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Popliteal Entrapment

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  • • Rare cause of stenosis or occlusion

    • Occurs because of anomalous course of popliteal artery

    • Popliteal artery passes medial to medial head of gastrocnemius muscle (normally passes lateral)

    • -Causes compression of popliteal artery when knee extended

    • 5 anatomic variations

    • Fibrous thickening progresses to occlusion, with poststenotic dilation which may be source for mural embolus

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Cystic Degeneration of Popliteal Artery

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  • • Arterial stenosis produced by mucoid cyst in adventitia

    • Located in middle third of artery

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Epidemiology

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Popliteal Entrapment

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  • • Occurs more often in young, healthy persons

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Symptoms and Signs

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Popliteal Entrapment

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  • • Symptoms range from calf claudication to severe ischemia

    • Diminished pedal pulses with foot dorsiflexion and plantar flexion

    • Atherosclerotic changes absent

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Cystic Degeneration of Popliteal Artery

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  • • Calf claudication most common

    • Decreased pedal pulse strength

    • Mass may be palpated (rarely)

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Imaging Findings

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Popliteal Artery Entrapment

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  • • MRI often useful to diagnose

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Cystic Degeneration of Popliteal Artery

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  • Arteriography: Sharply localized zone of politeal stenosis with smooth concentric tapering, having hourglass appearance

    US/CT scan: Can demonstrate cyst in artery wall

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  • • Atherosclerotic changes absent

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  • • Complete history and physical exam

    • -Consider diagnosis in young healthy patient with calf claudication or ischemia

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Surgery

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Popliteal Entrapment

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  • • Division of medial head of gastrocnemius muscle, graft replacement of diseased artery; lumbar sympathectomy performed as well

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Cystic Degeneration of Popliteal Artery

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  • • Cyst excision, may recur

    • Arterial excision and graft replacement may be necessary in some patients

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References

Ring DH Jr et al. Popliteal artery entrapment syndrome: arteriographic findings and thrombolytic therapy. J Vasc Interv Radiol. 1999:10:713.
O'Hara N et al. Surgical treatment for popliteal artery entrapment syndrome. Cardiovasc Surg. 2001;9:141.

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