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Abstract

The comments made in the letter by Dr Russell Samson and Dr David Showalter are much appreciated. All patients in our series presented with severe claudication that limited their sporting and, occasionally, their daily activities. As part of the initial diagnostic workup, each patient was evaluated using noninvasive studies that included tests intended to exclude hemodynamically significant aortoiliac inflow stenosis. Both limbs of all patients were evaluated by contrast arteriography, and in all cases the aortoiliac segment was carefully studied to exclude inflow disease before treating the patient for popliteal artery entrapment. In only one patient was a lesion of the aortoiliac segment detected, and in this female the pathology was stenosis due to fibromuscular dysplasia, which was subjected to successful balloon angioplasty. She has remained asymptomatic and with normal inflow on noninvasive tests after 5 years' follow-up. We are very aware of the existence of the iliac artery compression syndrome that has been described in competitive cyclists. We have actively pursued such a diagnosis in our series, as we believe that the pathological changes in the arterial wall of such cases are similar to those degenerative changes that we have described in the popliteal artery with entrapment and in the subclavian artery with thoracic outlet syndrome.1Levien LJ. Popliteal artery thrombosis caused by popliteal entrapment syndrome.in: Inflammatory and thrombotic problems in vascular surgery. WB Saunders, London1997: 159-168Google Scholar, 2Levien LJ. Historical changes in external arterial compression syndromes.Cardiovasc Surg. 1999; 7: 57-58Google Scholar The majority of our patients in whom a diagnosis of functional popliteal artery entrapment was made were referred after full evaluation at sports medicine clinics where compartmental syndromes and other more common causes of leg pain in the athlete had been excluded. In addition, virtually all patients diagnosed with symptomatic functional popliteal artery entrapment and treated with myotomy of the medial head of the gastrocnemius muscle have returned to full sporting activities after the surgery. In conclusion, we have carefully excluded the iliac artery compression syndrome in our series of symptomatic popliteal artery entrapments reported in the Journal. We continue to believe that this condition, both anatomic and functional, is a frequently underdiagnosed cause of symptoms in the young, athletic claudicant.