RESEARCH ARTICLE


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



Hasan Baki Altinsoy1, Ozkan Alatas1, Emjed Khalil2, Kenan Abdurrahman Kara3, Candan Cudi Okten4, Omer Faruk Dogan4, *
1 Department of Radiology, Health Sciences University, Elazig Research and Training Hospital, Elazig, Turkey
2 Department of Cardiovascular Surgery, Health Sciences University, Dr. Cengiz Aslan Research and Training Hospital, Gaziantep, Turkey
3 Department of Cardiovascular Surgery, Private Camlica Medicana Hospital, Istanbul, Turkey
4 Department of Cardiovascular Surgery, Health Sciences University, Adana Numune Research and Training Hospital, Adana, Turkey


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Creative Commons License
© 2018 Altinsoy et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Cardiovascular Surgery, Adana Numune Research and Training Hospital, Adana, Turkey, Tel: 090533-4813056; E-mail: ofdogan@hacettepe.edu.tr


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.

Keywords: Popliteal artery entrapment syndrome, Diagnosis, Surgery, Treatment.