Surgical management of functional popliteal entrapment syndrome in athletes

Lavingia, Kedar S.; Dua, Anahita; Rothenberg, Kara A.; Fredericson, Michael; Lee, Jason T.

doi:10.1016/j.jvs.2019.01.068

Cited by 26 publications

(23 citation statements)

References 17 publications

(18 reference statements)

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“…When popliteal artery is completely occluded, great saphenous vein autograft or artificial vascular bypass can be performed. 20 Doppler ultrasound can reveal locations of the saphenous vein and provide accurate positioning for surgery ( Figures. 3d and 3e).…”

Section: Discussionmentioning

confidence: 99%

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

Zhong¹,

Shao²,

Qi³

et al. 2020

Preprint

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Introduction:To retrospectively evaluate Doppler ultrasound findings for patients with popliteal vascular entrapment syndrome (PVES).Methods:Twenty-four patients (30legs) who underwent surgical intervention for PVES were included in this study.The popliteal artery, popliteal vein, and surrounding musculotendinous structures were explored in all symptomatic lower extremities using ultrasound. Intraoperative findings served as the gold standard. In the absence of popliteal artery occlusion, popliteal arteries were examined using Doppler ultrasound at rest and during a provocative maneuver.Results:Ultrasonography in 25 cases (25/30,83%) showed that gastrocnemius medial head or popliteal vascular anomalies were consistent with surgical photography results.The classic type I was found in five limbs, type II in twelve limbs, type III in seven limbs, and type V in one limb.In the remaining five cases (5/30,17%), no anatomical abnormalities of the popliteal fossa were discovered by the ultrasound examination.Among these, two cases (2/30,7%) were misdiagnosed as lower extremity atherosclerosis and popliteal vascular depression was not found. In addition, increasing blood flow velocity was found in three cases (3/30,10%) of compressed popliteal arteries using Duplex scanning during active plantar flexion, with decreasing flow at the distal end.Color Doppler ultrasound of the affected popliteal vessels showed varied degrees of vascular structure pathology, including arterial stenosis in ten limbs, occlusion in fifteen limbs, and aneurysm in two limbs.Conclusion:Conclusion: Doppler ultrasound may have a high diagnostic rate in PVES. Due to its simplicity, repeatability, functional evaluation of blood flow, and non-invasiveness, it can be used as a primary screening examination modality in PVES.Provocative maneuvers could help clinicians diagnose PVES

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Section: Discussionmentioning

confidence: 99%

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

Zhong¹,

Shao²,

Qi³

et al. 2020

Preprint

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“…Separately phased scans can be performed with ankle dorsiflexion or plantarflexion to investigate specifically for evidence of popliteal entrapment [51]. Plethysmography using an oximeter on the hallux of the afflicted side can ensure the ankle has been sufficiently positioned or flexed [16,52]. CTA may demonstrate mild to severe popliteal artery stenosis, popliteal artery occlusion, and even popliteal venous compression [51].…”

Section: Investigationsmentioning

confidence: 99%

“…The plantaris may also be divided at this point [63]. Proponents of this approach state that it allows better access and visualization of the neurovascular bundle, and easy access to the medial head of gastrocnemius [13,16,23,52]. Potential drawbacks are the difficulty of proximal arterial access, should an arterial bypass be necessary, and that the patient must be positioned in a prone position.…”

Section: Managementmentioning

confidence: 99%

“…Its less invasive nature has led many to prefer it over DSA in the investigation of functional PAES [53]. Some patients with symptoms of PAES and signs of popliteal artery compression on CTA demonstrate minimal drop in pressure on exercise ABIs [52] -it is unclear whether this subset of patients did not exercise vigorously enough to incur a drop in ABI, or if there is a subset of patients with functional PAES who have symptoms and imaging consistent with the diagnosis, but normal exercise ABIs.…”

Section: Investigationsmentioning

confidence: 99%

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Functional Popliteal Artery Entrapment Syndrome: An Approach to Diagnosis and Management

2021

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Popliteal Artery Entrapment Syndrome (PAES) is an uncommon syndrome that predominantly affects young athletes. Functional PAES is a subtype of PAES without anatomic entrapment of the popliteal artery. Patients with functional PAES tend to be younger and more active than typical PAES patients. A number of differential diagnoses exist, the most common of which is chronic exertional compartment syndrome. There is no consensus regarding choice of investigation for these patients. However, exercise ankle-brachial indices and magnetic resonance imaging are less invasive alternatives to digital subtraction angiography. Patients with typical symptoms that are severe and repetitive should be considered for intervention. Surgical intervention consists of release of the popliteal artery, either via a posterior or medial approach. The Turnipseed procedure involves a medial approach with a concomitant release of the medial gastrocnemius and soleal fascia, the medial tibial attachments of the soleus and excision of the proximal third of the plantaris muscle. Injection of botulinum A toxin under electromyographic guidance has recently shown promise as a diagnostic and/or therapeutic intervention in small case series. This review provides relevant information for the clinician investigating and managing patients with functional PAES.

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“…In case of popliteal artery injury, endarterectomy and venous patch repair can be used. When popliteal artery is completely occluded, great saphenous vein autograft or artificial vascular bypass can be performed [21]. Doppler ultrasound can reveal locations of the saphenous vein and provide accurate positioning for surgery (Figures 3d and 3e).…”

Section: Journal Of Heart Healthmentioning

confidence: 99%

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

Zhong¹,

Liang²,

Shao³

et al. 2021

J Heart Health

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Surgical management of functional popliteal entrapment syndrome in athletes

Cited by 26 publications

References 17 publications

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

Functional Popliteal Artery Entrapment Syndrome: An Approach to Diagnosis and Management

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

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