| Introduction |
 A condition characterized by constriction of the popliteal artery by either
- adjacent muscles
- tendons
- fibrous tissues
- Epidemiology
- 2-4:1 female predominance
- patient age typically 25-40 years old
- Mechanism
- typically due to underlying anatomic abnormality
- Pathophysiology
- decreased blood flow distal to the popliteal fossa leading to signs and symptoms consistent with compartment syndrome
- Prognosis
- 70-100% of patients are reported to be asymptomatic after surgery
|
| Classification and Anatomy |
| |
| Modified Whelan Classification |
| Type I |
Medial head of the gastrocnemius is normal but the popliteal artery runs in a aberrant course
|
|
| Type II |
Medial head of the gastrocnemius is located laterally, no deviation of popliteal artery |
|
| Type III |
There is an abnormal muscle bundle from the medial head of the gastrocnemius that surrounds and constricts the popliteal artery |
|
| Type IV |
Popliteal artery is entrapped by the popliteus muscle |
|
Type V
|
Type V occurs when the popliteal vein is entrapped with the popliteal artery in any of the above scenarios |
|
|
| Presentation |
- Symptoms
- swelling
- patients often report limb swelling as primary complaint
- paresthesias
- foot numbness and paresthesias also common
- tingling sensation of toes following vigorous exercise
- cramping
- calf cramping following light exercise which improves with vigorous exercise
- limbs can occasionally be asymptomatic
- Physical exam
- diminished pulses with active foot plantar flexion or passive foot dorsiflexion
- coolness of posterior calf and paresthesias may also be present
- can easily be confused with posterior compartment syndrome
|
| Imaging |
- Radiographs
- Doppler ultrasound
- less invasive than arteriogram
- useful during physical exam to detect changes in pulse when active plantar flexion or passive dorsiflexion is performed
- Arteriogram
- used to confirm diagnosis
- close to 100% sensitivity
- will show stenosis, obliteration and post-stenotic dilation
- MRI/MRA and CT/CTA
- studies ongoing to evaluate usefulness for detection of popliteal artery entrapment
|
| Treatment |
- Nonoperative
- activity modification and observation
- indications
- mild symptoms with rigorous exercise only
- Operative
- vascular bypass with saphenous vein vs endarterectomy
- indications
- if damage to the popliteal artery or vein
- most patients eventually require surgery
- technique
- can perform posterior or medial approach to popliteal fossa
- posterior approach provides improved exposure
- medial approach used more when bypass is indicated
- structures released depend on the type of entrapment
|
| Complications |
- Surgical failure
- 30% rate of return of entrapment
- can result in need for amputation
- Wound infection
- DVT
|