Lewis J. Levien, MB, BCh, FCS(SA), PhD, FACS, Martin G

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Presentation transcript:

Popliteal artery entrapment syndrome: More common than previously recognized Lewis J. Levien, MB, BCh, FCS(SA), PhD, FACS, Martin G. Veller, MB, BCh, FCS(SA) Journal of Vascular Surgery Volume 30, Issue 4, Pages 587-598 (October 1999) DOI: 10.1016/S0741-5214(99)70098-4 Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Embryologic derivation of popliteal and other lower limb arteries indicating which are derived from the axial artery and which nonaxial arteries develop with later differentiation. Journal of Vascular Surgery 1999 30, 587-598DOI: (10.1016/S0741-5214(99)70098-4) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Pictorial representation of migration of the medial head of gastrocnemius muscle through the popliteal fossa during formation of the popliteal artery. A, Medial head of gastrocnemius muscle commences migration from region of fibula. At this stage, axial distal popliteal artery lies deep to popliteus muscle. B, Distal portion of popliteal artery involutes as medial head of gastrocnemius muscle passes from lateral to medial. Proximal popliteal artery is derived from fusion with developing femoral plexus, and mid portion of popliteal artery is formed from persistent axial artery remnant. C, New or nonaxial distal popliteal artery now forms superficial to popliteus muscle, after medial head has migrated through popliteal fossa. D, Normal definitive popliteal anatomy. Journal of Vascular Surgery 1999 30, 587-598DOI: (10.1016/S0741-5214(99)70098-4) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Classification of types of popliteal artery entrapment syndrome. Journal of Vascular Surgery 1999 30, 587-598DOI: (10.1016/S0741-5214(99)70098-4) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Examples of angiography of popliteal artery entrapment syndrome. A, Demonstrates medial and then lateral deviation of artery at rest as result of type III additional muscular head causing entrapment. B, Demonstrates localized entrapment of artery with plantar flexion as result of localized fibrous band causing type III entrapment. C, Demonstrates occlusion of distal popliteal artery with plantar flexion as result of type IV popliteal entrapment confirmed at operation. D, Demonstrates localized popliteal artery aneurysm formation as result of popliteal artery entrapment syndrome. E, Demonstrates embolic occlusion of distal popliteal artery, embolus originating from aneurysmal change because of popliteal entrapment. F, Demonstrates longer smooth entrapment often seen with “functional” or type VI entrapment. Journal of Vascular Surgery 1999 30, 587-598DOI: (10.1016/S0741-5214(99)70098-4) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions