腘动脉压迫综合征八例

目的 总结腘动脉压迫综合征诊治经验.方法 回顾性分析2002年7月至2010年7月收治的8例患者临床资料,其中男性7例,女性1例,年龄16～56岁,平均(29±14)岁.6例经腘窝S形切口发现并解除解剖畸形,2例腘动脉局限性狭窄合并远侧腘动脉瘤,其中1例行腘动脉缩缝成形,1例切除部分动脉瘤壁以自体大隐静脉补片成形;4例患者腘动脉闭塞,其中2例行腘动脉血栓内膜剥脱术(1例自体大隐静脉补片成形术),1例行自体大隐静脉间置术,1例行自体大隐静脉旁路手术.2例腘动脉闭塞病变较长者直接经膝下内侧切口行自体大隐静脉旁路手术.结果 8例患者术后恢复良好出院,随访4～99个月,平均(50±37)个月.7例患肢血运良好,正常活动.1例自体大隐静脉旁路术后51个月远端吻合口及腘动脉分支狭窄,行球囊扩张术后1个月后再闭塞,经保守治疗后轻度跛行.结论 腘动脉压迫综合征是导致青少年下肢缺血的少见疾病,早期正确诊断和及时手术治疗可取得良好效果.

Abstract：

Objective To summarize our experience on the diagnosis and management of 8 patients with popliteal artery entrapment syndrome (PAES). Methods Clinical data of 8 PAES cases admitted from Jul 2002 to Jul 2010 were retrospectively analyzed. There were 7 males and 1 female with the mean age of (29 ± 14)years (ranging 16 -56 years). In 6 cases posterior "S" shaped incisions in the popliteal fossa were applied and anomalous anatomic structures were verified. Segmental stenosis and post-stenotic popliteal arterial aneurysm was identified in 2 cases, and partial resection of the aneurismal wall and arterioplasty including one with saphenous vein patch were applied; For 4 cases with short segmental occlusion of the popliteal artery, surgical treatment included thromboendarterectomy in 2 cases (with saphenous vein patch plasty in one case), saphenous vein interposition in 1 case, and saphenous vein bypass grafting in 1 case.Medial longitudinal incisions and saphenous vein bypass grafting were applied in 2 cases with long segmental occlusion in popliteal artery without exploration for anatomic anomalies. Results All patients recovered uneventfully without any notable complication. During the follow-up period ranging from 4 to 99 months [average (50± 37) months], no ischemic symptom reoccurred in 7 cases with patent arteries or grafts, and recurrent claudication occurred in 1 case with distal anastomostic stenosis. The stenosis was subsequently treated with balloon angioplasty and vein graft thrombsis occurred one month later. Medicine and exercise were recommended for the patient and now mild claudication still remains without affecting his normal life.Conclusions PAES is a disease of relatively low incidence resulting in lower extremity ischemia, which can be successfully cured with proper management.     

青少年腘动脉陷迫综合征17例诊疗分析

目的 总结青少年腘动脉陷迫综合征（popliteal artery entrapment syndrome,PAES）的影像学诊断与手术治疗经验.方法 对17 例（18 条下肢）青少年PAES 患者术前施行了超声多普勒,CTA或MR检查,并对17条患肢施行了相应的手术治疗,监测手术前后患肢踝肱指数（ankle brachial index,ABI）变化.13 条患肢施行了腘动脉周围异常组织松解术,其中5条因动脉闭塞同时施行了大隐静脉旁路移植术,4条患肢因动脉内膜增厚实行腘动脉内膜切除＋动脉成形术;4条肢体行自体大隐静脉移植术.结果 16例患者随访 6个月～6年,平均（30.88±19.88）个月,所有手术肢体间歇性跛行症状治愈,踝肱指数由术前的（0.47±0.09）上升至术后的（0.96±0.07）,较术前显著提高（P＜0.01）.1例患者因肺动脉栓塞术后1d死亡.结论 PAES是青少年下肢动脉缺血的一个重要病因.影像学诊断是确诊本病的重要手段,早期积极外科干预预后较好.     

功能性腘动脉陷迫综合征的CTA解剖特点初探

目的运用CTA标线法探讨功能性腘动脉陷迫综合征(functional popliteal artery entrapment syndromef,PAES)是否存在"解剖畸形"。方法 2007～2011年手术确诊的14条fPAES患肢与180条对照肢体的CTA进行比较,并用CTA标线法分析腘窝轴位上两组的解剖位置差异。结果 fPAES组所有患肢腓肠肌内侧头向外移位且13条(93%)向外超过了腘动脉,所有腘动脉均向深方移位;对照组腓肠肌内侧头完全起自"股骨内侧髁后上方"(解剖学所描述的标准位置)的仅占12%(21/180);对照组21%(38/180)腓肠肌内侧头与腘动脉相对位置关系及38%(68/180)的腘动脉深浅位置关系不符合标准解剖。结论腓肠肌内侧头的外移普遍存在,解剖"移位"可能从量变到质变f,PAES可能是严重移位导致的结果。内侧头外移超越腘动脉及腘动脉向深方移位是fPAES两个有意义的观察指标。     

腘动脉陷迫综合征外科治疗疗效分析

目的探讨外科治疗腘动脉陷迫综合征(popliteal artery entrapment syndrome,PAES)的疗效。方法回顾分析2006年4月-2014年4月收治的14例PAES患者临床资料,其中男13例,女1例;年龄20~54岁,平均35.5岁。左侧4例,右侧9例,双侧1例。10条患肢足背动脉搏动消失,5条患肢足背动脉搏动减弱;踝肱指数0.51±0.07。病程2周~12个月,平均5.2个月。根据PAES不同诊断及分型对9例患者行腘动脉周围异常组织松解术及腔内治疗术,余5例腘动脉功能性陷迫行保守治疗。结果 1例行肌切除、闭塞动脉取栓动脉成形术者,术后5 d腘动脉再次闭塞,行插管溶栓术后再通。其余患者经手术治疗及保守治疗后踝肱指数上升至0.93±0.22,与术前比较差异有统计学意义(t=5.634,P=0.000),跛行症状均缓解。14例均获随访,随访时间5~81个月,平均29.7个月。8例行腘动脉松解术后下肢活动正常,腘动脉血流通畅;1例介入下行球囊扩张术后11个月腘动脉再狭窄,给予抗血小板、抗凝保守治疗后症状未见反复。5例保守治疗患者治疗后下肢活动正常,腘动脉血流通畅。结论 PAES患者早期确诊并及时外科干预能获较好近、中期临床疗效。     

手法诱发试验对早期腘动脉陷迫综合征的诊断价值

目的探讨手法诱发试验对早期腘动脉陷迫综合征（popliteal artery entrapment syndrome,PAES）的诊断价值。方法应用手法诱发试验Ⅰ踝被动背伸、手法诱发试验Ⅱ踝主动跖屈、手法诱发试验Ⅲ踝主动抗阻跖屈、手法诱发试验Ⅳ全力收缩全小腿肌肉4种诱发试验检查8例确诊PAES及50例无症状对照者,并通过彩超、造影、手术进一步验证手法诱发试验的可靠性。结果手术确诊PAES患肢13条中,9条患肢4种手法诱发试验、彩超、造影检查均阳性;4条患肢足背动脉无搏动,无法手法诱发。PAES患者对侧3条正常肢体,4种手法诱发试验、彩超、造影检查均阴性。对照组100条肢体,无3种及以上手法诱发试验同时阳性情况;手法诱发试验Ⅰ～Ⅳ出现阳性肢体分别为2、49、0、1条。结论联合应用手法诱发试验Ⅰ、Ⅲ、Ⅳ能鉴别健康肢体与足背动脉尚有搏动的早期PAES患肢。     

腘动脉陷迫综合征23例

目的:分析23例腘动脉陷迫综合征(PAES)的临床资料,总结PAES影像学诊断与手术治疗的经验。方法:23例(26条下肢)PAES患者,男19例,女4例,年龄5～64岁,平均(31.2±14.4)岁。患者术前施行了超声多普勒,CTA或MR检查,并对25条患肢施行了相应的手术治疗,监测手术前后患肢踝肱指数(ABI)变化。20条患肢施行了腘动脉周围异常组织松解术,其中9条因动脉闭塞同时施行了大隐静脉旁路移植术,7条患肢因动脉内膜增厚实行腘动脉内膜切除加动脉成形术;5条肢体行自体大隐静脉移植术。结果:22例患者随访6月～6年,平均(30.09±17.92)个月,25条手术肢体间歇性跛行症状治愈,踝肱指数由术前的0.44±0.09上升至术后的0.92±0.10(P<0.01)。1例患者因肺动脉栓塞术后1 d死亡。结论:PAES是慢性下肢动脉缺血的一个病因,影像学诊断是确诊本病的重要手段,早期积极外科干预预后较好。     

膝下动脉闭塞的腔内治疗

Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76±6. The ABI(ankle brachial index)before intervention was 0.39±0.20 in anterior tibial artery and 0.39±0.23 in posterior tibial artery. CLI (critical limb ischemia) was 80.49% (33/41). Results The after intervention ABI increased by 0.43±0.22 (P<0.01) in anterior tibial artery and 0.43±0.25(P<0.01)in posterior tibial artery. 35 patients (36 limbs) were followed-up for (6±3) months. The limbs of Fontaine Ⅰ and Fontaine Ⅱ A were 28 (77.78%), CLI decreased to 19.44% (7/36) (P<0.01). At follow-up the ABI in anterior tibial artery was 0.63±0.22 and 0.56±0.22 in posterior tibial artery. The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2.5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.     

膝下动脉闭塞的腔内治疗

Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76±6. The ABI(ankle brachial index)before intervention was 0.39±0.20 in anterior tibial artery and 0.39±0.23 in posterior tibial artery. CLI (critical limb ischemia) was 80.49% (33/41). Results The after intervention ABI increased by 0.43±0.22 (P<0.01) in anterior tibial artery and 0.43±0.25(P<0.01)in posterior tibial artery. 35 patients (36 limbs) were followed-up for (6±3) months. The limbs of Fontaine Ⅰ and Fontaine Ⅱ A were 28 (77.78%), CLI decreased to 19.44% (7/36) (P<0.01). At follow-up the ABI in anterior tibial artery was 0.63±0.22 and 0.56±0.22 in posterior tibial artery. The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2.5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.     

膝下动脉闭塞的腔内治疗

Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76±6. The ABI(ankle brachial index)before intervention was 0.39±0.20 in anterior tibial artery and 0.39±0.23 in posterior tibial artery. CLI (critical limb ischemia) was 80.49% (33/41). Results The after intervention ABI increased by 0.43±0.22 (P<0.01) in anterior tibial artery and 0.43±0.25(P<0.01)in posterior tibial artery. 35 patients (36 limbs) were followed-up for (6±3) months. The limbs of Fontaine Ⅰ and Fontaine Ⅱ A were 28 (77.78%), CLI decreased to 19.44% (7/36) (P<0.01). At follow-up the ABI in anterior tibial artery was 0.63±0.22 and 0.56±0.22 in posterior tibial artery. The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2.5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.     

膝下动脉闭塞的腔内治疗

Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76±6. The ABI(ankle brachial index)before intervention was 0.39±0.20 in anterior tibial artery and 0.39±0.23 in posterior tibial artery. CLI (critical limb ischemia) was 80.49% (33/41). Results The after intervention ABI increased by 0.43±0.22 (P<0.01) in anterior tibial artery and 0.43±0.25(P<0.01)in posterior tibial artery. 35 patients (36 limbs) were followed-up for (6±3) months. The limbs of Fontaine Ⅰ and Fontaine Ⅱ A were 28 (77.78%), CLI decreased to 19.44% (7/36) (P<0.01). At follow-up the ABI in anterior tibial artery was 0.63±0.22 and 0.56±0.22 in posterior tibial artery. The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2.5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.     

Diagnosis and surgical management of popliteal artery entrapment syndrome

BACKGROUND: The purpose of the present study was to report the authors' experience of surgically treating eight limbs in six patients for popliteal artery entrapment syndrome (PAES), over a 10-year period. METHODS: From 1995 to 2004, six patients (eight limbs) underwent surgery for PAES at a single institution. The patients' data were collected retrospectively from the case records and operative notes. RESULTS: There were six patients with a mean age of 34 years (range, 27-38 years) at diagnosis and five of them were male. Two patients were found to have bilateral involvement. Both patients had symptoms involving both limbs and underwent bilateral surgery. Intermittent claudication was the most frequent presenting symptom (seven of eight limbs). All the patients had Delaney's type III PAES. Popliteal artery release was performed in all eight limbs and this was combined with a vein patch or a reversed long saphenous vein bypass graft in four limbs because the arteries in these four limbs were diseased or occluded. At a median follow up of 15 months (range, 40 days-9 years), five (seven limbs) of the six patients (eight limbs) were cured of their symptoms. One patient who presented late with rest pain and dusky toes underwent popliteal artery release, endarterectomy and a vein patch repair for an occluded popliteal artery. However, her limb could not be salvaged and her affected limb had to be amputated. CONCLUSION: Popliteal artery entrapment syndrome is a rare but important cause of peripheral vascular insufficiency especially in young patients. Early diagnosis and surgical intervention is imperative for good operative outcome and to prevent limb loss.     

腘动脉陷迫综合征的诊断和外科治疗

目的 总结腘动脉陷迫综合征(PAES)的诊断和外科治疗效果.方法 回顾性分析2006年3月至2009年8月收治的11例(14条患肢)PAES患者的诊断和治疗情况.其中男性9例,女性2例;年龄15～56岁,中位年龄22岁.双侧PAES 3例.首诊症状8例为间歇性跛行,3例为静息痛,出现症状至首次就诊时间为3周～10年.14条肢体通过多层螺旋CT明确诊断为PAES.Delaney's Ⅱ型或Ⅲ型11条肢体,Ⅴ型1条肢体,Ⅰ型2条肢体.手术方法包括单纯行腘动脉松解术2条肢体,行腘动脉松解、血栓内膜剥脱、补片成形术8条肢体,行置管溶栓、腘动脉松解术2条肢体,直接行股-腘(膝下)动脉自体大隐静脉原位转流术2条肢体.结果 术后所有患者临床症状缓解.随访1～36个月,中位随访13个月,1例患者术后6个月复发,再次溶栓成功后行腘动脉松解术.一期通畅率92.9%(13/14),累计通畅率100%,救肢率100%.12条腘动脉闭塞肢体术后中立位踝肱指数较术前升高(1.11±0.10比0.62±0.14,P<0.01).结论 多层螺旋CT对PAES的诊断和分型具有重要意义.PAES诊断明确后应尽快手术治疗.根据腘动脉闭塞情况选择适当的手术方法可获得满意效果.     

腘动脉闭塞的手术治疗经验

目的 探讨单纯腘动脉闭塞的外科治疗的策略及效果.方法 回顾性分析2007年6月至2008年6月25例单纯腘动脉闭塞患者手术治疗的临床资料.男性18例,女性7例;年龄17～83岁,平均(53±21)岁.急性缺血11例11条肢体(42.3%),慢性缺血14例15条肢体(57.7%).手术方式包括腘动脉取栓4条肢体,补片成形19条肢体,自体静脉旁路或间位移植2条肢体.人工血管间位移植1条肢体.其中6条肢体在血管重建手术同期行腓肠肌内侧头离断松解术.结果 本组患者手术均获成功,24例患者25条肢体症状改善,间歇性跛行距离延长;术后踝肱指数为0.75±0.29,高于术前的0.35±0.20(P<0.01).随访4～16个月,平均10.2个月,一期通畅率为92.3%;术后截肢3例,保肢率为88.5%.结论 腘动脉闭塞成因复杂,采取个体化手术治疗策略方能获得满意疗效.     

腘动脉陷迫综合征的诊治

目的 总结腘动脉陷迫综合征(popliteal artery entrapment syndrome,PAES)的诊断和手术治疗经验.方法 回顾性分析2002-2009年收治的10例(13条患肢)腘动脉陷迫综合征的临床资料,病程20 d至2年,平均(5±7)个月.9例以不同程度的间歇性跛行为始发症状,经数字减影造影(digital subtraction angiography,DSA)、计算机断层扫描血管成像(computed tomographic angiogram,CTA)、磁共振血管成像(magnetic resonance angiogram,MRA)检查或者术中确诊,10例患者均经手术治疗.结果 患者发病年龄17～41岁,平均(25±7)岁.间歇性跛行是主要临床症状(9例,12条肢体),手术方式:肌切除、腘动脉松解术1例,股动脉切开取栓、腘动脉病变段球囊扩张术1例,肌切除、腘动脉切开取栓、内膜剥脱、大隐静脉补片成型术2例,取自体大隐静脉间置或旁路移植术6例,人工血管间置或旁路移植术3例.所有患者均得到随访,随访时间(35±27)个月(2个月至7年),患者无术中和术后长期并发症,临床症状无复发.结论 PAES是一种少见疾病,腘动脉松解、血管旁路或者血管重建等手术治疗是较好的选择.     

Surgical treatment for popliteal artery entrapment syndrome

PURPOSE: This study was a retrospective review of 11 limbs of 10 patients with popliteal artery entrapment syndrome (PAES) treated surgically in a 20-yr period. METHODS: The patients were aged 34.7 +/- 17.4 SEM yr. Arteriographic findings varied, showing medial deviation in two limbs, poststenotic dilatation in four limbs and occlusion of the popliteal artery in five limbs. In addition, computed tomographic (CT) scanning showed positive findings of PAES in all the limbs. RESULTS: The surgical procedures consisted of musculotendonous section (MTS) with autogenous saphenous vein (ASV) graft in seven limbs, MTS and ASV patch angioplasty with or without thromboendarterectomy in three limbs, and MTS alone in one limb. All the ASV grafts were found to be patent during the postoperative follow-up period (10.9 +/- 4.0 yr). CONCLUSION: CT scanning was demonstrated to be the most sensitive diagnostic modality for PAES, and MTS with or without ASV grafting method was considered to be the best surgical procedure for PAES.     

Results of perioperative measurements of ankle-brachial index in popliteal artery entrapment syndrome

OBJECTIVE: The purpose of this study was to demonstrate whether there is postoperative improvement in blood flow in the affected limb after surgical decompression in popliteal artery entrapment syndrome (PAES). For this purpose, the simple method of measuring Doppler ankle pressure with and without provocation was used preoperatively and postoperatively. PATIENTS AND METHODS: Doppler ankle pressure was measured preoperatively and postoperatively in neutral position (n=32) and with provocation (forced plantar flexion of the foot; n=32) in 32 limbs in 23 patients with PAES (19 men, 4 women; average age, 38.24 +/- 12.25 years) operated on between January 1, 1986, and December 31, 2000. The reference method was angiography with provocation in 18 patients and duplex ultrasound scanning in 14 patients. RESULTS: Patients were assigned to one of two groups (A and B) on the basis of ankle-brachial index (ABI) at rest. Group A (mean age, 38.19 +/- 11.60 years) included all limbs (n=24) with ABI>0.9 preoperatively, and group B (mean age, 42.39 +/- 14.38 years) comprised all limbs (n=8) with ABI<0.9. Improvement in ABI under provocation after operation (group A, P<.0001; group B, P<.0004) was highly significant. In group B there was also a highly significant difference in ABI in the neutral position before and after operation (P=.0044); this could not be demonstrated in group A. Angiography or duplex sonography postoperatively did not provide any additional information. CONCLUSION: Our results indicate that determination of ABI alone, with and without provocation, is sufficient as a postoperative follow-up examination to appraise decompression and for quality assurance of PAES. Compared with other more elaborate instrumental methods, measurement of ABI is relatively noninvasive, quick and easy to carry out, effective, and inexpensive.     

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??Diagnose and treatment for popliteal artery entrapment syndrome in young people:A repont of 17 cases ZHANG Jing-yong?? WANG Mao-hua??JIN Xing??et al. Department of Vascular Surgery??Provincial Hospital Affiliated to Shandong University??Jinan 250021??China
Corresponding author??JIN Xing??E-mail??zhangjingyongys@163.com
Abstract Objective To summarize experience of imaging diagnosis and surgical treatment in popliteal artery entrapment syndrome (PAES) in young people. Methods From July 2003 to February 2012??17 patients (18 lower extremities) with PAES were performed doppler ultrasonography??CTA and MR before surgery and then performed surgery in Provincial Hospital Affiliated to Shandong University. Ankle brachial indexes (ABI) of all patients were contrasted before and after operation. Tenolysis of malformed muscle round of popliteal artery was performed in 13 lower extremities??in addition??bypass in 5 lower extremities with artery occlusion??endarterectomy and artery autoplasty in 4 lower extremities with artery stenosis and simple femoral-popleteal bypass with great saphenous veins in 4 lower extremities. Results The average time of follow up was??30.88±19.88??months (6 months-6 years). Symptom of intermittent claudication was disappeared in all patients. ABI ascended from??0.47±0.09??before operation to??0.96±0.07?? after operation with significant difference (P??0.01). One patient died of pulmonary embolism 1 day after surgery. Conclusion PAES is an important cause of arterial ischemia of the lower extremity. Imaging diagnosis is very important. It will have a favourable prognosis with active surgery in early time.     

Popliteales Entrapment-Syndrom

Popliteal artery entrapment syndrome (PAES) is one of the most important differential diagnoses of claudication in young patients. An aberrant course of the popliteal artery and/or congenital anomalies in the anatomy of muscles and ligaments of the popliteal fossa lead to vessel compression and subsequent stress-dependent ischemia. The continuous compression of the popliteal artery leads to damage of the vessel wall causing stenosis, occlusion or ectasia. The diagnosis is confirmed by duplex ultrasound and additional computed tomography (CT), magnetic resonance imaging (MRI) or digital subtraction angiography both at rest and in plantar flexion. Due to its rarity and young age of the patients PAES is belatedly recognized in many cases. Therapeutic options consist of surgical separation of the structures compressing the vessels or, if necessary, resection of the damaged vessel segment and reconstruction by venous interposition. The role of endovascular therapies for treatment of PAES has not yet been sufficiently evaluated.