Bilateral popliteal artery entrapment syndrome: reemphasis on reading axial tomograms

Dual source CT angiography in popliteal artery entrapment syndrome

AIM

To evaluate the clinical value of dual source computed tomography (DSCT) angiography in the diagnosis and treatment for popliteal artery entrapment syndrome (PAES).

MATERIALS AND METHODS

8 patients with PAES were retrospectively reviewed. 64-slice dual source CT angiography was performed based on the following protocol: 100 mL of Iopamidol (370 mgI/mL) was injected at a rate of 3.5 mL/s and arterial phase images were obtained by using bolus tracking. Axial DSCT images and reconstructed images including multi-planar reconstruction (MPR), maximum intensity projection (MIP), volume rendering (VR) were collected and analysed. All patients underwent Doppler colour ultrasound examinations and surgeries.

RESULTS

The popliteal artery and the neighbouring muscular structures were clearly shown on the axial images revealing the cause of the arterial entrapment. Furthermore, the site and length of the segmental occlusion and collateral developments were well demonstrated on reconstructed images. Characterisation and classification based on DSCT angiography were confirmed by surgeries. PAES was accurately diagnosed by DSCT angiography in all enrolled patients. In contrary, only 5 PAES cases were accurately diagnosed by ultrasound examination.

CONCLUSION

DSCT angiography is a noninvasive and valuable tool in the diagnosis of PAES and plays an important role in the determination of treatment plans.

Popliteal entrapment syndrome caused by fibular osteochondroma

Osteochondromas are the most common tumors of bone. In adolescence, they usually present as a painless growing mass. Femoropopliteal vascular complications associated with an osteochondroma are rare, with most cases involving pseudoaneurysms. This report describes an exceptional case of a popliteal entrapment syndrome caused by a proximal fibular osteochondroma.

Unilateral Acute Lower Extremity Ischemia with Popliteal Artery Aneurysm as a Result of Vascular Type III Entrapment in an Elderly Patient

Popliteal artery entrapment syndrome (PAES) is a rare cause of acute limb ischemia in adult patients but commonly demonstrates as claudication in young patients. The most significant, although rare, complication associated with PAES is aneurysm formation. We present the case of an elderly patient with a unilateral popliteal artery aneurysm owing to symptomatic anatomic entrapment. This report presents the oldest patient ever reported with this syndrome and highlights the advantage of multimodal treatment. As multidetector computed tomography highly contributed to the rapid diagnostic confirmation and choice of treatment in the popliteal fossa, limb salvage was achieved in this patient.

Bilateral asymmetric popliteal entrapment syndrome treated with successful surgical decompression and adjunctive thrombolysis

Popliteal artery entrapment syndrome (PAES) is the most common cause of lower leg claudication in patients younger than 50 years. The different types of PAES can result in different rates of arterial damage, leading to aneurysmal degeneration or occlusion. We report a rare case of a young patient presenting with asymmetrical bilateral popliteal artery entrapment. Type III PAES on the right resulted in severe limb ischemia and was treated by division of the accessory tendon and replacement of damaged artery with vein graft. On the left, the medial head of gastrocnemius was resected to release a type I PAES.