1. Infrageniculate bypass graft entrapment
Jeffrey P. Carpenter, MD, Micheal D. Lieberman, MD, Richard Shlansky-Goldberg, MD, Stuart E. Braverman, MD, Micheal Soulen, MD, George A. Holland, MD, Richard A. Baum, MD, Rodney S. Owen, MD, Michael A. Golden, MD, Henry D. Berkowitz, MD, Clyde F. Barker, MD, Leonard J. Perloff, MD 
Journal of Vascular Surgery 
Volume 18, Issue 1, Pages (July 1993)
DOI: /mva
Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

2. Fig. 1
Arteriographic findings in patient with vein graft entrapment (case 1). Patient's prebypass arteriogram (A) shows anatomic course of the native popliteal artery. Four years later the patient had acute leg ischemia and was found to have a thrombosed below-knee femoropopliteal bypass graft. After 36 hours of lytic therapy, a lateral projection arteriogram (B) was obtained, which showed brisk graft flow only with the knee flexed. An oblique projection (C) demonstrated the graft to be compressed on slight leg extension (arrow). By comparison with the prebypass arteriogram (A) it is apparent that the graft follows a course that is medial to the anatomic location of the popliteal artery. Subsequently this graft was found to pass medial to the medial head of the gastrocnemius muscle.
Journal of Vascular Surgery  , 81-89DOI: ( /mva )
Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

3. Fig. 2
Operative findings from case 1. Popliteal space shown exposed through a medial lower leg incision (A). One vascular tape surrounds the vein graft, whereas the lower vascular tape is around the medial head of the gastrocnemius muscle. The popliteal artery and vein (white arrow) are seen to lie in the popliteal space deep to the medial head of the gastrocnemius muscle, and the vein graft passes superficial to this muscle. On leg straightening the graft was compressed between the semitendinosus and gracilis tendons (black arrow) and the gastrocnemius muscle. Division of the medial head of the gastrocnemius (B) and placement of the vein graft in the popliteal space relieved the entrapment syndrome. The divided muscle (held in the clamps) was resutured.
Journal of Vascular Surgery  , 81-89DOI: ( /mva )
Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

4. Fig. 3
Arteriogram from case 3, performed for contralateral symptoms 2 years after creation of a below-knee femoropopliteal bypass graft on the side shown. Asymptomatic entrapment was suspected based on characteristic location of the vein graft medial to the anatomic course of the native popliteal artery (black arrow) and its kinked appearance at the level of the medial femoral condyle (white arrow). The graft occluded 2 years later. At operative exploration it was found to pass superficial to the medial head of the gastrocnemius muscle.
Journal of Vascular Surgery  , 81-89DOI: ( /mva )
Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

5. Fig. 4
Arteriogram from a patient with iatrogenic vein graft entrapment (case 4). Compression of the vein graft (white arrow) is noted as well as its course differing from that of the native popliteal artery (black arrow). Entrapment was between the medial head of the gastrocnemius muscle and the tendons of the semitendinosus and gracilis muscles.
Journal of Vascular Surgery  , 81-89DOI: ( /mva )
Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

6. Fig. 5
Intraarterial pressure measurements obtained during angiography in a patient with vein graft entrapment (case 4). Position-dependent dampening of the arterial pressure trace noted with leg extension.
Journal of Vascular Surgery  , 81-89DOI: ( /mva )
Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

7. Fig. 6
Magnetic resonance angiogram from a patient with iatrogenic entrapment of a below-knee femoropopliteal bypass graft (case 4). Axial images (A-D) demonstrate the course of the graft passing superficial to the medial head of the gastrocnemius muscle (arrow) and compression between the gastrocnemius and the tendons of the semitendinosus and gracilis muscles. Entrapment relieved by division of the medial head of the gastrocnemius muscle.
Journal of Vascular Surgery  , 81-89DOI: ( /mva )
Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

8. Fig. 7
Arteriographic findings after 6 hours of intraarterial lytic therapy in a patient with iatrogenic vein graft entrapment (case 5). Some residual clot is present in the vein graft which lysed after 24 hours of intraarterial urokinase. The graft follows a course medial to that of the native popliteal artery (black arrow), and appears to be compressed at the level of the tibial plateau (white arrow). The graft was found to pass through the medial head of the gastrocnemius muscle and to be compressed by the muscle itself and between the muscle and the tibial plateau. This was treated by division of the medial head of the gastrocnemius.
Journal of Vascular Surgery  , 81-89DOI: ( /mva )
Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

9. Fig. 8
Sites of vein graft entrapment, posterior (A) and lateral (B) views. Compression has been observed between the medial head of the gastrocnemius and the tendons of the semitendinosus and gracilis muscles (A), and the tibia and the femoral condyle (B).
Journal of Vascular Surgery  , 81-89DOI: ( /mva )
Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions