What Is Popliteal Artery Entrapment Syndrome?

1. The popliteal artery compression syndrome (PAES for short) is a rare vascular surgical disease. It is caused by the abnormality of the positional relationship between the popliteal artery and the surrounding muscles or tendons and fibrous tissue bundles. .

Iliac artery compression syndrome

Definition of iliac artery compression syndrome

1. The popliteal artery compression syndrome (PAES for short) is a rare vascular surgical disease. It is caused by the abnormality of the positional relationship between the popliteal artery and the surrounding muscles or tendons and fibrous tissue bundles. .

2. The term iliac artery compression syndrome was first coined by Love and Whelan in 1965. As early as 1959, Dutch scholars reported the first surgical treatment of the disease. Subsequent studies on PAES cases and treatment options have been reported on a case-by-case basis. As one of the most common causes of lower limb ischemia in adolescents, PAES is rarely reported in our country, and most cases may not be correctly diagnosed. We have encountered 3 cases in the past two years, so the understanding of this disease needs to be improved.

3. There is a certain gender and age difference in the onset of PAES. Some experts and other statistics show that the disease is more common in males (80%), generally under 30 years old (50%), and only 6.2% of patients over 50 years old. It is reported that anatomical compression is more common in men (70%), older and functional compression is more common in women (66%), and younger (24%). ^[1]

Causes of iliac artery compression syndrome

1. The root cause of the iliac artery compression syndrome is that the iliac artery is oppressed by an anatomical abnormal structure. Therefore, conventional antiplatelet and vasodilator conservative treatment is of little significance.

2. PAES is caused by congenital abnormal development of the iliac artery and surrounding muscles or fibrous tissue. The iliac artery is compressed by the surrounding muscles, tendons or fiber bundles, causing corresponding clinical symptoms. Complicated with iliac vein compression is only 7.6%, and in rare cases may be accompanied by tibial nerve compression.

Iliac artery compression syndrome disease symptoms

1. Start with intermittent lameness, but the way in which lameness appears is not exactly the same. In the early stage, most of them were during brisk walking or running, and the calf had numbness, weakness and cramping pain, and the symptoms disappeared after being forced to stop. But no symptoms when walking slowly. In contrast, a small number of patients have no symptoms during rapid movements and intermittent claudication when walking slowly. These patients did not show ischemia at rest. Once the arteries are occluded, there is ischemic intermittent claudication and other ischemic manifestations.

2. About 1/3 of the patients have an acute onset, but the course of most patients can last for months or years, or longer. After the arteries are blocked, typical ischemic symptoms such as chills, pale skin, and muscle atrophy appear in the affected limb. However, the limb ischemic symptoms are not serious in most patients. About 10% of patients have acute and severe ischemic symptoms, but it is rare to cause extremity ulcers, gangrene and severe resting pain.

3. About 1/5 of the patients are bilateral deformities, but only 50% have bilateral ischemic symptoms. If the veins are squeezed at the same time, swelling of the affected foot and lower leg will occur.

Treatment of iliac artery compression syndrome

1. Experts from our hospital point out that once the iliac artery compression syndrome is diagnosed, it should be treated surgically. Because only surgical intervention can resolve its anatomical abnormalities.

2. Choose the surgical method and surgical approach according to the nature of the lesion and the condition of iliac artery involvement. If it is stage I or early stage II iliac artery disease, there is no obvious intimal hyperplasia of the iliac artery, and there is no clear stenosis or occlusion of the iliac artery segment. It can simply correct the anatomical abnormalities between muscles and blood vessels and cut off the medial head of the gastrocnemius muscle that compresses the iliac artery , Or other unusual structures.

3. If the iliac artery is damaged due to long-term compression, secondary fibrosis and intimal thickening occur, and the iliac artery is narrowed or occluded, arterial bypass or reconstruction surgery should be performed while correcting the anatomical abnormalities. The autologous great saphenous vein is the best material for reconstructing blood vessels. Artificial vascular materials can also be used, but the long-term patency rate is significantly lower than that of autologous blood vessels.

4. There are two kinds of surgical approaches: posterior approach and lateral approach. The posterior approach is an S-shaped incision in the popliteal fossa, which is suitable for various types and most patients. The lateral approach is most suitable for type I and lesions involving the iliac artery bifurcation. This technique is also easy to take from the saphenous vein of the body, but there is a possibility of missing the anatomic abnormality of the popliteal fossa and the potential risk of postoperative recurrence. ^[1]