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PubMed2000

[Popliteal artery entrapment syndrome].

Popliteal Artery Entrapment Syndrome (PAES) is an uncommon congenital anomaly. It arises due to compression of the popliteal artery by tendomuscular structures often combined with an anomalous position of the artery. Mostly young men are suffering of this disease. There are four common variations of this anomaly. We report on a 14 year old patient who had an acute 24 hours duration right leg ischemia caused by PAES. Using a posterior approach to the popliteal artery, following division of the accessory slip of gastrocnemius muscle we performed an arteriotomy and a floating thrombus was removed. The artery was reconstructed by direct continuous suture. One year postoperatively the boy has no complaints, peripheral pulse is palpable.

Adolescent↗
PubMed2004

Popliteal Artery Entrapment Syndrome.

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.

Journal Article↗
PubMed1998

MR imaging and MR angiography in popliteal artery entrapment syndrome.

Popliteal artery entrapment (PAE) syndrome is an uncommon congenital anomaly seen in young adults causing ischemic symptoms in the lower extremities. It is the result of various types of anomalous relationships between the popliteal artery and the neighboring muscular structures. The purpose of this study was to define the role of MR imaging combined with MR angiography in the diagnosis of PAE cases. Four cases with segmental occlusion and medial displacement of popliteal artery in digital subtraction angiography (DSA) examinations were diagnosed as PAE syndrome by MR imaging and MR angiography. The DSA and MRA images are compared. All of the cases showed various degrees of abnormal intercondylar insertion of the medial head of the gastrocnemius muscle. The MR images showed detailed anatomy of the region revealing the cause of the arterial entrapment. Subclassification of the cases were done and fat tissue filling the normal localization of the muscle was evaluated. The DSA and MRA images demonstrated the length and localization of the occluded segment and collateral vascular developments equally. It is concluded that angiographic evaluation alone in PAE syndrome might result in overlooking the underlying cause of the arterial occlusion, which in turn leads to unsuccessful therapy procedures such as balloon angioplasty. Magnetic resonance imaging combined with MR angiography demonstrates both the vascular anatomy and the variations in the muscular structures in the popliteal fossa successfully, and this combination seems to be the most effective way of evaluating young adults with ischemic symptoms suggesting PAE syndrome.

Adult↗
PubMed2007

Endovascular repair of an acute blunt popliteal artery injury.

Blunt popliteal arterial injury is uncommon and is usually associated with surrounding soft tissue and orthopedic injuries, which may complicate traditional open operative repair. We present the successful management of a blunt popliteal artery injury through an endovascular approach, where we imaged the lesion, extracted the thrombus, protected against distal embolization, and performed a balloon angioplasty to the intimal lesion. Our approach is the first documented in the literature in which endovascular repair of a blunt popliteal artery injury was performed successfully in an acutely ischemic extremity. Using a filter wire is a novel way to prevent distal embolization during manipulation.

Accidents, Traffic↗
PubMed1994

[Popliteal artery entrapment syndrome].

Popliteal artery entrapment syndrome (PAES) should be suspected in young persons without predisposing factors to arteriosclerosis, who present with unilateral claudication in the calf and foot. This entity results from a developmental abnormal relation between the popliteal artery and the medial head of the gastrocnemius muscle. PAES is mostly found in young sportsmen or young soldiers with well-developed muscles. The onset of the symptoms is often sudden, occurring during an episode of intense lower extremity activity. The diagnosis is best established by a thorough clinical examination combined with functional tests followed by a CT-scan and/or biplanar arteriography. The treatment is surgical with decompression of the popliteal artery and in cases of arterial thrombosis also interposition of an autologous graft. Prophylactic decompression should be considered in asymptomatic cases.

Adult↗
PubMed1998

Cystic adventitial degeneration and entrapment syndrome of the popliteal artery as a differential diagnosis of popliteal stenosis or occlusion in the younger age group.

Differential diagnosis in angiographically found popliteal artery stenosis or occlusion comprises some distinct and clinically important entities that should be considered as management and prognosis may vary considerably. We present two patients with the final diagnosis of cystic adventitial disease of the popliteal artery and popliteal artery entrapment syndrome. Angiographic findings and the value of additional diagnostic imaging are discussed.

Adult↗
PubMed1994

Does infrapopliteal arterial runoff predict success for popliteal artery aneurysmorrhaphy?

BACKGROUND: A 6-year experience with surgical management of popliteal artery aneurysms (PAAs) was examined to determine the influence of infrapopliteal outflow vessel patency on the long-term success of popliteal artery aneurysmorrhaphy. METHODS: Arteriograms were reviewed to characterize the anatomy of the infrapopliteal arterial runoff. Regular clinical evaluation and prospective serial duplex scan surveillance assessed graft patency. RESULTS: A total of 28 patients underwent 45 popliteal aneurysmorrhaphies. Elective repair was performed in 32 limbs (71%); emergency treatment was needed for 13 limbs (29%) because of acute limb-threatening ischemia. All patients were managed with PAA exclusion and reversed saphenous vein grafting. Only 20 limbs (44%) had a patent trifurcation with three continuous vessels to the ankle, 13 (29%) had two continuous tibial vessels, 10 (22%) had one patent runoff artery, and 2 (4%) had no vessel continuous to the foot. With a mean follow-up of 19.1 months, the 5-year primary graft patency by life-table analysis was 95 +/- 12.3%, with a 5-year assisted primary patency of 97 +/- 10.0%. One vein graft underwent elective secondary revision. Another graft thrombosed, requiring a secondary bypass. Outcome did not correlate with the status of the runoff anatomy. Limb salvage was 100%. CONCLUSION: The use of autologous reversed vein grafting and attention to technical details yielded normal graft hemodynamics and excellent long-term patency and limb salvage despite the suboptimal runoff anatomy associated with PAAs.

Aged↗
PubMed1995

Predictors of amputation for popliteal artery injuries.

BACKGROUND: Popliteal artery injuries continue to result in limb loss. This study identifies risk factors that predict amputation. METHODS: Over a 5-year period, a retrospective chart review was conducted of 80 consecutive patients with 81 popliteal artery injuries. RESULTS: The overall amputation rate was 16.5%. Blunt trauma carried a higher rate of amputation (47%) than penetrating injuries (6.2%); P < 0.0001). Associated fractures had a higher amputation rate, regardless of mechanism (odds ratio +2.7, 95% confidence limits 1.2 to 6.2). Fasciotomy at the time of operation was associated with reduced amputation rate. CONCLUSIONS: Blunt injuries and associated fractures carry an increased risk for amputation. Compartmental pressures should be appropriately monitored postoperatively. Fasciotomy at the time of vascular repair may be considered even without evidence of compartment syndrome.

Adolescent↗
PubMedDate not supplied

[Popliteal artery entrapment syndrome].

The popliteal artery entrapment syndrome is characterized by extrinsic compression of this artery as a result of anatomic deviation from its usual course, or by compression from musculotendinous structures in the popliteal fossa. Clinical symptoms appear when these affected individuals do strenuous exercises. There are two types of popliteal artery entrapment syndrome: the classicalor congenital form, and the functional or acquired form. In the classical form, disturbances in the embryogenesis lead either directy to popliteal artery anomalies or to alterations of adjacent structures that cause compression of the popliteal artery. In the functional form, hypertrophy of the gastrocnemius muscle secondary to exercise has been postulated as a cause. In both types, diagnosis is made through the detection of total occlusion or important stenosis of the popliteal artery. This is identified by duplex scan, magnetic resonance or arteriography during active plantar flexion-extension. A positive test in non-symptomatic subjects presenting no anatomical anomalies led to discussions about its specificity. This study presents a review of anatomical and functional popliteal artery entrapment syndrome and discusses accuracy, sensitivity and specificity of the diagnostic tests.

Angiography↗
PubMed1989

[True and false popliteal artery entrapment in sportsmen].

Popliteal artery entrapment and its various anatomical type I, II, III and IV has been perfectly described in previous studies. The only test that diagnoses true entrapment due to an anatomical abnormality in the course of the popliteal artery, where it is tied by an embryonic anomaly, is passive dorsiflexion of the foot on the extended leg the deviation then observed at ultrasonography and angiography and the disappearance of downstream signal at doppler examination are pathognomonic. Ultrasonography, computerized tomography (CT) and, more recently, nuclear magnetic resonance (NMR) provide detailed information on the abnormality: separation of the artery from the vein by a muscular bridge is the hallmark of true popliteal entrapment. On the other hand, there is a functional pathology due to dynamic compression of the popliteal artery by the medial gastrocnemius muscle, which raises difficult diagnostic and therapeutic problems, especially in high-level sportsmen for whom the leg muscle activity is very important. In these subjects with a developed muscular mass the medial gastrocnemius muscle crushes the popliteal artery against the femoral condyle without deviation of the artery, particularly in active dorsiflexion and activity hyperextension of the foot on the extended leg. In such case, the popliteal artery and vein remain close to each other, as demonstrated by ultrasounds, CT and NMR. True popliteal artery entrapment can be cured by surgery with subsequent resumption of sporting activities, but whether false entrapment must be operated is difficult to decide. Surgery has been performed with success in some cases of highly disabling false entrapment due to compression of the artery by the medical gastrocnemius muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Popliteal artery entrapment syndrome].

The popliteal artery entrapment syndrome is observed in about 0.5% of patients suffering from intermittent claudication, most often in young fit people. Significant diagnostic problems are the reason of frequent underestimation of the patients complaints. The development of the disease may further lead to lower leg arteries thrombosis or popliteal artery aneurysm. The latter condition is caused by abnormal course of the popliteal artery. Preliminary diagnostic procedures may comprise the examination with most simple Doppler apparatus. The diagnostic should be confirmed with the use of colour-Doppler ultrasonography or computed tomography (with contrast). The treatment of choice is an operation restoring normal anatomy within the popliteal space.

Adolescent↗
PubMed1994

[Sub-adventitial arterial cysts of the popliteal artery. Results from the vascular group of AURC].

A retrospective multicentric study conducted by the vascular group of the AURC (University association of surgical research) included 36 sub-adventitial cysts of the popliteal artery. This is a rare cause of claudication in the young male and usually involves the adventitia of the arterial wall. There is usually only one localization. Echography of the cyst may wrongly suggest partial thrombosis of a popliteal aneurysm. Angiography and CT scan provide the correct diagnosis. The results of surgical treatment were analyzed after a follow-up ranging form 3 months to 20 years (mean 9 years). The reports in the literature confirm that these are rare lesion of a poorly understood origin (congenital or acquired?). Simple complete surgical excision gives excellent results with the exception of initially complicated forms which require resection and grafting.

Adolescent↗
PubMed1985

Popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome (PAES) is caused by an abnormal anatomical relationship between vessels and muscle within the popliteal fossa. This may result in compression and ultimately thrombosis of the popliteal artery. Awareness of the condition is probably the most important factor in making the diagnosis. This article reviews the clinical features and management of PAES, with observations from personal experience of several cases.

Angiography↗
PubMed1991

[Computed tomography in the diagnosis of popliteal artery entrapment syndrome].

Popliteal artery entrapment syndrome (PAES), a rare cause of lower limb ischemia, is due to an anomalous relationship between the popliteal artery and the gastrocnemius muscle in the popliteal fossa. Hypertrophy of the muscle, or its anomalous insertion, can displace or compress the artery, leading to stenosis or obstruction. It is clinically manifested by intermittent claudication and most often occurs in young, healthy men. Arteriography is the method of choice to demonstrate vascular lesions, but it can only visualize change in the course of vessels or intrinsic lesions. Due to its high spatial and density resolution, CT scan can differentiate between bony structures, vessels, muscles, and fatty tissue in the popliteal fossa. It is therefore a very useful supporting examination in PAES and can demonstrate whether or not stenosis or occlusion of the artery results from causes outside the artery itself.

Arterial Occlusive Diseases↗
PubMed1991

Popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome is an uncommon cause of peripheral vascular disease in young fit individuals, presenting as progressive claudication or sudden limb ischaemia. It can also present later in life with insidious symptoms relating to popliteal thrombosis or aneurysm. As a local cause of atherosclerosis in the popliteal artery it is probably under-diagnosed, as clinical and radiological features are subtle and varied. Early diagnosis and surgical division of aberrant muscular relations result in an excellent clinical result. Late surgical treatment with vein grafting is less durable. The disease incidence, clinical features, pathology, investigations, treatment and prognosis are reviewed.

Adolescent↗
PubMed2005

Popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome is a rare but potentially limb threatening peripheral vascular disease occurring predominantly in young adults. We report a case of a 17-year-old boy who presented with intermittent claudication on the right side. Digital subtraction angiography revealed bilateral, focal narrowing of the popliteal arteries. Magnetic resonance imaging displayed compression of the arteries by the medial head of the gastrocnemius muscles. The mechanism, presentation, imaging findings, and management of this rare disease are discussed.

Adolescent↗