Long-term follow-up of patients with popliteal artery entrapment syndrome treated by endoluminal revascularization

The treatment of bilateral popliteal artery entrapment syndrome with nonuniform symptoms: A case report and literature review

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.

Incidence, diagnosis and treatment of popliteal artery entrapment syndrome in current vascular practice in Japan

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.

A Very Rare Cause of Lower Limb Ischemia in Young People: Popliteal Artery Entrapment

Background

Popliteal artery entrapment syndrome (PAES) is a very rare pathology that can cause lower extremity ischemia in healthy young people. Anomalous anatomic relationships between the popliteal artery (PA) and the surrounding musculo-tendinous structures cause PAES. We present 31 patients with PAES in 35 limbs that were treated surgically in our clinic within a 12-year period.

Patients and Methods

From 2001 to 2015, 31 patients (mean age: 32 ± 7.4 years) underwent surgery for PAES. ; 4 patients presented had bilateral PAES. Doppler ultrasonography (US), magnetic resonance angiography (MRA), and conventional angiography were performed as diagnostic procedures. We detected Type I PAES in 4 limbs and Type II PAES in 12 limbs. In the remaining 19 limbs, we diagnosed Type III or Type IV PAES. Simple release of the PA, PA embolectomy and simple release, and the radial artery (RA) patch angioplasty, with or without thromboendarterectomy (TEA), were performed. In 12 limbs, PA continuity was provided by RA interposition.

Results

With the exception of 5 patients, no complications were seen after surgery. Haematoma was detected in 2 patients and local infection in 2 patients. One patient required a revision for recurrent PA thromboembolic event 12 h after surgery. At a median follow- up of 23 months (range: 11-29 months), there were no postoperative complications.

Conclusions

PAES can result in lower limb ischemia due to chronic vascular trauma in young healthy patients. The use of diagnostic tools such as US, a non-invasive method, and MRA are effective diagnostic tools for early diagnosis. With their combined approach, exact and early diagnosis can be achieved. PA release, alone or with arterial bypass using RA, is a viable treatment option when intervention is necessary to prevent limb loss in the early stages of the disease.

Successful endovascular treatment of popliteal artery entrapment syndrome: a case report with 3-years follow-up

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.

Chronic leg pain in athletes

Chronic leg pain is commonly treated by orthopaedic surgeons who take care of athletes. The sources are varied and include the more commonly encountered medial tibial stress syndrome, chronic exertional compartment syndrome, stress fracture, popliteal artery entrapment syndrome, nerve entrapment, Achilles tightness, deep vein thrombosis, and complex regional pain syndrome. Owing to overlapping physical examination findings, an assortment of imaging and other diagnostic modalities are employed to distinguish among the diagnoses to guide the appropriate management. Although most of these chronic problems are treated nonsurgically, some patients require operative intervention. For each condition listed above, the pathophysiology, diagnosis, management option, and outcomes are discussed in turn.

Long-term outcomes of surgical treatment in patients with popliteal artery entrapment syndrome

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.

Chronic lower leg pain in athletes: a guide for the differential diagnosis, evaluation, and treatment

Context:

Chronic lower leg pain in athletes can be a frustrating problem for patients and a difficult diagnosis for clinicians. Myriad approaches have been suggested to evaluate these conditions. With the continued evolution of diagnostic studies, evidence-based guidance for a standard approach is unfortunately sparse.

Evidence Acquisition:

PubMed was searched from January 1980 to May 2011 to identify publications regarding chronic lower leg pain in athletes (excluding conditions related to the foot), including differential diagnosis, clinical presentation, physical examination, history, diagnostic workup, and treatment.

Results:

Leg pain in athletes can be caused by many conditions, with the most frequent being medial tibial stress syndrome; chronic exertional compartment syndrome, stress fracture, nerve entrapment, and popliteal artery entrapment syndrome are also considerations. Conservative management is the mainstay of care for the majority of causes of chronic lower leg pain; however, surgical intervention may be necessary.

Conclusion:

Chronic lower extremity pain in athletes includes a wide differential and can pose diagnostic dilemmas for clinicians.

Popliteal artery entrapment syndrome in a young girl: case report of a rare finding

The popliteal artery (PA) entrapment syndrome, a rare cause of arterial thrombosis, is most often encountered in young male athletes. Here, we report a very unusual case of PA entrapment syndrome in a 14-year-old girl who presented with a 1-month history of calf claudication to our observation facility. Diagnostic work-up revealed obesity, sedentary lifestyle, and an aberrant accessory slip of the medial head of gastrocnemius around the PA. Arterial echo color Doppler ultrasonography and computed tomographic angiography studies were performed. Surgical treatment involved revascularization with resection of the medial head of gastrocnemius, the cause of the arterial entrapment, and enlargement angioplasty using an autologous saphenous vein patch, in combination with antiplatelet therapy, resulting in restitution ad integrum of the affected limb and, finally, an improved quality of life of the patient. This case underscores the importance of clinical suspicion, diagnosis, and treatment of lower-limb claudication in very young patients presenting with unusual symptoms. If missed, the condition may evolve dramatically. Prompt diagnosis and surgical treatment are key to complete recovery and the prevention of irreversible complications that may result in limb loss.