Todd M. Gerkin, MD, Hugh G. Beebe, MD, David M. Williams, MD, Jess R

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Presentation transcript:

Popliteal vein entrapment presenting as deep venous thrombosis and chronic venous insufficiency Todd M. Gerkin, MD, Hugh G. Beebe, MD, David M. Williams, MD, Jess R. Bloom, RVT, Thomas W. Wakefield, MD Journal of Vascular Surgery Volume 18, Issue 5, Pages 760-766 (November 1993) DOI: 10.1016/0741-5214(93)90329-K Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Arteriogram demonstrates entrapment of left popliteal artery (arrow). B, Fibrous extension of medial head of gastrocnemius muscle drawn in on subtraction arteriogram with entrapment of left popliteal artery (arrow, case 1). Arteriograms have been reversed 180 degrees to remain consistent with drawings in Fig. 2. Journal of Vascular Surgery 1993 18, 760-766DOI: (10.1016/0741-5214(93)90329-K) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Normal anatomy of left popliteal fossa. B, Compression of left popliteal artery and vein as seen from left posterior approach by fibrous extension of medial head of gastrocnemius muscle as indicated by Loop around fibrous extension (case 1). Journal of Vascular Surgery 1993 18, 760-766DOI: (10.1016/0741-5214(93)90329-K) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Bilateral ascending venograms reveal entrapment of duplicated popliteal veins at midportion (arrows). A, Right leg; B, left leg (case 2). Journal of Vascular Surgery 1993 18, 760-766DOI: (10.1016/0741-5214(93)90329-K) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Drawing of entrapment of duplicated popliteal veins by medial head of gastrocnemius muscle as would be noted from left posterior approach (case 2). Because patient did not undergo surgical treatment, exact anatomic variant can only be speculated; however, only venous entrapment and not arterial entrapment was present. Journal of Vascular Surgery 1993 18, 760-766DOI: (10.1016/0741-5214(93)90329-K) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Ascending right leg venogram without tourniquet (A) and with tourniquet (B) demonstrates significant narrowing of midright popliteal vein (arrows, case 3). Journal of Vascular Surgery 1993 18, 760-766DOI: (10.1016/0741-5214(93)90329-K) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Note lesser saphenous vein taking abnormal origin and medial route, compression of tibial nerve, and severe distortion and narrowing of popliteal vein (arrow). Also note altered relationship between tibial nerve medially and popliteal vein laterally (case 3). Journal of Vascular Surgery 1993 18, 760-766DOI: (10.1016/0741-5214(93)90329-K) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Ascending venogram obtained 6 months after surgery shows no obstruction of popliteal vein with knee in extension (A) and flexion (B) (case 3). Note area of previous entrapment (arrow). Journal of Vascular Surgery 1993 18, 760-766DOI: (10.1016/0741-5214(93)90329-K) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions