ENTRAPMENT SYNDROME IN A NON-ATHLETIC PATIENT
DOI:
https://doi.org/10.48750/acv.51Keywords:
Entrapment, PAES, popliteal artery, surgery, diagnosis, treatmentAbstract
The popliteal artery entrapment syndrome (PAES) is a major cause of claudication and acute ischemia of lower limb in young athletes without risk factors for atherosclerosis.
We present a 39 years-old female patient with no relevant past history and no sport activity, admitted to our emergency department with acute disabling claudication in the right lower limb caused by retrogeniculate popliteal artery occlusion. Computed tomography scan confirmed a type II popliteal entrapment syndrome with popliteal artery occlusion. The patient was submitted to surgery that consisted in myotomy of the medial head of the gastrocnemius muscle, division of the anomalous fibrous band, resection of the diseased popliteal artery and interposition of a reverse ipsilateral saphenous vein graft. The patient recovered distal pulse on the right foot.
Previously considered as a rare disease, the growing number of publications about PAES in the medical literature show the opposite. However, little is known about the prevalence of this syndrome and some studies report a prevalence of 0.165–3.5%. PAES is more common in males and in almost 60% is bilateral. The best treatment results are obtained with replacement of the popliteal artery with graft interposition, preferably venous. Currently, this approach is advocated in all patients with entrapment with the exception of early stages with arterial disease confined to the adventitia.
PAES is not as rare as previously admitted and therefore it is important to maintain a high index of suspicion in these age group.
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References
2. Stuart TP. Note on a Variation in the Course of the Popliteal Artery. J Anat Physiol. 1879;13(Pt 2):162.
3. Hamming JJ. Intermittent claudication at an early age, due to an anomalous course of the popliteal artery. Angiology. 1959;10:369–371. doi:10.1177/000331975901000505.
4. Di Marzo L, Cavallaro A, Sciacca V, Mingoli A, Stipa S. Natural history of entrapment of the popliteal artery. J Am Coll Surg. 1994;178(6):553–556.
5. Levien L. Popliteal artery entrapment syndrome. Semin Vasc Surg. 2003;16(3):223–231.http://www.sciencedirect.com/science/article/pii/S0895796703000280.
6. Gibson M, Mills J, Johnson G, Downs A. Popliteal Entrapment Syndrome. Ann Surg. 1977;185(3):341–348.
7. Bouhoutsos J, Daskalakis E. Muscular abnormalities affecting the popliteal vessels. Br J Surg. 1981;68(7):501–506. doi:10.1002/bjs.1800680720.
8. Sinha S, Houghton J, Holt PJ, Thompson MM, Loftus IM, Hinchliffe RJ. Popliteal entrapment syndrome. J Vasc Surg. 2012;55(1):252–262. e30. doi:10.1016/j.jvs.2011.08.050.
9. Di Marzo L, Cavallaro A. Popliteal vascular entrapment. World J Surg. 2005;29(SUPPL. 1):43–45. doi:10.1007/s00268-004-2058-y.
10. Kim HK, Shin MJ, Kim SM, Lee SH, Hong HJ. Popliteal artery entrapment syndrome: Morphological classification utilizing MR imaging. Skeletal Radiol. 2006;35(9):648–658. doi:10.1007/s00256-006-0158-5.
11. Hai Z, Guangrui S, Yuan Z, et al. CT angiography and MRI in patients with popliteal artery entrapment syndrome. Am J Roentgenol. 2008;191(6):1760–1766. doi:10.2214/AJR.07.4012.
12. Cronenwett JL, Johnston KW. Rutherford’s Vascular Surgery. 8th ed. Philadelphia: Saunders Elsevier; 2014.
13. Akkersdijk WL, de Ruyter JW, Lapham R, Mali W, Eikelboom BC. Colour duplex ultrasonographic imaging and provocation of popliteal artery compression. Eur J Vasc Endovasc Surg. 1995;10(3):342–345. doi:10.1016/S1078-5884(05)80054-1.
14. Henry MF, Wilkins DC, Lambert AW. Popliteal artery entrapment syndrome. Curr Treat Options Cardiovasc Med. 2004;6(2):113–120. doi:10.1007/s11936-004-0039-y.
15. Levien L. Popliteal artery thrombosis caused by popliteal entrapment syndrome. In: Greenhalgh R, Powell J, eds. Inflammatory and Thrombotic Problems in Vascular Surgery. London: W. B. Saunders Co Ltd; 1997:159–168.
16. Hoelting T, Schuermann G, Allenberg JR. Entrapment of the popliteal artery and its surgical management in a 20-year period. Br J Surg. 1997;84(3):338–341. doi:10.1002/bjs.1800840321.