Bilateral popliteal artery entrapment syndrome: case report

Abstract

Popliteal artery entrapment syndrome occurs due to an extrinsic compression of the popliteal vessels that results in vascular damage. It is one of the most frequent causes of intermittent claudication in young patients. The authors describe a case of bilateral syndrome by anomalous position of the gastrocnemius muscle, with abnormal slip of its medial head (Rich's type III). During the operation the occluded right side was reconstructed by autologous saphenous vein bypass from femoral superficial to peroneal artery and on the left side the slip muscle was transected by posterior approach. Popliteal artery entrapment syndrome should be treated by surgery despite the degree of symptoms. Surgical treatment technique has released the vessel by extracting the muscle that caused entrapment, and reconstructing the narrow lumen bypass grafting.Keywords: Popliteal artery, surgery, popliteal artery entrapment syndrome. ResumoA síndrome do aprisionamento da artéria poplítea ocorre em função de compressão extrínseca dos vasos poplíteos, que resulta em lesão vascular. Trata-se de uma das causas mais freqüentes de claudicação intermitente em pacientes jovens. Os autores descrevem um caso de síndrome bilateral devida à posição anômala do músculo gastrocnêmio, com deslizamento de sua cabeça média (tipo III da classificação de Rich). Durante a cirurgia, o lado direito ocluído foi reconstruído por derivação da veia safena autóloga da artéria superficial femoral para a artéria peroneal e, do lado esquerdo, o músculo que sofreu o deslizamento foi secionado através de via posterior. A síndrome do aprisionamento da artéria poplítea deve ser tratada por cirurgia, independente do grau dos sintomas. A técnica de tratamento cirúrgico liberou o vaso, extraindo o músculo que causava o aprisionamento e reconstruindo o lúmen estreito por derivação. Palavras-chave:Artéria poplítea, cirurgia, síndrome do aprisionamento da artéria poplítea.

Popliteal Artery Entrapment Syndrome: A Case Report and Review of the Literature

“…For patients with PAES and muscle insertion abnormalities, surgery is indicated even when the patient is asymptomatic [ 20 , 21 ]. Ideally, if the disease is diagnosed early and the artery remains uninjured, simple surgical exploration with fasciotomy, myotomy, or fibrous band sectioning and arterial release may be sufficient [ 22 ].…”

Síndrome do aprisionamento da artéria poplítea: relato de caso

“…Imaging exams are decisive for the diagnosis of this syndrome [10][11][12] , and may include Doppler ultrasonography 10,11 , computed axial tomography 12 , magnetic resonance 10 and angiography 12 . The latter are more useful for allowing better surgery planning 10,12 .…”

“…The prevalence of PAES in the general population ranges from 0.16 to 3.5%, and type III is the most common form, affecting 35% of all cases 11 . The patient PAES is young, with a recent history of intense sport practice 13 .…”

“…The importance of correct diagnosis and treatment of PAES is reflected on the differential diagnosis and the resulting complications of the disease. The physician should distinguish PAES from arteritis, neurogenic claudication, muscle diseases, adventitial tumors in the popliteal artery, cystic disease of popliteal artery and traumatic causes of lesion in the popliteal artery 11 . Non-treated popliteal artery entrapment can lead, in the anatomical form, to complications, such as stenosis, embolism, post-stenotic dilatation and arterial thrombosis, and in the functional form, to incapacity to practice physical exercises 9,15 .…”

“…Non-treated popliteal artery entrapment can lead, in the anatomical form, to complications, such as stenosis, embolism, post-stenotic dilatation and arterial thrombosis, and in the functional form, to incapacity to practice physical exercises 9,15 . The most common symptoms are: intermittent claudication 9,11,12,16 , in 40% of the patients 11 , and feet and calf pain, which appear after physical exertion 9,17 . Intermittent claudication -complaints of pain only while walking -can occur 9 .…”