Ann Surg Treat Res.  2018 May;94(5):262-269. 10.4174/astr.2018.94.5.262.

Anatomical popliteal artery entrapment syndrome

Affiliations
  • 1Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. twkwon2@amc.seoul.kr
  • 2Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
  • 3Department of Anatomy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 4Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

PURPOSE
The aim of this study was to analyze anatomical popliteal artery entrapment syndrome (PAES) and to individualize the treatment of this condition according to the anatomical status of the artery and the adjacent structure.
METHODS
A total of 35 anatomical PAES legs in 23 consecutive patients treated within the Asan Medical Center, Seoul, Korea between 1995 and 2011 were analyzed retrospectively. Anatomical PAES was diagnosed by MRI and/or CT scans of the knee joint, and CT or conventional transfemoral arteriography of the lower extremities.
RESULTS
We noted a type II gastrocnemius medial head (GNM) anomaly, a type III GNM anomaly, or an aberrant plantaris muscle in 51.4%, 20%, and 28.6% of PAES legs, respectively. In assessments of the arterial lesions, popliteal or tibial artery occlusion was noted in 19 of 26 symptomatic PAES legs. For cases without popliteal artery lesions, myotomy of the anatomically deranged muscle was performed in 5 of 7 symptomatic and 4 of 9 asymptomatic PAES legs. For occluded popliteal arteries, we performed ten direct repairs of the pathological popliteal artery and 4 femoro-below the knee popliteal bypass surgeries. As a result of the arterial Surgery, 9 direct procedures with myotomy yielded a patent artery, while 3 graft failures were noted in the bypass group. The median follow-up period was 84 months (range, 12-206 months).
CONCLUSION
We recommend that treatment of PAES should be individualized based on pathology, symptoms, and various imaging studies.

Keyword

Plantaris muscle; Popliteal artery

MeSH Terms

Angiography
Arteries
Chungcheongnam-do
Follow-Up Studies
Head
Humans
Knee
Knee Joint
Korea
Leg
Lower Extremity
Magnetic Resonance Imaging
Muscle, Skeletal
Pathology
Popliteal Artery*
Retrospective Studies
Seoul
Tibial Arteries
Tomography, X-Ray Computed
Transplants
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