presents in younger, athletic patients without atherosclerotic risk factors. Typical presentation of unilateral or bilateral, intermittent claudication in the feet and calves specifically after exercise and relieved by rest in a young person should prompt further evaluation. Early diagnosis and intervention is essential for preventing thromboembolic complication and in worst cases limb loss. Initial tests with Ankle Brachial indices or Doppler ultrasound with provocative maneuvers will prompt more definitive cross sectional imaging studies. CTA or MRA also with provocative maneuvers has a high sensitivity and specificity and will clinch the diagnosis. There are six subtypes based on the relationship of the vascular structure with surround myofascial structures. CTA and MRA can characterize the subtypes and guide surgical planning. Catheter directed thrombolysis may be attempted adjunctively to reduce surgical thrombectomy or resolve distal emboli; however, myotendinous decompression with or without vascular repair is the definitive treatment. Long term surgical outcomes are satisfactory when the distal circulation is preserved.
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Affiliation(s)
- Stanley Bradshaw
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peiman Habibollahi
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jayesh Soni
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marcin Kolber
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anil K Pillai
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ramondou P, Hersant J, Bernardeau E, Moumneh T, Feuilloy M, Henni S, Abraham P. Kneeling-induced calf ischemia: a pilot study in apparently healthy European young subjects. Eur J Appl Physiol 2021; 121:3031-3040. [PMID: 34254181 DOI: 10.1007/s00421-021-04764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Many tasks, sports or leisure activities require maximal knee flexion. We hypothesized that this position could result in reduced calf perfusion, in young European subjects. METHODS We quantified calf ischemia resulting from the knee flexion with transcutaneous oxygen pressure (TcpO2) sensors by assessing the decrease from rest of TcpO2 (DROP) defined as limb changes minus chest changes. A minimal DROP (DROPm) <-15 mmHg defines the presence of ischemia. From the crawling position, participants kneeled for 3 min while bending as in prostration/prayer position (P). Thirty-five participants repeated this maneuver a second time, while 7 participants were also required to sit on their heels with the torso in the vertical position to attain knee flexion without significant groin flexion (S). RESULT In 41 healthy young volunteers (30 males), 25 [20-31] years old, 37 patients showed a DROPm < -15 mmHg from "R" to "P" in one (n = 4) or both (n = 33) calves (90.2%; 95% CI 76.9-97.3). After backward regression of the DROPm, there was no significant association with side, body weight of systolic blood pressure. However, age was strongly associated with DROPm (OR 5.34 [2.45-8.69]) so that DROPm was significantly higher in older, with a correlation ρ = 0.31 (p = 0.003). CONCLUSION Kneeling dramatically reduces calf perfusion, likely through popliteal artery kinking, possibly through muscle crushing. Eastern lifestyle includes routine flexed position since childhood. Whether or not such a chronic training reduces the risk of kneeling-induced ischemia in adults is unknown to date.
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Affiliation(s)
- Pierre Ramondou
- Vascular Medicine, University Hospital, Angers, France.,Institut MITOVASC, UMR CNRS 6015 UMR INSERM 1083, Université d'Angers, Angers, France
| | | | - Elise Bernardeau
- Sports and Exercise Medicine and Vascular Medicine, University Hospital, Angers, France
| | - Thomas Moumneh
- Vascular Medicine, University Hospital, Angers, France.,Institut MITOVASC, UMR CNRS 6015 UMR INSERM 1083, Université d'Angers, Angers, France.,Département de Médecine d'Urgence, CHU d'Angers, Angers, France
| | - Mathieu Feuilloy
- School of Electronics (ESEO), Angers, France.,UMR CNRS 6613 LAUM, Le Mans, France
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France.,Institut MITOVASC, UMR CNRS 6015 UMR INSERM 1083, Université d'Angers, Angers, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital, Angers, France. .,Institut MITOVASC, UMR CNRS 6015 UMR INSERM 1083, Université d'Angers, Angers, France. .,Sports and Exercise Medicine and Vascular Medicine, University Hospital, Angers, France.
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4
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Jayaraj A, Gloviczki P, Duncan AA, Kalra M, Oderich GS, DeMartino RR, Bower TC. Popliteal entrapment syndrome-The case for a new classification. Vascular 2021; 30:285-291. [PMID: 33866882 DOI: 10.1177/17085381211007612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess the ability of the current classification system for popliteal entrapment syndrome to accurately capture all patients, and if not, to design an all-inclusive new classification. METHODS Retrospective review of all interventions performed for popliteal entrapment syndrome between 1994 and 2013 at our institution was performed. Preoperative imaging and intraoperative findings were used to establish the compressive morphology of popliteal entrapment syndrome. Patients were categorized, when possible, into six types of the current classification system (Rich classification, modified by Levien) and into seven types of a new classification. RESULTS Sixty-seven limbs of 49 patients were operated on for unilateral (31) or bilateral (18) popliteal entrapment syndrome. The current classification system captured the anatomy of only 43 (64%) of 67 limbs with popliteal entrapment syndrome. Compressive morphologies without a defined class included aberrant insertion of the lateral head of gastrocnemius muscle, muscle slip originating from the lateral head of gastrocnemius or hamstrings, hypertrophied hamstring muscle, abnormal fibrous bands, perivascular connective tissue, and prominent lateral femoral condyle. The new classification captured 100% of the limbs with popliteal entrapment syndrome. CONCLUSIONS Current classification of popliteal entrapment syndrome is inadequate as more than one-third of the cases reviewed fell outside of the standard classification system. Consideration of a more inclusive new anatomic classification system is warranted.
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Affiliation(s)
- Arjun Jayaraj
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Audra A Duncan
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Thomas C Bower
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Huang WC, Tsai MM, Chang TL, Lai CL. Popliteal Artery Entrapment Syndrome in a Young Baseball Pitcher: A Case Report. J Pain Res 2020; 13:777-781. [PMID: 32368131 PMCID: PMC7185988 DOI: 10.2147/jpr.s236306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/19/2020] [Indexed: 11/23/2022] Open
Abstract
Background Popliteal artery entrapment syndrome (PAES) is a rare disease in young adults and is thought to be under-diagnosed, and its main cause is the abnormal structure between the popliteal artery and gastrocnemius muscle. The patients experience symptoms after the blood vessels are compressed. Failure to diagnose and treat PAES can cause serious sequelae. Case A 19-year-old male baseball pitcher with PAES type 2 suffered from left calf muscle tension and foot numbness and was mis-diagnosed for nearly a year. Finally, the lesion was detected by ultrasonography and confirmed by magnetic resonance imaging. After surgical intervention, he quickly returned to sport. Discussion/Conclusion PAES has 6 types. Type 2 (25%) and type 3 (30%) are the most common. Patients with this syndrome suffer from aching pain, numbness, and cramping in the calf area when they exercise. It is necessary to include this disease in differential diagnosis to implement early diagnosis, and ultrasonography is a more cheap and simple method for early detection.
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Affiliation(s)
- Wei-Ching Huang
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Ming-Miau Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Tzu-Ling Chang
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chung-Liang Lai
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
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6
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Chronic Lower Leg Pain in Athletes: Overview of Presentation and Management. HSS J 2020; 16:86-100. [PMID: 32015745 PMCID: PMC6973789 DOI: 10.1007/s11420-019-09669-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Athletes with chronic lower leg pain present a diagnostic challenge for clinicians due to the differential diagnoses that must be considered. PURPOSE/QUESTIONS We aimed to review the literature for studies on the diagnosis and management of chronic lower leg pain in athletes. METHODS A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The PubMed, Scopus, and Cochrane library databases were searched, and articles that examined chronic lower leg pain in athletes were considered for review. Two independent reviewers conducted the search utilizing pertinent Boolean operations. RESULTS Following two independent database searches, 275 articles were considered for initial review. After the inclusion and exclusion criteria were applied, 88 were included in the final review. These studies show that the most common causes of lower leg pain in athletes include medial tibial stress syndrome, chronic exertional compartment syndrome, tibial stress fractures, nerve entrapments, lower leg tendinopathies, and popliteal artery entrapment syndrome. Less frequently encountered causes include saphenous nerve entrapment and tendinopathy of the popliteus. Conservative management is the mainstay of care for the majority of cases of chronic lower leg pain; however, surgical intervention may be necessary. CONCLUSIONS Multiple conditions may result in lower leg pain in athletes. A focused clinical history and physical examination supplemented with appropriate imaging studies can guide clinicians in diagnosis and management. We provide a table to aid in the differential diagnosis of chronic leg pain in the athlete.
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Song X, Zhou M, Tang L, Liu Z, Zheng Y, Chen Y. Popliteal artery entrapment syndrome as a cause of failed treatment of a false popliteal aneurysm. J Int Med Res 2019; 48:300060519868628. [PMID: 31448662 PMCID: PMC7574365 DOI: 10.1177/0300060519868628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Popliteal artery entrapment syndrome is a rare cause of popliteal artery
aneurysms. We present a rare case of a false aneurysm associated with
popliteal artery entrapment syndrome that was treated with endovascular
repair that initially failed. Case report A 60-year-old man with a false popliteal artery aneurysm and limb ischemia
was treated with endovascular repair that initially failed. The popliteal
artery was suspected to be compressed by an abnormal bundle of muscle
according to the findings of a subsequent magnetic resonance imaging
examination. The popliteal artery was entrapped by an abnormal slip of the
medial gastrocnemius muscle head. Parts of the popliteus muscle were also
involved in compression of the popliteal artery, which was not distinguished
on preoperative magnetic resonance imaging. Thus, the patient was diagnosed
with a mixed type of popliteal artery entrapment syndrome (types III and
IV). Bypass with the small saphenous vein was then performed. The patient
was finally discharged with satisfactory relief of his ischemic
symptoms. Conclusion Popliteal artery entrapment syndrome should be considered before treating
popliteal artery aneurysms, especially atypical pseudoaneurysms without
significant atherosclerosis. Definitive surgical management rather than
endoluminal treatment is required unless combined with open decompressive
surgery to correct the musculotendinous anatomy.
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Affiliation(s)
- Xitao Song
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mengxin Zhou
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Tang
- Department of Vascular Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Zhili Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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8
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Successful endovascular treatment of popliteal artery entrapment syndrome: a case report with 3-years follow-up. J Thromb Thrombolysis 2017; 44:112-117. [PMID: 28497223 DOI: 10.1007/s11239-017-1505-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Popliteal artery entrapment syndrome (PAES) is a rare cause of lower extremity arterial ischemia, especially in elder patients. At present, the role of the endovascular technique for PAES is still mainly auxiliary, there is no successful case treated successfully by endovascular treatment without open surgery, and also the long-term follow-up after endovascular treatment are lacking. We successfully treated a 51-year-old man with pale, cold right foot by endovascular therapy only, including percutaneous transluminal angioplasty and catheter directed thrombolysis. After endovascular treatment, the ABI of the right leg increased from 0.41 to 0.85, and the patient return to his life without claudication. Computed tomography angiography demonstrated the diagnosis of PAES. The 3-year follow-up showed a good clinical outcome, suggesting that for certain type of PAES, endovascular treatment alone may achieve good results. However, this result still requires confirmation in a large-sample study.
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9
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Walensi M, Berg C, Piotrowski M, Brock FE, Hoffmann JN. Adductor Canal Compression Syndrome in a 46-Year-Old Female Patient Leading to Acute External Iliac, Femoral, and Popliteal Artery Thrombosis and Critical Ischemia: A Case Report. Ann Vasc Surg 2016; 38:319.e11-319.e15. [PMID: 27554690 DOI: 10.1016/j.avsg.2016.05.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/27/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022]
Abstract
The adductor canal compression syndrome is one of the several rare nontraumatic causes of arterial occlusions, which may lead to critical ischemia of the lower limb. We report the case of a 46-year-old athletic woman, who suffered from activity-related paresthesia and sharp pain in the left upper and lower leg for 2 years. Imaging and neurological investigations of the spine remained without pathological findings that would explain the patient's complaints. Actually, the patient presented with symptoms of critical lower limb ischemia. Magnetic resonance angiography revealed nearly complete thrombotic occlusion of the common femoral artery and the arteries of the lower leg. An emergency surgery was performed, revealing an external compression of the superficial femoral artery in the adductor canal. Subsequently, a thrombectomy was performed and a venous bypass graft was installed. No postoperative complications occurred, the patient recovered well and could return to her activities of daily living about 3 weeks after the surgery. The adductor canal compression syndrome results from a local anomalous musculotendinous band or hypertrophic musculature surrounding the passing structures. It mainly occurs in athletes exposed to repetitive stress, especially runners and skiers, and may lead to thrombosis followed by critical lower extremity ischemia. The lack of obvious symptoms during routine physical examination often impedes rapid diagnosis and timely therapy. Considering the high thrombotic risk, attention should be paid to this rare cause of lower limb pain to prevent the patient from critical lower extremity ischemia and potential limb loss due to consecutive acute thrombotic occlusions.
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Affiliation(s)
- Mikolaj Walensi
- Clinical Trial Unit, Hirslanden Private Hospital Group, Klinik Hirslanden, Zurich, Switzerland.
| | - Christian Berg
- Division of Angiology, Endocrinology and Diabetology, Department of Internal Medicine, Hospital of Mettmann, Mettmann, Germany
| | - Michael Piotrowski
- Department of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Franz-Eduard Brock
- Division of Angiology, Department of Internal Medicine, University Hospital of Essen, Essen, Germany
| | - Johannes N Hoffmann
- Division of Vascular Surgery, Department of Surgery, University Hospital of Essen, Essen, Germany
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10
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Uncommon Diseases of The Popliteal Artery: A Pictorial Review. Insights Imaging 2016; 7:679-88. [PMID: 27525419 PMCID: PMC5028342 DOI: 10.1007/s13244-016-0513-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/06/2016] [Accepted: 07/19/2016] [Indexed: 12/19/2022] Open
Abstract
Uncommon diseases of the popliteal artery include cystic adventitial disease, popliteal artery entrapment syndrome (PAES) and popliteal artery aneurysm (PAA). Because all of these conditions may present with pain or intermittent claudication, imaging is crucial for differentiating them and directing management. Delayed diagnosis can lead to major complications, including acute limb ischemia. Our aim is to provide an illustrative overview of these conditions in order to make radiologists aware of them and avoid misdiagnosis for timely appropriate management. Teaching Points • Cystic adventitial disease diagnosis is based on evidence of cysts within artery walls. • A variety of anatomic variations may result in PAES. • PAES may be bilateral. • PAA is most commonly encountered in men. • Acute complications of PAA include acute thrombosis and distal embolization.
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11
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Bensaid MB, Ouldsalek E, Cheysson PE, Kechabtia K, Feito B, Davaine JM. An Aneurysmal Degeneration of Venous Bypass for Popliteal Artery Entrapment Syndrome. Ann Vasc Surg 2016; 36:296.e1-296.e4. [PMID: 27427342 DOI: 10.1016/j.avsg.2016.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/21/2016] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
Abstract
Popliteal artery entrapment syndrome (PAES) is a rare condition, and its long-term outcome after surgical treatment is scarcely reported. We report the case of an aneurysmal degeneration of a venous bypass performed to treat PAES, which ultimately led to rupture. Hybrid treatment combining embolization and surgery resulted in favorable outcome. This case emphasizes the need for long-term follow-up after surgical treatment of PAES.
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Affiliation(s)
- Mohamed B Bensaid
- Vascular, Endovascular and Thoracic Surgery Department, Centre Hospitalier René Dubos, Pontoise, France
| | - Elhadj Ouldsalek
- Vascular, Endovascular and Thoracic Surgery Department, Centre Hospitalier René Dubos, Pontoise, France
| | - Pierre E Cheysson
- Vascular, Endovascular and Thoracic Surgery Department, Centre Hospitalier René Dubos, Pontoise, France
| | - Kamel Kechabtia
- Vascular and Interventional Radiology Department, Centre Hospitalier René Dubos, Pontoise, France
| | - Boris Feito
- Vascular, Endovascular and Thoracic Surgery Department, Centre Hospitalier René Dubos, Pontoise, France
| | - Jean-Michel Davaine
- Vascular, Endovascular and Thoracic Surgery Department, Centre Hospitalier René Dubos, Pontoise, France; Vascular Surgery Department, University Hospital of La Pitié Salpêtrière, Paris, France.
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12
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A rare muscular variation in the superficial region of the popliteal fossa. Surg Radiol Anat 2013; 36:721-3. [DOI: 10.1007/s00276-013-1224-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 10/17/2013] [Indexed: 10/26/2022]
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13
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Abstract
OBJECTIVE The purpose of this review is to illustrate various applications of gadofosveset trisodium in evaluating abdominal and peripheral vascular disease. The basic properties, technical considerations, and clinical and potential future applications of gadofosveset are described. CONCLUSION Gadofosveset trisodium facilitates comprehensive high-resolution arterial and venous MR angiography. Because of its prolonged intravascular residence time, gadofosveset trisodium is particularly useful for evaluating venous, dynamic, and functional vascular disease with a single low-dose contrast injection.
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14
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Altintas Ü, Helgstrand UVJ, Hansen MA, Stentzer KF, Schroeder TV, Eiberg JP. Popliteal Artery Entrapment Syndrome. Vasc Endovascular Surg 2013; 47:513-8. [DOI: 10.1177/1538574413495466] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The purpose of this study was to report our experience with popliteal artery entrapment syndrome (PAES) with special emphasis on the applicability of duplex ultrasound scanning (DUS) when diagnosing PAES. In addition to examining the correlation between DUS and intraoperative findings in symptomatic limbs, the ultrasonic effect of plantar flexion in healthy volunteers were also evaluated. Methods: During a 12-month period, 11 symptomatic limbs in 8 patients with a mean age of 29 years were referred with suspected PAES and enrolled consecutively. The popliteal artery was studied preoperatively with DUS in rest and during active plantar flexion. The popliteal artery was explored in all symptomatic limbs, and the intraoperative findings served as gold standard. Additionally, the popliteal arteries in 11 healthy volunteers (22 limbs) were evaluated with DUS during rest and plantar flexion. Results: Intraoperative findings confirmed PAES in all 11 symptomatic limbs in accordance with the preoperative DUS examination. Surgical release of the popliteal artery was performed in 11 limbs. At a median follow-up of 15 months, all 11 limbs were free of ischemic symptoms and regained normalized popliteal flow on DUS. In the 22 symptom-free limbs, DUS showed normal popliteal flow during both rest and plantar flexion. Conclusions: In this series of patients with surgically confirmed PAES, we found preoperative DUS to have perfect agreement with the intraoperative findings in diagnosing PAES. The applicability of the method seems to be emphasized by the restoration of popliteal flow and relief of arterial insufficiency after surgical release in all patients, and by the fact, that none of the healthy volunteers were able to compress the popliteal artery during plantar flexion.
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Affiliation(s)
- Ümit Altintas
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Marc A. Hansen
- Department of Cardiovascular Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Kim F. Stentzer
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Torben V. Schroeder
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Jonas P. Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
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15
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Simsek E, Bugra O, Teber MA, Katircioglu SF. What should be the first treatment of popliteal artery entrapment syndrome. Ann Thorac Cardiovasc Surg 2012; 20:169-72. [PMID: 23269271 DOI: 10.5761/atcs.cr.12.02007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Popliteal artery entrapment syndrome (PAES) is the rare congenital abnormality. It is a threat to the lower extremity due to ischemia in young adults. CASE REPORT A 32-year-old health worker (medical doctor) applied to our clinic with a complaint of lower extremity pain, paleness, and coldness, post-exercise. He did not have any complaint to make him think as ischemia. Peripheral arterial angiography was applied, but the main diagnosis was given by magnetic resonance imaging angiography. Medical thrombolytic treatment, femoral embolectomy and then tendon resection, approached posteriorly, were applied to the popliteal region. DISCUSSION Repeated exterior microtraumas cause thickening in the arterial wall, early atherosclerosis, thrombus and ischemia. To diagnose this entity is difficult. Treatment should be surgical, oriented to abolish the compression. CONCLUSION In this case, we wanted to emphasize how quiet the progression of the PAES may be, and effacement of the compression is essential in the treatment. Femoral embolectomy does not have any aid to treatment.
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Affiliation(s)
- Erdal Simsek
- Department of Cardiovascular Surgery, Etlik Ihtisas ˙Training and Research Hospital, Ankara, Turkey
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16
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Gallo RA, Plakke M, Silvis ML. Common leg injuries of long-distance runners: anatomical and biomechanical approach. Sports Health 2012; 4:485-95. [PMID: 24179587 PMCID: PMC3497945 DOI: 10.1177/1941738112445871] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
CONTEXT Long-distance running (greater than 3000 m) is often recommended to maintain a healthy lifestyle. Running injury rates increase significantly when weekly mileage extends beyond 40 miles cumulatively. With the development of running analysis and other diagnostic tests, injuries to the leg secondary to bone, musculotendinous, and vascular causes can be diagnosed and successfully managed. EVIDENCE ACQUISITION Searches used the terms running, injuries, lower extremity, leg, medial tibial stress syndrome, compartment syndrome, stress fractures, popliteal artery entrapment, gastrocnemius soleus tears, and Achilles tendinopathy. Sources included Medline, Google Scholar, and Ovid from 1970 through January 2012. RESULTS Tibial stress fractures and medial tibial stress syndrome can sometimes be prevented and/or treated by correcting biomechanical abnormalities. Exertional compartment syndrome and popliteal artery entrapment syndrome are caused by anatomic abnormalities and are difficult to treat without surgical correction. CONCLUSION Leg pain due to bone, musculotendinous, and vascular causes is common among long-distance runners. Knowledge of the underlying biomechanical and/or anatomic abnormality is necessary to successfully treat these conditions.
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Affiliation(s)
- Robert A. Gallo
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael Plakke
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew L. Silvis
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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17
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Taslakian B, Haddad F, Ghaith O, Al-Kutoubi A. Popliteal artery entrapment presenting as acute limb ischemia: treatment with intra-arterial thrombolysis. Case report and review of the literature. Eur J Pediatr 2012; 171:1703-6. [PMID: 22875315 DOI: 10.1007/s00431-012-1810-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 07/26/2012] [Indexed: 11/28/2022]
Abstract
Popliteal artery entrapment syndrome (PAES) is a relatively rare condition, which occurs predominantly in active young adults who lack atherogenic risk factors. It has been rarely reported in patients under the age of 18 years. The most common presentation in the early stages is intermittent claudication; however, in the later stages of undiagnosed PAES, acute ischemia can occur as a result of complete arterial occlusion or embolism. We present a 14-year-old boy, who presented with acute limb ischemia which was managed with a multidisciplinary approach.
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Affiliation(s)
- Bedros Taslakian
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, 1107 2020 Beirut, Lebanon
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18
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Sinha S, Houghton J, Holt PJ, Thompson MM, Loftus IM, Hinchliffe RJ. Popliteal entrapment syndrome. J Vasc Surg 2012; 55:252-262.e30. [DOI: 10.1016/j.jvs.2011.08.050] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 08/16/2011] [Accepted: 08/21/2011] [Indexed: 10/15/2022]
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19
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Yildirim FB, Sarikcioglu L, Nakajima K. The co-existence of the gastrocnemius tertius and accessory soleus muscles. J Korean Med Sci 2011; 26:1378-81. [PMID: 22022193 PMCID: PMC3192352 DOI: 10.3346/jkms.2011.26.10.1378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/17/2011] [Indexed: 12/19/2022] Open
Abstract
A bilateral gastrocnemius tertius muscle and a unilateral accessory soleus muscle were encountered during the routine educational dissection studies. The right gastrocnemius tertius muscle consisted of one belly, but the left one of two bellies. On the left side, the superficial belly of the gastrocnemius tertius muscle had its origin from an area just above the tendon of the plantaris muscle, the deep belly from the tendon of the plantaris muscle. The accessory soleus muscle originated from the posteromedial aspect of the tibia and soleal line of the tibia and inserted to the medial surface of the calcaneus. On the right side, the gastrocnemius tertius muscle had its origin from the lateral condyle of the femur, and inserted to the medial head of the gastrocnemius muscle. The co-existence of both gastrocnemius tertius and accessory soleus muscle has not, to our knowledge, been previously reported.
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Affiliation(s)
| | - Levent Sarikcioglu
- Department of Anatomy, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Koh Nakajima
- Department of Oral Anatomy, School of Dentistry, Showa University, Japan
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20
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Anil G, Tay KH, Howe TC, Tan BS. Dynamic Computed Tomography Angiography: Role in the Evaluation of Popliteal Artery Entrapment Syndrome. Cardiovasc Intervent Radiol 2010; 34:259-70. [DOI: 10.1007/s00270-010-9925-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 06/04/2010] [Indexed: 11/28/2022]
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21
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Computed Tomographic Angiography and Digital Subtraction Angiography Findings in Popliteal Artery Entrapment Syndrome. J Comput Assist Tomogr 2010; 34:254-9. [DOI: 10.1097/rct.0b013e3181bbf173] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Koplas MC, Grooff P, Piraino D, Recht M. Third head of the gastrocnemius: an MR imaging study based on 1,039 consecutive knee examinations. Skeletal Radiol 2009; 38:349-54. [PMID: 19002457 DOI: 10.1007/s00256-008-0606-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 09/25/2008] [Accepted: 10/06/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objectives of this study were to determine the frequency of a third head of the gastrocnemius and to describe the course, morphology, and insertion of the third head as seen on the basis of routine magnetic resonance (MR) imaging of the knee. MATERIALS AND METHODS This study was a prospective study of 1,039 consecutive knee MR examinations which were performed for symptoms of pain not associated with claudication. The examinations were performed between September 2004 and January 2005 and were evaluated for the presence of an anomalous third head of the gastrocnemius and to determine its origin and course. Examinations were performed on a variety of magnets ranging from 0.2 to 1.5 T. RESULTS Of the 1,039 knees, 20 (1.9%) demonstrated an anomalous third head of the gastrocnemius which was seen arising near the midline of the posterior distal femur, between the mid and medial aspect, and joining the medial aspect of the lateral head of the gastrocnemius. The size of the third head varied from a thin threadlike muscle to a rather bulky muscle. In all of these patients, the third head coursed lateral to the popliteal vessels, and none coursed between the vessels. One additional case of a third head of the gastrocnemius was seen which joined the medial head of the gastrocnemius. CONCLUSION A third head of the gastrocnemius joining the lateral head is not an uncommon variant, seen in 1.9% of knee MR examinations. Most are not associated with vascular symptoms.
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Affiliation(s)
- Monica C Koplas
- Imaging Institute, Cleveland Clinic Foundation, Hb6, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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23
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CT Angiography and MRI in Patients with Popliteal Artery Entrapment Syndrome. AJR Am J Roentgenol 2008; 191:1760-6. [PMID: 19020248 DOI: 10.2214/ajr.07.4012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Noorani A, Walsh SR, Cooper DG, Varty K. Entrapment syndromes. Eur J Vasc Endovasc Surg 2008; 37:213-20. [PMID: 19046647 DOI: 10.1016/j.ejvs.2008.10.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 10/27/2008] [Indexed: 02/07/2023]
Abstract
Entrapment syndromes represent a pathological process that vascular specialists encounter infrequently. However symptomatic patients are often young with impaired quality of life and successful treatment can produce great benefit, making knowledge of these conditions essential. The purpose of this review was to bring together the entrapment syndromes to understand and gain consensus on the aetiology, pathogenesis, diagnosis and modern management of these rare and interesting vascular disorders. This includes entrapment syndromes of the popliteal artery, superior mesenteric artery, coeliac artery, renal vein and iliac vein.
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Affiliation(s)
- A Noorani
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
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25
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Tamaki Y, Sano A, Okada T, Narabayashi M, Hashimoto T, Uezono H, Kusunoki N, Maeda T, Higashino T, Taniguchi T, Noma S. Bilateral popliteal artery entrapment syndrome: reemphasis on reading axial tomograms. ACTA ACUST UNITED AC 2007; 25:548-52. [DOI: 10.1007/s11604-007-0175-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 07/15/2007] [Indexed: 11/27/2022]
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26
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Pineau S, Vidal V, Monnet O, Varoquaux A, Le Corroller T, Gaubert JY, Jacquier A, Bartoli JM, Moulin G. Indagini radiologiche preoperatorie in chirurgia vascolare. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1283-0801(07)70071-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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Kim HK, Shin MJ, Kim SM, Lee SH, Hong HJ. Popliteal artery entrapment syndrome: morphological classification utilizing MR imaging. Skeletal Radiol 2006; 35:648-58. [PMID: 16741737 DOI: 10.1007/s00256-006-0158-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2005] [Revised: 02/06/2006] [Accepted: 04/26/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To retrospectively analyze magnetic resonance (MR) findings in patients with popliteal arterial entrapment syndrome. MATERIALS AND METHODS This study was a retrospective MRI and CT scan review of 12 patients with 23 limbs with popliteal artery entrapment syndrome (PAES) treated over a 10-yr period. All 12 patients (23 limbs) were evaluated with MR and CT scan (11 patients - bilateral sides; one patient - unilateral side). All cases were classified as to various types of anomalous relationships between the popliteal artery and the neighboring muscles. The PAES was classified to gastrocnemius medial head and lateral head anomaly. Gastrocnemius medial head anomaly was classified according to the classification made by Whelan and Rich, from type 1 to type 6 [12, 13]. Gastrocnemius lateral head anomaly was defined as popliteal artery entrapment due to medially inserted gastrocnemius lateral head or aberrant accessory head of gastrocnemius lateral head. RESULTS The gastrocnemius medial head anomaly was found in 14 limbs (14/23). The classic type 1 was found in none, type 2 in five patients (six limbs), type 3 in four patients (five limbs), type 4 in none, type 5 in one patient (one limb) and type 6 in one patient (two limbs). The uncommon type, i.e. lateral head of gastrocnemius anomaly, was found in five patients (eight limbs). CONCLUSION The gastrocnemius medial head anomaly was the cause of PAES, and PAES was classified by medial head anomaly. However the gastrocnemius lateral head anomaly was also the cause of PAES, and most cases of gastrocnemius lateral head anomaliy showed aberrant accessory slip which entrapped the popliteal artery and vein.
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Affiliation(s)
- Hee Kyung Kim
- Department Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-dong, Songpa-Gu, Seoul, 138-736, South Korea
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28
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Ehsan O, Darwish A, Edmundson C, Mills V, Al-Khaffaf H. Non-traumatic lower limb vascular complications in endurance athletes. Review of literature. Eur J Vasc Endovasc Surg 2004; 28:1-8. [PMID: 15177226 DOI: 10.1016/j.ejvs.2004.02.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To review the importance, clinical features, investigations, management and prognosis of non-traumatic vascular injuries, affecting the lower limbs of endurance athletes. DESIGN Review of literature. MATERIALS AND METHODS A literature search was conducted from Medline, Pubmed, the National Electronic Library for Health, Google and Yahoo search engines for related articles and case reports regarding non-traumatic vascular complications involving the lower limb of endurance athletes. CONCLUSIONS Non-traumatic vascular complications affecting the lower limbs include endofibrosis, stenosis/kinking of iliac arteries, dissection of external iliac artery, adductor canal syndrome, popliteal entrapment syndrome, chronic exertional compartment syndrome and effort-induced venous thrombosis. These are important as they affect athletes at the peak of their career and can be confusing to diagnose. The management is relatively well documented and produces good results in short term but the long term results are not known.
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Affiliation(s)
- O Ehsan
- Department of Vascular Surgery, Burnley General Hospital, Burnley, Lancashire, UK
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29
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Henry MF, Wilkins DC, Lambert AW. Popliteal artery entrapment syndrome. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2004; 6:113-120. [PMID: 15066240 DOI: 10.1007/s11936-004-0039-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Popliteal artery entrapment syndrome is a condition caused by direct compression of the popliteal artery as it passes within or exits the popliteal fossa. It is surprisingly uncommon and usually affects young patients, typically men, and often presenting with symptoms of claudication, or more rarely acute limb ischemia, calf cramps, or a picture of compartment syndrome. The diagnosis should be considered early within the differential diagnosis of all patients presenting with these problems in this age group. The key to management of this condition lies in a high index of suspicion. The treatment of popliteal artery entrapment syndrome is surgical. When the condition is detected at an early stage surgery may be limited to release of the artery alone. However, if the artery has been compressed for some time the resulting intimal damage necessitates bypass of the affected segment. There are numerous reports of thrombectomy with simple vein patching, but the results are inferior to interpositional vein grafting. Reports have also been published of attempts made at endovascular treatment. At present, this mode of management adds little to the definitive treatment of affected limbs and appears limited to use as a bridging procedure in cases presenting with limb ischemia. Unfortunately, an effective clinical screening test does not exist and imaging remains the mainstay in the diagnosis of symptomatic limbs and the screening of asymptomatic limbs. The exact modality of imaging remains unclear, but for the moment duplex scanning, angiography, computed tomography, and magnetic resonance imaging all appear to have their place.
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Affiliation(s)
- Mark F. Henry
- Department of General Surgery, Derriford Hospital, Derriford Road, Plymouth PL6 8DH, UK.
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30
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Ducasse E, Chevalier J, Dasnoy D, Speziale F, Fiorani P, Puppinck P. Popliteal Artery Entrapment Associated with Cannabis Arteritis. Eur J Vasc Endovasc Surg 2004; 27:327-32. [PMID: 14760605 DOI: 10.1016/s1533-3167(03)00100-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report popliteal artery entrapment in a patient with distal necrosis and cannabis-related arteritis, two rare or exceptional disorders never described in association. To conduct a targeted review and especially to seek information on the clinical presentation with characteristics specific to each disorder so as to hasten the diagnosis and choose appropriate management. MATERIAL AND METHODS A 19-year-old man who presented with plantar claudication associated with necrosis in a toe underwent diagnostic arteriography and surgery for popliteal artery entrapment type III. RESULTS Surgical clearance resolved the popliteal artery entrapment but left the clinical symptoms unchanged. Closer questioning disclosed a history of cannabis consumption and intravenous vasodilatory therapy was started. After the 21-day course of vasodilator agents the pain disappeared and the toe necrosis regressed. The patient stopped taking cannabis and had no signs of recurrence. CONCLUSION Whereas a popliteal artery entrapment, albeit a rare event, is well described and responds to standardized treatment, popliteal artery entrapment associated with cannabis-induced arteritis is an exceptional event that could confuse management. Because young people-the age group mainly at risk for popliteal artery entrapment-increasingly use cannabis, cannabis arteritis could become a more frequent event associated with other arterial disorders that may confuse the diagnosis and complicate management. Our experience in a young patient suggests that coexisting popliteal artery entrapment and distal necrosis in a young patient should raise a strong suspicion of an associated vascular disorder possibly related to cannabis consumption. Intravenous vasodilatation treatment is successful provided that cannabis use is discontinued.
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Affiliation(s)
- E Ducasse
- Unit of Vascular Surgery, Catholic Institute of Lille, Lille, France
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31
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Macedo TA, Johnson CM, Hallett JW, Breen JF. Popliteal Artery Entrapment Syndrome: Role of Imaging in the Diagnosis. AJR Am J Roentgenol 2003; 181:1259-65. [PMID: 14573416 DOI: 10.2214/ajr.181.5.1811259] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Thanila A Macedo
- Department of Radiology, Mayo Clinic and Foundation, 200 First St., SW, Rochester, MN 55905, USA
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32
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Bockisch G, Kniemeyer H, Korsakas S, Mahler F, Baumgartner I. Images in vascular medicine. Popliteal artery entrapment syndrome. Vasc Med 2001; 6:265-6. [PMID: 11958394 DOI: 10.1177/1358836x0100600411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G Bockisch
- Swiss Cardiovascular Center, Division of Angiology, University Hospital, Bern
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33
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Abstract
BACKGROUND Popliteal artery entrapment syndrome (PAES) is rare and may be underdiagnosed. Improved specialized, non-invasive imaging techniques are producing detailed topographical evidence of the anomaly. METHODS A historical review of the literature and Medline search was performed with reference to the diagnosis and treatment of the condition. In addition, embryologically based theories for the condition have been postulated. RESULTS AND CONCLUSION PAES may be the result of abnormal development of the popliteal artery or a consequence of excessive cranial migration of the medial head of the gastrocnemius muscle. Magnetic resonance imaging appears to be the most useful single investigation to demonstrate the anomaly. Popliteal artery release alone or with vein bypass is the treatment of choice when intervention is indicated.
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Affiliation(s)
- A W Lambert
- Department of Vascular Surgery, Derriford Hospital, Plymouth, UK
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34
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Ring DH, Haines GA, Miller DL. Popliteal artery entrapment syndrome: arteriographic findings and thrombolytic therapy. J Vasc Interv Radiol 1999; 10:713-21. [PMID: 10392938 DOI: 10.1016/s1051-0443(99)70105-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To review the arteriographic appearance of popliteal artery entrapment syndrome (PAES) and functional popliteal artery entrapment, and determine the role of thrombolysis in the treatment of these disorders. MATERIALS AND METHODS Retrospective review of hospital records from 1991 to 1998. RESULTS Seven patients with PAES and one with functional entrapment were identified. The popliteal artery was occluded in two limbs and compressed in 13. Active plantar flexion was necessary to demonstrate impingement in nine limbs. Medial deviation of the popliteal artery was evident in six of 14 patent popliteal arteries, and lateral deviation was observed in one limb. "Classic" abrupt medial angulation of the popliteal artery was observed in one limb. Both limbs were involved in all six patients who underwent bilateral popliteal exploration. Thrombolytic therapy was performed in three limbs. In two instances, it permitted a less extensive surgical procedure than would otherwise have been required. CONCLUSIONS There is considerable variability in the arteriographic appearance of PAES, which is arteriographically indistinguishable from functional entrapment. It is frequently bilateral. Thrombolytic therapy does not obviate surgery but may permit a less extensive procedure to be performed.
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Affiliation(s)
- D H Ring
- Department of Radiology, National Naval Medical Center, Bethesda, MD 20889-5600, USA
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