Popliteal artery entrapment syndrome. Surgical treatment and analysis of patients

Popliteal artery entrapment syndrome is a rare (prevalence: 1.55%) but important cause of claudication in young adults with anomalous anatomic relationships between the popliteal artery and surrounding musculotendinous structures. Other reasons for popliteal artery compression syndromes are cystic adventitial disease, collagen vascular disease, cysts, and anomalies of the femur. The clinical picture of patients with popliteal artery entrapment syndrome is cramping in the calf and foot and claudication. The treatment of choice is surgical restoration of the artery and vascular reconstruction to avoid secondary vascular complications. From 1997 to 2003 we found popliteal artery entrapment syndrome in 30 of 806 patients with femorodistal arterial reconstructions for chronic ischemia of the lower extremities. In these 30 cases, popliteal compression syndrome arose due to compression of the popliteal artery by tendomuscular structures and an abnormal position of the artery. Using a dorsal approach to the fossa poplitea, we performed a myotomy and interposition of vein graft in 13, and thromboendarterectomy with patch graft in nine cases, while in eight other cases we performed a myotomy and restoration of the artery to the normal position. In one patient a graft thrombosis and in another a popliteal re-entrapment (5 years after primary treatment) occurred. Conclusions: All cases of popliteal artery entrapment syndrome, whether the artery was occluded or not, could be operated using a dorsal approach (anatomic restoration) and had a low postoperative complication rate.