Popliteal Vascular Entrapment Research Articles

Cross-sectional imaging of popliteal artery entrapment syndrome

A 63-year-old asymptomatic man with unlimited exercise tolerance is investigated for suspected popliteal aneurysms, due to absent pedal pulses and prominent popliteal pulsations. Contrast-enhanced computed tomography (CT) shows occlusion of the left popliteal artery with geniculate collaterals surrounding the popliteal vein (A). The medial head of gastrocnemius separates the popliteal vein and the occluded (entrapped) popliteal artery. CT also shows entrapment of the right popliteal artery, due to extrinsic compression by the abnormally sited tendon of the medial head of gastrocnemius, which separates the artery and vein, mirroring the muscular anatomy on the left (B). A second 55-year-old man, normally walking 10-12 miles per day without restriction, presents with acute right leg claudication at 200 m. Contrast-enhanced CT demonstrates left popliteal artery stenosis with post-stenotic dilatation and right distal popliteal embolic occlusion due to a popliteal aneurysm with thrombus secondary to bilateral popliteal entrapment syndrome (PAES) (C). Axial balanced flow fast field echo magnetic resonance images and corresponding CT axial images demonstrate that the left medial head of gastrocnemius passes between the popliteal artery and popliteal vein. However, the aneurysmal right popliteal artery and the right popliteal vein are both located medial to, and are not separated by, the medial head of gastrocnemius (D). PAES is an uncommon cause of occlusive arterial disease, which is often bilateral. It is caused either by abnormal muscular insertions, typically of the medial head of gastrocnemius or the popliteus muscle, or by anomalous fibrous bands (types II, III, and IV, according to the modified Whelan classification).1Rich N.M. Collins G.J. McDonald P.T. Kozloff L. Clagett G.P. Collins J.T. Popliteal vascular entrapment: its increasing interest.Arch Surg. 1979; 114: 1377-1384Google Scholar Less commonly, an abnormal course of the popliteal vessels around normally inserted muscles is responsible for the entrapment (type I). Arteriovenous (type V) and functional entrapments have also been described. As illustrated, cross-sectional studies are very useful in demonstrating the abnormal anatomy. These two cases also show that muscular abnormalities are not always symmetrical in bilateral PAES (all limbs presenting as type II, except for the right leg of the second patient, which can be classed as type I, due to the medial course of the artery around a normal insertion of the medial head of gastrocnemius). Both patients consented to the publication of the case details and relative images.

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

Background: To retrospectively evaluate Doppler ultrasound findings for patients with Popliteal Vascular Entrapment Syndrome (PVES).

Popliteal Vessels Entrapment by a Variant Accessory Belly of Medial Head of Gastrocnemius

The present case report regards the incidental finding of right popliteal vessels entrapment by a variant accessory belly of the medial head of gastrocnemius. The accessory head of gastrocnemius took origin from the popliteal surface of the femur and joined the medial head. The popliteal vessels passed between the medial and the accessory head of the gastrocnemius. The accessory head was quite large and was supplied by a branch of tibial nerve. Popliteal vessels compression usually leads to a condition called popliteal vascular entrapment syndrome which is a rare clinical entity, predominantly in young adults. This anomaly might cause intermittent claudication, aneurysmal dilatation, thromboembolism and eventually limb-threatening ischemia. Early recognition and diagnosis is important to minimize surgical treatment and avoid vascular reconstruction. Knowledge about the rare anatomical variants of popliteal vessels is helpful for correct diagnosis and planning of treatment.

Popliteal vascular entrapment syndrome caused by variant lateral head of the gastrocnemius muscle leading to pulmonary artery embolism

A young man with popliteal vascular entrapment syndrome (PVES) presented with arterial occlusion, deep venous thrombosis (DVT), pulmonary artery embolism, and pulmonary hypertension. He received computer tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI showed that the left thrombosed popliteal vein and artery were entrapped by a variant lateral head of the gastrocnemius muscle. The anomalous slip originated from the lateral head of left gastrocnemius muscle and ended between the medial and lateral femoral condyles. PVES Type V was diagnosed. Compression of the popliteal vein without arterial compression can be explained by the more lateral location of the popliteal vein relative to the artery and its proximity to the lateral head of the gastrocnemius. Compression of the popliteal vein with arterial compression was found in this patient. Compression of popliteal vein and artery in this patient led to DVT and arterial occlusion. The case was the first reported case accompanied by popliteal vein and artery thrombosis caused by variant lateral head of the gastrocnemius muscle. Radiologists and doctors should continue to look for possible abnormalities in the popliteal fossa in young patients with peripheral vascular disease because early diagnosis of PVES allows better choices and outcomes of treatment.

Role of CT Angiography in the Diagnosis and Treatment of Popliteal Vascular Entrapment Syndrome

Popliteal vascular entrapment syndrome is an uncommon congenital abnormality of the anatomic relations between the popliteal vessels and the neighboring musculotendinous structures. The purpose of this essay is to describe the CT angiographic findings in the diagnosis and treatment of this syndrome. Digital subtraction angiography is of limited value in the evaluation of popliteal vascular entrapment syndrome and has been replaced by noninvasive imaging techniques, such as Doppler sonography, CT angiography, MRI, and MR angiography.

Endovascular Stenting for Popliteal Vascular Entrapment Is Not Recommended

Endovascular techniques are often applied, but they have occasionally been reported in the treatment of popliteal vascular entrapment (PVE). A case of bilateral PVE is presented with an acute occlusion of the right popliteal artery. This was twice unsuccessfully treated with arterial recanalization and stenting at another Institution. The patient required an arterial reconstruction with his reversed saphenous vein, in addition to resection of the medial gastrocnemius muscle laterally inserted on his right limb. The left limb was treated with a simple myotomy. Recanalization and stenting is not recommended for PVE treatment.

Diagnosis of Popliteal Venous Entrapment Syndrome by Magnetic Resonance Imaging Using Blood-Pool Contrast Agents

Popliteal vascular entrapment syndrome is caused by aberrations or hypertrophy of the gastrocnemius muscles, which compress the neurovascular structures of the popliteal fossa, leading to symptoms of vascular and degeneration as well as aneurysm formation. Imaging of popliteal vascular entrapment may be performed with ultrasound, magnetic resonance imaging (MRI), computed tomography angiography, and conventional angiography. The use of blood-pool contrast agents in MRI when popliteal vascular entrapment is suspected offers the possibility to perform vascular imaging with first-pass magnetic resonance angiographic, high-resolution, steady-state imaging and allows functional tests all within one examination with a single dose of contrast agent. We present imaging findings in a case of symptomatic popliteal vein entrapment diagnosed by the use of blood pool contrast-enhanced MRI.

Popliteal artery entrapment syndrome

Popliteal vascular entrapment is second only to atherosclerosis as the most common surgically correctible cause of leg claudication in young adults. Affected patients are often athletic individuals who present before the age of 50. This chapter highlights the abnormal developmental anatomy that is now accepted as the cause of popliteal entrapment and serves as the basis for the modern classification system. The importance of the unique histopathological changes observed in arterial entrapment syndromes are summarized, and the natural history of chronic arterial compression is reviewed. The diagnosis, investigation, and treatment proposed are based upon the currently published literature.

Popliteal Entrapment and Adventitial Cystic Disease

Both popliteal vascular entrapment and adventitial cystic disease of the popliteal artery have been recognized with increasing frequency during approximately the past 20 years. A knowledge of these lesions, which were previously thought to be rare and unusual, is mandatory in evaluating patients, particularly the younger, nonsmoking, nonarteriosclerotic, athletic man who has the sudden onset of intermittent claudication. With the increasing interest in these lesions and increasing consideration of these diagnostic possibilities, it will probably be recognized that these lesions are more common than has been thought.

Popliteal vascular entrapment. Its increasing interest.

In the past 20 years since the first clinical management of a patient with a congenital anomaly associated with an abnormal medial head of the gastrocnemius muscle causing external compression on the popliteal artery, approximately 100 similar lesions have been documented in the world's literature. This has been a lesion of international interest, with only approximately 25% of the cases from hospitals in the United States. This present series of 14 lesions from Walter Reed Army Medical Center, Washington, DC, during a 12 1/2-year period beginning in September 1966 emphasizes the increasing interest in this lesion. The young athletic male in whom intermittent claudication develops with strenuous exercise or the middle-aged patient with a popliteal aneurysm should be evaluated for the possibility of popliteal vascular entrapment. Medial deviation of the popliteal artery seen angiographically is a classic finding, however, there might also be segmental occlusion of the midpopliteal artery. This series outlines various types of popliteal vascular entrapment and documents successful surgical management.