Isolated popliteal vein entrapment

Popliteal vein entrapment syndrome associated with an accessory slip of the lateral head of the gastrocnemius muscle

Popliteal vein entrapment syndrome (PVES) is a rare subtype of popliteal entrapment syndrome that leads to symptoms of chronic venous stasis. We report a case of isolated PVES in a young patient associated with an accessory slip of the lateral head of the gastrocnemius muscle. The patient underwent resection of the anomalous muscle, and the symptoms were relieved postoperatively. PVES should be considered in young patients with unexplained symptoms or signs of venous stasis. Surgical resection of the causative lesion compressing the popliteal vein is indicated for selected patients.

Venous Compression Syndromes

Venous compression syndromes occur due to extrinsic compression causing complications of venous hypertension or venous thrombosis. This review focuses on 4 venous compression syndromes involving the left common iliac vein, subclavian vein, left renal vein, and popliteal vein. Clinical presentation, diagnostic methods, and management options are reviewed. When properly diagnosed and treated, long-term consequences can be avoided.

Isolated Popliteal Vein Entrapment by a Fibrous Band

Popliteal vein entrapment is commonly associated with popliteal artery entrapment, whereas isolated popliteal vein entrapment is a less common entity. The authors present a case of isolated popliteal vein entrapment caused by a fibrous band.

Popliteal vein compression syndrome: obesity, venous disease and the popliteal connection

Objectives

Obesity and venous disease are commonly encountered together. The aetio- logical relationship, however, has not been clear. Popliteal venous compression (PVC) has been encountered both on ultrasound and venographically. In this study, patients with symptoms and/or signs of chronic venous hypertension with PVC were investigated and the relationship to obesity was defined.

Methods

A total of 89 patients were included in the study, of which 49 limbs were classified as having PVC defined as a greater than 90% reduction in the maximum internal diameter (ID) of the popliteal vein (POPV) with knee locking. Forty consecutive limbs with venous disease with no evidence of PVC were used as controls. The body mass index (BMI) of each group was calculated and the clinical symptoms and signs were documented. After the failure of conservative treatment, 30 of the 49 underwent open popliteal decompression.

Results

Patients with PVC were found to have a BMI of 34.6 ± 6.2 compared with 25.3 ± 3.0 of the controls. The POPV ID in the PVC group before and after knee locking changed from 11.7 ± 5.0 to 1.0 ± 2.1 mm, respectively. Postoperatively, the POPV ID before and after knee locking changed from 10.2 ± 2.2 to 9.0 ± 1.5 mm, respectively. At 16.2 ± 12.1 months follow-up, all the major clinical parameters improved at a statistically significant level.

Conclusions

There appears to be a relationship between obesity, chronic venous disease and PVC. POPV compression syndrome may clarify the previously unexplained venous presentations. Surgical decompression provides good results in patients unresponsive to conservative treatment.

Popliteal vascular entrapment syndrome caused by a rare anomalous slip of the lateral head of the gastrocnemius muscle

Popliteal vascular entrapment syndrome can result in calf claudication, aneurysm formation, distal arterial emboli, or popliteal vessel thrombosis. The most commonly reported causes of this syndrome have been anomalies of the medial head of the gastrocnemius muscle as it relates to the course of the popliteal artery. We report two cases of rare anomalous slips of the lateral head of the gastrocnemius muscle causing popliteal vascular entrapment syndrome.

Belastungs- oder lageabh�ngige Schwellung der Wadenmuskulatur mit Spannungsgef�hl und krampfartigen Schmerzen

Popliteal vein entrapment must be taken in consideration in patients with symptoms of venous insufficiency. Leg edema, swelling, calf pain, and muscle cramps are all unspecific signs. Most patients thus far have presented with deep vein thrombosis or chronic venous insufficiency. Popliteal entrapment syndrome must be taken into account in younger patients in whom predisposing factors are absent and chronic calf swelling is notable. Diagnosis is easily confirmed by noninvasive stress testing with duplex imaging and pencil Doppler probe placed over the posterior tibial artery. Additionally, digital subtraction angiography with the foot in neutral and dorsi plantarflexion is recommended for arterial entrapment. Surgery is advisable for treatment and can be done without significant morbidity. In asymptomatic patients, we suggest using the term "popliteal vein entrapment phenomenon." We describe different etiologies of popliteal vein entrapment in three cases and present a review of the literature.

Popliteal vein entrapment: a benign venographic feature or a pathologic entity?

PURPOSE

Asymptomatic morphologic popliteal vein entrapment is frequently found in the healthy population (27%). In our institution, popliteal vein compression on plantar flexion was observed in 42% of all ascending venograms. Some authorities consider the lesion benign, without pathologic significance. This study examines the pathophysiologic importance in select patients, describes treatment with surgery, and suggests a diagnostic tool.

METHOD

Thirty severely symptomatic patients with venographic evidence of popliteal entrapment were selected to have popliteal vein release after a process of elimination (ie, other causes of chronic venous insufficiency [CVI] were ruled out by means of comprehensive hemodynamic and morphologic studies). In the last nine limbs, popliteal vein pressure was also measured by means of the introduction of a 2F transducer tip catheter. Patients were clinically and hemodynamically assessed before and after surgery, and anatomical anomalies encountered during surgery were recorded.

RESULTS

Popliteal vein release was performed without mortality or serious morbidity. Anomalies of the medial head of the gastrocnemius muscle caused entrapment in 60% of the patients; anatomic course venous anomalies were infrequent (7% of the patients). Significant relief of pain and swelling occurred in the patients who had surgery. Stasis ulceration/dermatitis resolved in 82% of patients. Popliteal venous pressures had normalized in the six patients who were studied postoperatively.

CONCLUSION

Popliteal vein entrapment should be included in the differential diagnosis of CVI in patients in whom other, more common etiologies have been excluded on the basis of comprehensive investigations. Popliteal vein compression can be demonstrated venographically in a large proportion of patients with CVI, but the lesion is likely pathological only in a small fraction of these patients. A technique for popliteal venous pressure measurement is described; it shows promise as a test for functional assessment of entrapment. Immediate results of popliteal vein release surgery are encouraging; long-term follow-up is necessary to judge the efficacy of surgical lysis of entrapment in symptomatic patients who fail to improve with conservative treatment measures.