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Mansour W, Miceli F, Di Girolamo A, Dajci A, Marzano A, Cangiano R, Ascione M, di Marzo L. Long-Term Results of Surgical Treatment for Popliteal Artery Entrapment Syndrome. Diagnostics (Basel) 2024; 14:1302. [PMID: 38928717 PMCID: PMC11202412 DOI: 10.3390/diagnostics14121302] [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: 05/23/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Popliteal artery entrapment syndrome (PAES) is a rare disease of the lower limbs, mainly affecting young patients, due to extrinsic compression of the neurovascular bundle at the popliteal fossa. The aim of this study was to describe our experience during a median 15-year period. METHODS Patients treated for PAES in our institution from 1979 to 2024 were included. Preoperative, intraoperative, and postoperative data were analyzed. RESULTS A total of 47 patients with a total of 78 limbs were treated. Duplex ultrasound with active maneuvers was performed in all limbs (100%). Angiography was performed in almost all patients (97.4%), computed tomography angiography in 56 (71.8%), and magnetic resonance angiography in 22 (28.2%). Concerning surgical treatment, musculotendinous section was performed in 60 limbs (76.9%), and autologous venous bypass was achieved in 18 limbs (23.1%). The rates for freedom from target lesion revascularization-meaning that no significant stenosis or occlusion during follow-up required revascularization-and 15-year primary patency were 92.4% and 98%, respectively. CONCLUSION Long-term results of surgical treatment for PAES seem to be very satisfying. Myotomy with or without arterial reconstruction using venous bypass can lead to good patency at 15 years of follow-up.
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Affiliation(s)
- Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.D.G.); (A.D.); (A.M.); (R.C.); (M.A.); (L.d.M.)
| | - Francesca Miceli
- Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.D.G.); (A.D.); (A.M.); (R.C.); (M.A.); (L.d.M.)
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Bi Y, Guo F. The treatment of bilateral popliteal artery entrapment syndrome with nonuniform symptoms: A case report and literature review. Vascular 2024; 32:674-678. [PMID: 36719366 DOI: 10.1177/17085381231154339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Popliteal artery entrapment syndrome (PAES) is a rare vascular disease, and cases of bilateral PAES associated with distinct symptoms in each of the affected legs are very rare. In an effort to improve current understanding regarding the presentation and treatment of this condition, a case of bilateral PAES is herein described with a corresponding review of the associated literature. The overall process of diagnosing and treating one patient affected by bilateral PAES was retrospectively assessed to provide comprehensive insight regarding this disease. This patient was diagnosed via contrast-enhanced computed tomography (CT), and right-sided symptomatic PAES was successfully treated via autogenous saphenous venous graft arterial bypass surgery. In contrast, the asymptomatic left-sided PAES in this patient was subject to close follow-up monitoring. Over a 2-year postoperative follow-up period, this patient did not experience any symptoms or complications. As such, autogenous saphenous venous graft arterial bypass surgery represents a safe and efficacious means of treating PAES, whereas surgery may not be required for cases of asymptomatic PAES even in patients with a bilateral presentation.
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Affiliation(s)
- Yan Bi
- Department of Laboratory Medicine Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Facai Guo
- Department of Vascular Surgery, Lanzhou University Second Hospital, Lanzhou, China
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Lee S, Hwang D, Yun WS, Huh S, Kim HK. Case Report: Popliteal artery entrapment syndrome as a cause of deep vein thrombosis and subsequent popliteal artery occlusion. Front Surg 2024; 11:1384331. [PMID: 38774025 PMCID: PMC11107289 DOI: 10.3389/fsurg.2024.1384331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/25/2024] [Indexed: 05/24/2024] Open
Abstract
Background Popliteal artery entrapment syndrome (PAES) is a relatively rare cause of arterial insufficiency in young and physically active individuals; however, deep vein thrombosis (DVT) can develop in association with PAES. Case report A 47-year-old man presented with a 6-day history of left leg swelling and discomfort which was diagnosed as DVT extending to the distal femoral vein and pulmonary embolism on computed tomography (CT). PAES was not suspected at this time, and the patient was administered anticoagulants for 1 year. Two years after the DVT diagnosis, the patient developed sudden-onset left calf claudication for 1 week. Repeat CT angiography showed popliteal artery (PA) occlusion caused by PA displacement from an abnormally lateral insertion of the medial gastrocnemius head. A retrospective review of the initial CT scan confirmed this, as well as compression of the popliteal vein between the displaced medial head and the normal lateral head of the gastrocnemius. The patient eventually underwent myotomy and resection of the PA with an interposition graft. Conclusion This case underscores the potential of PAES as a rare etiology of DVT, emphasizing the importance of considering it in the differential diagnosis of DVT in younger patients lacking common predisposing factors.
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Affiliation(s)
- Sangho Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Deokbi Hwang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Woo-Sung Yun
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Huh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyung-Kee Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Optimizing the diagnostic approach of functional popliteal artery entrapment syndrome. J Vasc Surg 2023; 77:580-587.e1. [PMID: 35970305 DOI: 10.1016/j.jvs.2022.07.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Functional popliteal artery entrapment syndrome (fPAES) is an underdiagnosed and undertreated etiology of atypical claudication. Symptoms of fPAES include deep posterior muscle cramping and pain with exercise and, unlike anatomic PAES, there are seldom vascular complications. Common noninvasive diagnostic modalities include ankle-brachial index, arterial duplex Doppler ultrasound (DUS) examination, and cross-sectional imaging such as magnetic resonance angiography (MRA). Entrapment can be difficult to reproduce during diagnostic testing, requiring provocative maneuvers. Because we believed different provocative maneuvers provide different diagnostic efficacy, we sought to optimize our diagnostic approach to fPAES. METHODS We performed a retrospective review of patients before and after optimizing our noninvasive imaging protocol comparing patients with fPAES versus other atypical claudicants with chronic compartment syndrome. RESULTS Arterial DUS examination and exercise ankle-brachial index were important components of our protocol with a significant decrease in systolic posterior tibial blood pressure of -14 mm Hg after exercise, whereas nonentrapment release patients had an overall increase of 8 mm Hg (P = .006). Arterial DUS examination of the distal PA with forced plantarflexion demonstrated a trend toward an increase in the measured velocity ratio, especially in the middle and distal PA. MRA with stressed plantar flexion findings were positive in 6 of 11 patients with fPAES, with false negatives likely owing to patients' inability to maintain a provocative position for the duration of the MRA. CONCLUSIONS Diagnosing fPAES is challenging owing to a lack of standardized diagnostic testing and provocative maneuvers. Different maneuvers demonstrated varying diagnostic yields for fPAES. Exercise ABIs were the most reliable vascular laboratory test to detect changes attributable to fPAES and to distinguish it from chronic compartment syndrome. Segmental PA DUS examination seems to be promising as a means of detecting PA impingement. Stress positional MRA effectively demonstrates anatomic PAES, but has a false-negative rate for fPAES.
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Troisi N, Melani A, Raspanti C, Panci S, Chisci E, Pratesi C, Michelagnoli S. A comparative analysis of anatomical variations of popliteal artery and its branches in concomitant aneurysmal disease. Vascular 2023; 31:33-38. [PMID: 34809515 DOI: 10.1177/17085381211052369] [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: 11/16/2022]
Abstract
OBJECTIVES Open or endovascular treatment of popliteal artery aneurysms (PAAs) is still debated. Data about the popliteal artery anatomy and its branches are essential to plan a surgical approach. The aim of this study was to report the anatomical variations of the popliteal artery and its branches in a population with aneurysmal disease and compare them with a standard population with non-aneurysmal disease. METHODS A retrospective review of consecutive patients who underwent surgical PAA repair in our center between January 2011 and December 2020 was performed. One-hundred-forty-six limbs in 128 patients underwent PAA treatment (Group 1). Computed tomography angiography images using a 128-section configuration were reviewed for anatomical variations of the popliteal artery and its branches. A control population of 178 limbs in 89 patients with non-aneurysmal disease was used to compare the outcomes (Group 2). All limbs were classified according to Kim's classification. The two groups were analyzed and compared by means of nonparametric Pearson chi-square test. RESULTS Both groups were homogeneous in terms of demographics, risk factors, and clinical presentation. In Group 1, the limbs with PAA were classified as type IA, 133 (91.1%); type IB, 2 (1.4%); type IC, 0; type IIA1, 1 (0.7%); type IIA2, 1 (0.7%); type IIB, 4 (2.7%); type IIC, 0; type IIIA, 3 (2.1%); type IIIB, 0; and type IIIC, 2 (1.4%). In Group 2 the limbs with non-aneurysmal disease were classified as type IA, 163 (91.6%); type IB, 5 (2.8%); type IC, 1 (0.6%); type IIA1, 1 (0.6%); type IIA2, 3 (1.7%); type IIB, 2 (1.1%); type IIC, 0; type IIIA, 3 (1.7%); type IIIB, 0; and type IIIC, 0. No difference in terms of anatomy of the popliteal artery and its branches was found between the two groups (P = NS). CONCLUSIONS Knowledge of anatomical variations of the popliteal artery and its branches is mandatory in case of the surgical approach. Anatomy in PAA patients is not different. Studies with larger population size are needed to validate these outcomes.
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Affiliation(s)
- Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery26187, University of Pisa, Pisa, Italy
| | - Alberto Melani
- Department of Vascular Surgery, 9300University of Florence, Florence, Italy
| | - Claudio Raspanti
- Department of Diagnostic Imaging, 26187San Giovanni di Dio Hospital, Florence, Italy
| | - Simone Panci
- Department of Diagnostic Imaging, 26187San Giovanni di Dio Hospital, Florence, Italy
| | - Emiliano Chisci
- 26187Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Carlo Pratesi
- Department of Vascular Surgery, 9300University of Florence, Florence, Italy
| | - Stefano Michelagnoli
- 26187Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
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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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Farina R, Foti PV, Pennisi I, Vasile T, Clemenza M, Rosa GL, Crimi L, Catalano M, Vacirca F, Basile A. Vascular compression syndromes: a pictorial review. Ultrasonography 2022; 41:444-461. [PMID: 35644605 PMCID: PMC9262661 DOI: 10.14366/usg.21233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/23/2022] [Indexed: 12/01/2022] Open
Abstract
Vascular compression syndromes include a group of rare vascular changes due to extrinsic compression of veins or arteries by surrounding structures. These pathologies are often underestimated due to their rarity, clinicians’ poor level of knowledge, and the non-specificity of their symptoms. The best known are Eagle syndrome, thoracic outlet syndrome, nutcracker syndrome, May-Thurner syndrome, Dunbar syndrome, and popliteal entrapment syndrome. This work summarizes the main ultrasonographic characteristics, symptoms, and treatments of choice for these syndromes. Knowledge of these conditions’ characteristic signs is essential for the differential diagnosis. Failure to diagnose these rare diseases can expose patients to serious complications and risks to their health.
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Affiliation(s)
- Renato Farina
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Pietro Valerio Foti
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Isabella Pennisi
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Tiziana Vasile
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Mariangela Clemenza
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Giuliana La Rosa
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Luca Crimi
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Marco Catalano
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Francesco Vacirca
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Antonio Basile
- Department of Surgical and Medical Sciences, Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
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Helboob M, Iftikhar H, Abdurabu M, Anjum S, Kumar TS. A Rare Case of Bilateral Popliteal Artery Occlusion. Cureus 2022; 14:e20895. [PMID: 35145800 PMCID: PMC8808662 DOI: 10.7759/cureus.20895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/05/2022] Open
Abstract
Peripheral arterial disease (PAD) is a common condition of the upper and lower extremities caused by atherosclerosis. It is often accompanied by symptomatic cardiovascular and cerebrovascular disease and is a major risk factor for amputation of an extremity. Timely diagnosis and intervention can prevent morbidity in these patients. We describe a case of a 48-year-old man with multiple co-morbidities who presented to our emergency department (ED) complaining of acute onset of bilateral leg pain. He was found to have bilateral acute popliteal artery occlusion confirmed by angiography of the lower limbs. Treatment was started early, right after reaching the provisional diagnosis. Popliteal artery occlusion is quite common, but it becomes a rare diagnosis when it happens bilaterally. Detailed evaluation of the peripheral arterial circulation and an early diagnosis seem to be important in the ED management of these patients.
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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: 12] [Impact Index Per Article: 4.0] [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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Popliteal Artery Entrapment Syndrome: A Diagnostic and Treatment Enigma for Orthopaedic Surgeons. J Am Acad Orthop Surg 2021; 29:e834-e845. [PMID: 34106091 DOI: 10.5435/jaaos-d-21-00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
Popliteal artery entrapment syndrome (PAES) is an uncommon condition that causes recurrent posterior leg pain and foot paresthesia in running athletes. This condition occurs most commonly due to an accessory or abnormal implant of the medial head of the gastrocnemius muscle. It may mimic or coincide with other chronic conditions of the lower extremity including chronic exertional compartment syndrome but is most consistent with vascular claudication. Clinical features that distinguish PAES from other causes of leg pain include a sensation of coolness of the posterior leg during exercise and associated paresthesia of the plantar aspect of the foot. Physical examination often reveals decreased intensity of the posterior tibial or dorsalis pedis pulses with passive dorsiflexion or active plantarflexion of the ankle. Diagnostic tests that confirm the presence of PAES include lower extremity angiography during active resisted plantarflexion or maximal passive dorsiflexion, and magnetic resonance angiography done after exercise provocation. Nonsurgical treatment with physical therapy and stretching of the gastrocnemius complex should be done as the first line of treatment. When conservative treatments are ineffective, referral to a vascular specialist for surgical intervention with a muscular band excision or transection, vascular bypass, or arterial reconstruction is necessary.
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Fujimura N, Hosokawa K, Obara H, Igari K, Akamatsu D, Matsumoto H, Asami A, Shibutani S, Akiyoshi T, Nunokawa M, Harada H, Inoue K, Koya A, Furuyama T, Sagara D, Shintani T, Yamaoka T, Akiyama Y, Inoue Y, Hoshina K. Incidence, diagnosis and treatment of popliteal artery entrapment syndrome in current vascular practice in Japan. Cardiovasc Interv Ther 2020; 36:506-513. [PMID: 32989708 DOI: 10.1007/s12928-020-00710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
Few data regarding popliteal artery entrapment syndrome (PAES) is available in Japan. In this study, we investigated incidence, diagnosis and treatment of PAES in current vascular practice. A retrospective analysis of all patients with PAES visiting 31 participating institutes between 2003 and 2015 was conducted. Thirty-five limbs (28 patients) were identified during the 13-year study period, and the incidence of PAES was 0.12% of all peripheral artery disease cases revascularized. Mean age was 32.0 ± 16.9 years old, and 60 and more years old was 10.7%. Also, 92.9% were male and 39.3% were athletes. Most frequent initial symptoms were intermittent claudication in 23 limbs (65.7%); 4 limbs (11.4%) had chronic limb-threatening ischemia. CT scan was most frequently (94.3%) used for the diagnostic imaging followed by MRI (45.7%) and duplex ultrasound (45.7%). Stress test such as dorsal flexion during duplex ultrasound was used only in 28.6%. Thirty-two limbs (91.4%) received surgical treatment, including 23 arterial reconstructions (71.9%); there were no major perioperative complications. All patients achieved improvement of their symptoms, and the average ankle brachial index increased from 0.69 ± 0.22 to 1.00 ± 0.14 post-surgery. The average postoperative follow-up period was 26.0 months with only one reintervention during the follow-up. In conclusion, PAES was a rare condition and traditional surgical treatment was solid. However, given a broad spectrum of clinical feature of PAES and less usage of diagnostic duplex ultrasound with stress test, there might be a miss- or delayed diagnosis of PAES even in the current vascular practice.
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Affiliation(s)
- Naoki Fujimura
- Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kyousuke Hosokawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daijirou Akamatsu
- Division of Vascular Surgery, Tohoku University Hospital, Miyagi, Japan
| | | | - Atsunori Asami
- Department of Surgery, Saitama Municipal Hospital, Saitama, Japan
| | - Shintaro Shibutani
- Department of Vascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | | | - Masao Nunokawa
- Department of Cardiovascular Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Hirohisa Harada
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Kyozo Inoue
- Department of Cardiovascular Surgery, Kobe Rosai Hospital, Hyogo, Japan
| | - Atsuhiro Koya
- Department of Vascular Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Tadashi Furuyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Sagara
- Department of Surgery, Hamamatsu Red Cross Hospital, Shizuoka, Japan
| | - Tsunehiro Shintani
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan
| | | | | | - Katsuyuki Hoshina
- Department of Surgery, Division of Vascular Surgery, The University of Tokyo, Tokyo, Japan
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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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Henry HT, Szolomayer LK, Sumpio BE, Sutton KM. Popliteal Artery Entrapment Syndrome: Bilateral Lower Extremity Involvement. Orthopedics 2018; 41:e295-e298. [PMID: 28934539 DOI: 10.3928/01477447-20170918-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 08/02/2017] [Indexed: 02/03/2023]
Abstract
Popliteal artery entrapment syndrome is a condition in which compression of the popliteal neurovascular structures results in symptoms of lower extremity claudication by way of a constricting anatomic structure or a hypertrophied surrounding musculature. This diagnosis is often missed or misdiagnosed because popliteal artery entrapment syndrome has a presentation similar to that of exertional compartment syndrome. Popliteal artery entrapment syndrome may result in persistent disability or unnecessary morbidity or prevent athletes' return to sport. A female collegiate athlete presented with bilateral popliteal artery entrapment syndrome. She had successful surgical treatment and returned to a high level of sport. This article describes popliteal artery entrapment syndrome, emphasizes the importance of a thorough history and physical examination to elucidate the diagnosis, and provides information that may lead to the identification of individuals who will benefit from surgical intervention. [Orthopedics. 2018; 41(2):e295-e298.].
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Degeneración aneurismática de la arteria poplítea por síndrome de atrapamiento poplíteo. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2014.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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Tomaszewski KA, Popieluszko P, Graves MJ, Pękala PA, Henry BM, Roy J, Hsieh WC, Walocha JA. The evidence-based surgical anatomy of the popliteal artery and the variations in its branching patterns. J Vasc Surg 2016; 65:521-529.e6. [PMID: 26994952 DOI: 10.1016/j.jvs.2016.01.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of our study was to analyze the prevalence of branching pattern variations in the popliteal artery (PA) along with morphometrics of the PA to better address its importance in disease and vascular surgical procedures. METHODS An extensive search for the PA and its anatomic variations was done in the major online medical databases. The anatomic data found were extracted and pooled for a meta-analysis. RESULTS A total of 33 studies (N = 12,757 lower limbs) were included in the analysis. The most common variant was a division of the PA below the knee into the anterior tibial artery and a common trunk for the posterior tibial and peroneal arteries, with a prevalence of 92.6% (95% confidence interval [CI], 90.2-93.8). The second most common variation was a trifurcation pattern of all three branches dividing within 0.5 cm of each other, with a prevalence of 2.4% (95% CI, 1.4-3.5). Of the three studies that reported the diameter of the PA at the level of the subcondylar plane, a mean diameter of 8 mm (95% CI, 7.29-8.70) was found. CONCLUSIONS The PA most commonly divides below the knee into the anterior tibial artery and the common trunk of the posterior tibial artery and the peroneal artery. Knowledge of the prevalence of possible variations in this anatomy as well as morphometric data is crucial in the planning and execution of any surgical intervention in the area of the knee.
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Affiliation(s)
- Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
| | - Patrick Popieluszko
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Matthew J Graves
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Joyeeta Roy
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Wan Chin Hsieh
- International Evidence-Based Anatomy Working Group, Krakow, Poland; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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White JM, Golarz SR, White PW, Craig RM, Whittaker DR. Intraoperative duplex ultrasound criteria for performing interposition bypass in the treatment of popliteal artery entrapment syndrome. Ann Vasc Surg 2014; 29:124.e7-12. [PMID: 25449985 DOI: 10.1016/j.avsg.2014.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/17/2014] [Accepted: 10/18/2014] [Indexed: 11/29/2022]
Abstract
We present a case series of 3 surgical procedures (2 patients) in which intraoperative duplex ultrasound (IDUS) was used to determine whether the chronic compression of the popliteal artery caused by popliteal artery entrapment syndrome had injured the artery to such a degree that interposition bypass was required. Patients initially underwent standard clinical evaluation including history and physical examination and noninvasive diagnostic testing including postexercise ankle-brachial indexes and angiography with evocative maneuvers before surgery. IDUS was performed. Doppler was used to calculate peak systolic velocities (PSVs) and velocity ratios (VRs) across areas of suspected injury. B-mode was used to assess arterial wall thickness (AWT) and sclerotic changes. Patients were followed in the postoperative period with surveillance duplex ultrasound (US). Three limbs (2 patients) underwent IDUS evaluation after popliteal decompression. Limb 1 demonstrated an elevated intraoperative PSV of 295 cm/sec with an elevated VR of 2.52 (295/117 cm/sec) and AWT of 1.1 mm. Interposition bypass was performed after popliteal decompression. Postoperative surveillance duplex US revealed a reduction of the PSV to 90 cm/sec. Limb 2 showed a mildly elevated intraoperative PSV of 211.5 cm/sec with a VR of 1.86 (211.5/114 cm/sec) and AWT of 0.8 mm. An interposition bypass was not performed. Limb 3 demonstrated an elevated intraoperative PSV of 300 cm/sec with an elevated VR of 2.51 (300/119.5 cm/sec) and AWT of 1.0. Interposition bypass was performed. Postoperative surveillance duplex US revealed a reduction of the PSV to 115 cm/sec. IDUS was very helpful in the operative management and intraoperative decision making process for popliteal artery entrapment. An elevated PSV of 250-275 cm/sec or greater on IDUS and a VR of 2.0 or greater, in conjunction with B-mode demonstration of arterial wall injury, was useful in identifying severely injured popliteal arterial segments. Additional prospective studies are warranted to further investigate objective criteria that indicate the need for bypass.
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Affiliation(s)
- Joseph M White
- Department of Vascular Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
| | - Scott R Golarz
- Department of Vascular Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Paul W White
- Department of Vascular Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Robert M Craig
- Department of Vascular Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - David R Whittaker
- Department of Vascular Surgery, Walter Reed National Military Medical Center, Bethesda, MD
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Yamamoto S, Hoshina K, Hosaka A, Shigematsu K, Watanabe T. Long-term outcomes of surgical treatment in patients with popliteal artery entrapment syndrome. Vascular 2014; 23:449-54. [DOI: 10.1177/1708538114560460] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The object of the study is to determine the long-term outcomes of surgical treatment of patients with popliteal artery entrapment syndrome at a single institute. We retrospectively reviewed 19 limbs of 16 consecutive patients who underwent surgery for popliteal artery entrapment syndrome at our hospital over the past 36 years. The popliteal artery was stenotic in 11 limbs, occlusive in 7 limbs, and compressed and deviated by the medial head of the gastrocnemius muscle but not damaged in 1 limb. Six limbs were treated with autologous saphenous vein bypass, 10 with bypass or venous patch graft concomitant with musculotendinous section, and 3 limbs underwent musculotendinous section alone. The 10-year cumulative patency of the 13 limbs treated with bypass was 100%, although two of them showed occlusion at 23 and 12 years after surgery. One patient who received a venous patch graft showed occlusion 15 years after surgery. Additionally, one asymptomatic patient with an apparently non-damaged popliteal artery who received preventive musculotendinous section alone showed stenosis of the artery 2 years after musculotendinous section. In conclusion, the bypass patency observed in this study was excellent in the long term. Careful examination of popliteal artery anatomy using imaging studies is essential for selecting the appropriate surgical procedure for popliteal artery entrapment syndrome.
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Affiliation(s)
- Satoshi Yamamoto
- Department of Vascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Katsuyuki Hoshina
- Department of Vascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiro Hosaka
- Department of Vascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Toshiaki Watanabe
- Department of Vascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Igari K, Sugano N, Kudo T, Toyofuku T, Jibiki M, Inoue Y, Iwai T. Surgical treatment for popliteal artery entrapment syndrome. Ann Vasc Dis 2014; 7:28-33. [PMID: 24719659 DOI: 10.3400/avd.oa.13-00081] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 01/08/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the long-term outcomes of surgical treatment for popliteal artery entrapment syndrome (PAES). MATERIALS AND METHODS This study was undertaken from a retrospective review of case notes of patients treated for PAES between August 1974 and July 2013. We examined patients' characteristics and surgical procedures, and evaluated long-term outcomes including clinical symptoms and graft or native artery patency. RESULTS Twenty-nine limbs (24 patients, mean age: 32 years) underwent surgery. Popliteal arteries were occluded (n = 18) stenosed (n = 7) and normal (n = 4). Twenty-five limbs required both revasularization (interposition [n = 24] and bypass surgery [n = 1]) and myotomy. Four limbs were treated solely with myotomy. During the long-term follow-up period, three limbs required reoperation. The overall primary graft and native popliteal artery patency rates at one and 5 years were 96.3% and 91.9%, respectively. CONCLUSION The treatment of PAES with myotomy and selective revascularization achieves good short- and long-term outcomes. The use of an interposition vein graft reconstruction is associated with minimal morbidity and good long-term patency.
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Affiliation(s)
- Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norihide Sugano
- Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan
| | - Toshifumi Kudo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Toyofuku
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masatoshi Jibiki
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Inoue
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehisa Iwai
- Tsukuba Vascular Center, Buerger Disease Research Institute, Moriya, Ibaraki, Japan
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Liu Y, Sun Y, He X, Kong Q, Zhang Y, Wu J, Jin X. Imaging Diagnosis and Surgical Treatment of Popliteal Artery Entrapment Syndrome: A Single-Center Experience. Ann Vasc Surg 2014; 28:330-7. [DOI: 10.1016/j.avsg.2013.01.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/12/2013] [Accepted: 01/20/2013] [Indexed: 11/27/2022]
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Gemayel G, Murith N, Mugnai D, Khabiri E, Kalangos A. Popliteal artery entrapment syndrome: report of two cases. Vascular 2012; 20:314-7. [PMID: 22871546 DOI: 10.1258/vasc.2011.cr0307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Popliteal artery entrapment syndrome accounts for an important part of correctible causes of claudication and limb ischemia in young people. It is caused by an abnormal relation between the popliteal artery (PA) and the medial head of the gastrocnemius muscle. The diagnosis should be considered in any patient under 50 with calf claudication. The mainstay of treatment is prevention of PA fibrosis because if left untreated, the syndrome leads to irreversible damage to the PA with thrombosis and limb ischemia. We describe two cases of different types in 21- and 27-year-old males, respectively, and we review the literature about the presentation, diagnosis, classification and management of this entity.
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Affiliation(s)
- Gino Gemayel
- Division of Cardiovascular Surgery, University Hospital of Geneva, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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22
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Ng VY, Wilmoth JC, McShane MA. A Sixty-One-Year-Old Woman with Ischemia After Total Knee Arthroplasty: A Case Report. JBJS Case Connect 2012; 2:e34. [PMID: 29252532 DOI: 10.2106/jbjs.cc.k.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Vincent Y Ng
- Department of Orthopaedics, The Ohio State University Medical Center, 725 Prior Hall, 376 West 10th Avenue, Columbus, OH 43210.
| | - Jill C Wilmoth
- Department of Orthopaedics, The Ohio State University Medical Center, 725 Prior Hall, 376 West 10th Avenue, Columbus, OH 43210.
| | - Michael A McShane
- Riverside Methodist Hospital, Ohio Orthopaedic Center of Excellence, 3535 Olentangy River Road, Columbus, OH 43214
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Eliahou R, Sosna J, Bloom AI. Between a rock and a hard place: clinical and imaging features of vascular compression syndromes. Radiographics 2012; 32:E33-49. [PMID: 22236908 DOI: 10.1148/rg.321115011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vascular compression syndromes are caused by the entrapment of vessels between rigid or semirigid surfaces in a confined anatomic space. Chronic entrapment may lead to arterial ischemia and embolism, venous stasis and thrombosis, and hematuria. These syndromes are usually seen in otherwise healthy young patients, among whom underdiagnosis is common. Most occurrences of vascular compression are associated with an underlying anatomic abnormality. In a small percentage of cases, other contributing factors, including repetitive microtrauma, may cause pathologic changes leading to the onset of pain and other symptoms of vascular and neural compression. Hence, the diagnosis must be based on both clinical and radiologic findings. Because some cases of vascular entrapment become symptomatic only when specific physical maneuvers are performed, dynamic diagnostic imaging methods are especially useful. Digital subtraction angiography has been the mainstay of imaging-based diagnosis for most vascular compression syndromes, but other methods (eg, color Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) are used with increasing frequency for initial diagnostic evaluation. Because vascular compression syndromes are caused by the external compression of vessels, endoluminal treatment alone is rarely adequate and surgical decompression is likely to be required for optimal and durable clinical benefit. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.321115011/-/DC1.
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Affiliation(s)
- Ruth Eliahou
- Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel
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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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Kim SY, Min SK, Ahn S, Min SI, Ha J, Kim SJ. Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion. J Vasc Surg 2011; 55:90-7. [PMID: 21944915 DOI: 10.1016/j.jvs.2011.06.107] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 06/20/2011] [Accepted: 06/20/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There are few long-term follow-up studies about the result of revascularization surgery for the treatment of popliteal artery entrapment syndrome (PAES). We performed this retrospective study to analyze the long-term result of revascularization surgery in patients with advanced PAES during the last 16 years. METHODS Twenty-two limbs in 18 consecutive patients with PAES were treated surgically at Seoul National University Hospital between January 1994 and December 2009. The preoperative diagnosis of PAES was made by duplex ultrasonography, three-dimensional computed tomography angiography, magnetic resonance imaging, or conventional angiography. The method of surgical approach was determined by the extent of arterial occlusion in preoperative images. RESULTS The mean age was 31 years old and the majority of patients were men (94%). The chief complaints were claudication in 18 limbs, ischemic rest pain in three limbs, and toe necrosis in one limb. All 22 limbs underwent revascularization for advanced PAES with segmental arterial occlusion. Fourteen limbs underwent musculotendinous section and popliteo-popliteal interposition graft (13 posterior approaches, one medial approach), five femoropopliteal (below-knee) bypasses, one femoro-posterior tibial bypass, and two popliteo-posterior tibial bypasses. All revascularization surgeries were performed with reversed saphenous veins. The overall primary graft patency rates at 1, 3, and 5 years were 80.9%, 74.6%, and 74.6%, respectively. Comparing 5-year graft patency according to the extent of arterial occlusion, patients with occlusion confined to the popliteal artery (n = 14) showed a better patency rate than patients with occlusion extended beyond the popliteal artery (n = 8) with no statistical significance (83.6% vs 53.6%; P = .053). Comparing 5-year graft patency according to the inflow artery, superficial femoral artery inflow (n = 6) showed a worse patency rate than popliteal artery inflow (n = 16) (30.0% vs 85.9%; P = .015). CONCLUSION In advanced popliteal entrapment syndrome, longer bypass with superficial femoral artery inflow showed poor long-term graft patency rate. The graft patency rate was excellent in patients whose arterial occlusion was confined to the popliteal artery and treated by popliteal interposition graft with reversed saphenous vein. With these data, we suggest that longer bypass extending beyond the popliteal artery might only be indicated in patients with critical limb ischemia when the extent of disease does not allow short interposition graft.
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Affiliation(s)
- Seong-Yup Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Merino Díaz B, Salvador Calvo R, Revilla Calavia A, Carpintero Mediavilla L, González Fajardo J, Vaquero Puerta C. Tratamiento quirúrgico del síndrome de atrapamiento de arteria poplítea: nuestra experiencia. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70044-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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Causey MW, Singh N, Miller S, Quan R, Curry T, Andersen C. Intraoperative Duplex and Functional Popliteal Entrapment Syndrome: Strategy for Effective Treatment. Ann Vasc Surg 2010; 24:556-61. [DOI: 10.1016/j.avsg.2009.07.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 07/24/2009] [Indexed: 11/15/2022]
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Variant of popliteal entrapment syndrome involving the lateral head of the gastrocnemius muscle: a case report. Ann Vasc Surg 2009; 23:535.e5-9. [PMID: 19467831 DOI: 10.1016/j.avsg.2009.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 02/03/2009] [Indexed: 11/21/2022]
Abstract
Popliteal artery entrapment syndrome is a congenital anomaly of the relationship of the popliteal artery with the surrounding musculotendinous structures that causes functional extrinsic compression of the artery, most commonly involving the medial head of the gastrocnemius muscle. We discuss a new variant of popliteal artery entrapment syndrome involving a slip of muscle from the lateral head of the gastrocnemius muscle compressing the popliteal artery against the head of the medial gastrocnemius muscle.
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31
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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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32
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Kim HK, Laor T, Racadio JM. MR imaging assessment of the lateral head of the gastrocnemius muscle: prevalence of segmental anomalous origins in children and young adults. Pediatr Radiol 2008; 38:1300-5. [PMID: 18839166 DOI: 10.1007/s00247-008-1018-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 08/25/2008] [Accepted: 09/09/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND Variations in the lower extremity musculature have been identified, including an anomalous origin of the medial head of the gastrocnemius muscle. Anomalies of the lateral head of the gastrocnemius muscle (LGN) have been less frequently described, especially in children. OBJECTIVE To describe the MR imaging appearance, frequency and clinical symptoms associated with anatomic variations of the LGN in children and young adults. MATERIALS AND METHODS A retrospective review of 465 knee MR imaging examinations was performed. The site of origin of the LGN was identified as either normal, lateral segmental anomalous origin (LSAO), or medial accessory anomalous origin (MAAO). The clinical indication for imaging was recorded. RESULTS An anatomic variation of the LGN was identified in 16 patients (3.4%). Nine patients had LSAO, and five of these had symptoms referable to or abnormalities of the patella. Seven patients had MAAO, and three of these had chronic nontraumatic knee pain. CONCLUSION Anatomic variations of the LGN are not rare in young patients, occurring with a frequency of 3.4% in our series. It is unknown whether these anomalies play a role in the etiology of patellofemoral pain or unexplained joint pain in children.
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Affiliation(s)
- Hee Kyung Kim
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
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33
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Paraskevas N, Castier Y, Fukui S, Alsac JM, Soury P, Laurian C, Leseche G. Superficial femoral artery autograft reconstruction for complicated popliteal artery entrapment syndrome. Vasc Endovascular Surg 2008; 43:165-9. [PMID: 19033275 DOI: 10.1177/1538574408326584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present an alternative surgical approach to popliteal artery entrapment syndrome with vascular complications in the absence of a suitable saphenous vein. Three patients (29, 35, and 78 years old) with thrombotic and/or aneurysmal lesions of the popliteal artery from popliteal artery entrapment syndrome were treated with superficial femoral artery autograft reconstruction. The procedure was performed through a medial approach. The superficial femoral artery was harvested in the upper third of the thigh and used as the conduit for reconstruction and the harvested segment was replaced by a polytetrafluoroethylene graft. At follow-up, patients were asymptomatic and duplex ultrasound revealed patent reconstruction with no morphological abnormalities.
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Affiliation(s)
- Nikolaos Paraskevas
- Service de Chirurgie Vasculaire, Hôpital Saint-Joseph, Paris, France, Service de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, Paris Cedex 18, France.
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34
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Assessment of the medial head of the gastrocnemius muscle in functional compression of the popliteal artery. J Vasc Surg 2008; 48:1189-96. [PMID: 18971035 DOI: 10.1016/j.jvs.2008.06.057] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 06/17/2008] [Accepted: 06/22/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Nonfunctional popliteal entrapment is due to embryologic maldevelopment within the popliteal fossa. Functional entrapment occurs in the apparent absence of an anatomic abnormality. Gastrocnemius hypertrophy has been associated with the latter. Both forms of entrapment may cause arterial injury and lower limb ischemia. This study assessed the attachment of the medial head of the gastrocnemius muscle in healthy occluders and healthy nonoccluders. METHODS Provocative tests were used to identify 58 nonoccluders and 16 occluders. Ten subjects from each group underwent magnetic resonance imaging evaluation of the popliteal fossa. The medial head of the gastrocnemius muscle attachment was assessed in the supracondylar, pericondylar, and intercondylar areas. RESULTS In the occluder group, significantly more muscle was attached towards the femoral midline (supracondylar), around the lateral border of the medial condyle (pericondylar), and within the intercondylar fossa. CONCLUSION The more extensive midline position of the medial head of the gastrocnemius in occluders is likely to be a normal embryological variation. Forceful contraction results in compression and occlusion of the adjacent popliteal artery. The clinical significance of these anatomic variations remains unclear. However, these new observations may provide insight for future analysis of the causes and natural history of functional compression and the potential progression to clinical entrapment.
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Affiliation(s)
- William Moore
- Physical Medicine and Rehabilitation, Johns Hopkins Sports Medicine, Baltimore, Maryland, USA.
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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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Liu PT, Moyer AC, Huettl EA, Fowl RJ, Stone WM. Popliteal vascular entrapment syndrome caused by a rare anomalous slip of the lateral head of the gastrocnemius muscle. Skeletal Radiol 2005; 34:359-63. [PMID: 15480642 DOI: 10.1007/s00256-004-0850-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2004] [Revised: 07/16/2004] [Accepted: 07/28/2004] [Indexed: 02/02/2023]
Abstract
Popliteal vascular entrapment syndrome can result in calf claudication, aneurysm formation, distal arterial emboli, or popliteal vessel thrombosis. The most commonly reported causes of this syndrome have been anomalies of the medial head of the gastrocnemius muscle as it relates to the course of the popliteal artery. We report two cases of rare anomalous slips of the lateral head of the gastrocnemius muscle causing popliteal vascular entrapment syndrome.
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MESH Headings
- Angiography, Digital Subtraction/methods
- Anticoagulants/administration & dosage
- Arterial Occlusive Diseases/diagnosis
- Arterial Occlusive Diseases/etiology
- Arterial Occlusive Diseases/therapy
- Constriction, Pathologic/diagnosis
- Constriction, Pathologic/etiology
- Constriction, Pathologic/therapy
- Female
- Fibrinolytic Agents/administration & dosage
- Humans
- Leg/blood supply
- Magnetic Resonance Angiography/methods
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Muscle, Skeletal/abnormalities
- Muscle, Skeletal/diagnostic imaging
- Muscle, Skeletal/pathology
- Popliteal Artery/abnormalities
- Popliteal Artery/diagnostic imaging
- Popliteal Artery/pathology
- Popliteal Vein/abnormalities
- Popliteal Vein/diagnostic imaging
- Rare Diseases
- Syndrome
- Tissue Plasminogen Activator/administration & dosage
- Tomography, X-Ray Computed/methods
- Ultrasonography, Doppler, Color/methods
- Venous Thrombosis/diagnosis
- Venous Thrombosis/etiology
- Venous Thrombosis/therapy
- Warfarin/administration & dosage
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Affiliation(s)
- Patrick T Liu
- Department of Radiology, Mayo Clinic Scottsdale, 13400 East Shea Boulevard, Scottsdale, AZ 85253, USA.
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Ruppert V, Verrel F, Geppert SN, Sadeghi-Azandaryani M, Burklein D, Steckmeier B. Results of perioperative measurements of ankle-brachial index in popliteal artery entrapment syndrome. J Vasc Surg 2004; 39:758-62. [PMID: 15071437 DOI: 10.1016/j.jvs.2003.11.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to demonstrate whether there is postoperative improvement in blood flow in the affected limb after surgical decompression in popliteal artery entrapment syndrome (PAES). For this purpose, the simple method of measuring Doppler ankle pressure with and without provocation was used preoperatively and postoperatively. PATIENTS AND METHODS Doppler ankle pressure was measured preoperatively and postoperatively in neutral position (n=32) and with provocation (forced plantar flexion of the foot; n=32) in 32 limbs in 23 patients with PAES (19 men, 4 women; average age, 38.24 +/- 12.25 years) operated on between January 1, 1986, and December 31, 2000. The reference method was angiography with provocation in 18 patients and duplex ultrasound scanning in 14 patients. RESULTS Patients were assigned to one of two groups (A and B) on the basis of ankle-brachial index (ABI) at rest. Group A (mean age, 38.19 +/- 11.60 years) included all limbs (n=24) with ABI>0.9 preoperatively, and group B (mean age, 42.39 +/- 14.38 years) comprised all limbs (n=8) with ABI<0.9. Improvement in ABI under provocation after operation (group A, P<.0001; group B, P<.0004) was highly significant. In group B there was also a highly significant difference in ABI in the neutral position before and after operation (P=.0044); this could not be demonstrated in group A. Angiography or duplex sonography postoperatively did not provide any additional information. CONCLUSION Our results indicate that determination of ABI alone, with and without provocation, is sufficient as a postoperative follow-up examination to appraise decompression and for quality assurance of PAES. Compared with other more elaborate instrumental methods, measurement of ABI is relatively noninvasive, quick and easy to carry out, effective, and inexpensive.
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Affiliation(s)
- Volker Ruppert
- Department of Vascular Surgery, Hospital Ludwig-Maximillian, University of Munich, Germany.
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