J Korean Soc Vasc Surg.  2000 Nov;16(2):249-254.

Thrombolytic Therapy Followed by Myotomy of Gastrocnemius Muscle in Popliteal Artery Entrapment Syndrome

• Jung IM
• Seong IW
• Choe SC
• Jeon ES
• Bae JS

Abstract

Popliteal artery entrapment syndrome (PAES) is rare, but increasingly reported in the literature as a cause of lower limb arterial impairment. Management of a patient with PAES depends on the clinical pictures. Currently, myotomy of the medial head of gastrocnemius muscle with interposition grafting or bypass of diseased popliteal artery has been widely used in cases with a demaged or occluded artery. But, other less extensive therapeutic approaches were also performed instead of it. We present a case of type II popliteal entrapment syndrome in an 36-year-old male. Presenting symptom was exercise- induced pain in his right calf since one month ago. Arteriography showed occlusion in short segment of right popliteal artery and intact distal run-off arteries. After overnight urokinase thrombolysis, residual focal stenosis and medial deviation of popliteal artery were observed. CT scan showed abnormal structure between right popliteal artery and popliteal vein, so, diagnosis was established. After myotomy of the medial head of gastrocnemius muscle, the symptom resolved completely. Post-operative duplex scan showed normal blood flow, even in active plantar flexion of the foot. In our case, early diagnosis and combined approach of endovascular thrombolytic therapy followed by surgical release of popliteal artery enabled to avoid direct vascular surgery such as bypass or interposition grafting with resolution of ischemic symptoms. This thrombolytic therapy does not obviate surgery but may permit a less extensive procedure to be performed in PAES.

Keyword

Popliteal artery entrapment syndrome; Thrombolytic therapy

MeSH Terms

Adult
Angiography
Arteries
Constriction, Pathologic
Diagnosis
Early Diagnosis
Foot
Head
Humans
Lower Extremity
Male
Muscle, Skeletal*
Popliteal Artery*
Popliteal Vein
Thrombolytic Therapy*
Tomography, X-Ray Computed
Transplants
Urokinase-Type Plasminogen Activator
Urokinase-Type Plasminogen Activator