William D. Turnipseed, MD, Myron Pozniak, MD

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Presentation transcript:

Popliteal entrapment as a result of neurovascular compression by the soleus and plantaris muscles William D. Turnipseed, MD, Myron Pozniak, MD Journal of Vascular Surgery Volume 15, Issue 2, Pages 285-294 (February 1992) DOI: 10.1016/0741-5214(92)90250-C Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 The medial approach is routinely used in symptomatic patients suspected of having functional popliteal entrapment. The popliteal fossa is explored to rule out an anatomic form of entrapment. If the semimembranous and semitendinous tendons or gracilis and sartorial insertions must be transected during exploration of the popliteal fossa, they should be repaired before closure. Journal of Vascular Surgery 1992 15, 285-294DOI: (10.1016/0741-5214(92)90250-C) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 The deep proximal (soleal compartment) is decompressed by lysing the medial attachments of the muscle to the tibia. The dense anterior fascial sling of the soleus is sharply excised laterally to its fibular attachments. The plantaris muscle is resected. Journal of Vascular Surgery 1992 15, 285-294DOI: (10.1016/0741-5214(92)90250-C) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Screening test in a patient with right-sided soleal claudication demonstrates bilateral popliteal artery compression in both the plantar flexion and dorsiflexion positions. Journal of Vascular Surgery 1992 15, 285-294DOI: (10.1016/0741-5214(92)90250-C) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 A, Duplex imaging demonstrates a widely patent popliteal artery and normal flow in the foot in neutral position. B, A popliteal artery in the same patient occludes against the posterior surface of the tibia with forced plantar flexion of the foot. Journal of Vascular Surgery 1992 15, 285-294DOI: (10.1016/0741-5214(92)90250-C) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Intravenous digital subtraction angiography demonstrates normal arterial anatomy on the right side with the foot in neutral position. On the left side lateral deviation from the midline position and compression of the popliteal artery occur against the lateral condyle of the femur (arrow). Journal of Vascular Surgery 1992 15, 285-294DOI: (10.1016/0741-5214(92)90250-C) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 A, Magnetic resonance gradient echo image demonstrates a normally positioned popliteal artery at rest. B, Sagittal MRI shows patient's popliteal artery in neutral position. C, When the foot is plantar flexed, the popliteal artery is occluded by lateral compression against the femoral condyle and the soleal sling. D, Sagittal MRI in plantar flexion demonstrates popliteal artery occlusion. Journal of Vascular Surgery 1992 15, 285-294DOI: (10.1016/0741-5214(92)90250-C) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 Postoperative pulse volume recording demonstrates release of a functional entrapment on the right side after a deep proximal compartment release and plantar resection. Journal of Vascular Surgery 1992 15, 285-294DOI: (10.1016/0741-5214(92)90250-C) Copyright © 1992 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions