A Very Rare Cause of Lower Limb Ischemia in Young People: Popliteal Artery Entrapment

Abstract

Background:Popliteal artery entrapment syndrome (PAES) is a very rare pathology that can cause lower extremity ischemia in healthy young people. Anomalous anatomic relationships between the popliteal artery (PA) and the surrounding musculo-tendinous structures cause PAES. We present 31 patients with PAES in 35 limbs that were treated surgically in our clinic within a 12-year period.Patients and Methods:From 2001 to 2015, 31 patients (mean age: 32 ± 7.4 years) underwent surgery for PAES. ; 4 patients presented had bilateral PAES. Doppler ultrasonography (US), magnetic resonance angiography (MRA), and conventional angiography were performed as diagnostic procedures. We detected Type I PAES in 4 limbs and Type II PAES in 12 limbs. In the remaining 19 limbs, we diagnosed Type III or Type IV PAES. Simple release of the PA, PA embolectomy and simple release, and the radial artery (RA) patch angioplasty, with or without thromboendarterectomy (TEA), were performed. In 12 limbs, PA continuity was provided by RA interposition.Results:With the exception of 5 patients, no complications were seen after surgery. Haematoma was detected in 2 patients and local infection in 2 patients. One patient required a revision for recurrent PA thromboembolic event 12 h after surgery. At a median follow- up of 23 months (range: 11-29 months), there were no postoperative complications.Conclusions:PAES can result in lower limb ischemia due to chronic vascular trauma in young healthy patients. The use of diagnostic tools such as US, a non-invasive method, and MRA are effective diagnostic tools for early diagnosis. With their combined approach, exact and early diagnosis can be achieved. PA release, alone or with arterial bypass using RA, is a viable treatment option when intervention is necessary to prevent limb loss in the early stages of the disease.

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“…The use of angioplasty to treat extensive disease of the superficial femoral artery has particularly poor results: at one year, the rates of restenosis exceed 70 percent for lesions longer than 100 mm. Drug-coated balloon angioplasty (DCBA) was shown to be superior to standard balloon angioplasty (POBA) in terms of restenosis prevention for de novo superficial femoral artery disease [26,27]…”

Síndrome do aprisionamento da artéria tibial anterior bilateral pelo retináculo extensor do tornozelo: relato de caso

“…Popliteal artery entrapment (PAA) is the most prevalent of these conditions, with an incidence in the range of 0.16 to 3.5%, has congenital or functional etiology, affects young people, primarily males, causes symptoms involving muscle groups below the knee, and is generally unilateral and asymptomatic. [2][3][4][5] However, when the site of effort-related discomfort is more distal, located in the dorsal or plantar part of the foot, we must consider other sites of arterial compression, lower than those typically found in PAA. In these situations, anterior tibial artery entrapment (ATAE) should be suspected.…”

Waist Training Corset: An Unusual Cause of Acute Lower Limb Ischemia

“…Clinical events that cause ALI include acute thrombosis of a limb artery or bypass graft, embolism from the heart, or a diseased artery, dissection, and trauma (from the severing of an artery or thrombosis) [1][2]. There is, however, a growing list of uncommon causes of ALI, which include aortic intimal sarcoma [3], popliteal artery entrapment syndrome [4], and prolonged arterial vasospasm of multiple vessels in multiple extremities simultaneously [5].…”