Popliteal artery entrapment syndrome

Opinion statement Popliteal artery entrapment syndrome is a condition caused by direct compression of the popliteal artery as it passes within or exits the popliteal fossa. It is surprisingly uncommon and usually affects young patients, typically men, and often presenting with symptoms of claudication, or more rarely acute limb ischemia, calf cramps, or a picture of compartment syndrome. The diagnosis should be considered early within the differential diagnosis of all patients presenting with these problems in this age group. The key to management of this condition lies in a high index of suspicion. The treatment of popliteal artery entrapment syndrome is surgical. When the condition is detected at an early stage surgery may be limited to release of the artery alone. However, if the artery has been compressed for some time the resulting intimal damage necessitates bypass of the affected segment. There are numerous reports of thrombectomy with simple vein patching, but the results are inferior to interpositional vein grafting. Reports have also been published of attempts made at endovascular treatment. At present, this mode of management adds little to the definitive treatment of affected limbs and appears limited to use as a bridging procedure in cases presenting with limb ischemia. Unfortunately, an effective clinical screening test does not exist and imaging remains the mainstay in the diagnosis of symptomatic limbs and the screening of asymptomatic limbs. The exact modality of imaging remains unclear, but for the moment duplex scanning, angiography, computed tomography, and magnetic resonance imaging all appear to have their place.     

Laparoscopic total abdominal colectomy

The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included the length of surgery, length of ileus, length of hospitalization, morbidity, and mortality. Five patients underwent standard TAC (Group I), and five underwent L-TAC (Group II). Group I consisted of five patients of a mean age of 32 (range, 24–51) years who had mucosal ulcerative colitis (n=1), familial adenomatous polyposis (n=3), or colonic inertia (n=1). Group II consisted of five patients of a mean age of 33 (range, 17–43) years who had mucosal ulcerative colitis (n=1), familial adenomatous polyposis (n=3), or colonic inertia (n=1). This preliminary prospective study indicates that laparoscopically assisted TAC is feasible. L-TAC resulted in a slightly longer length of ileus and length of hospitalization; these differences were not statistically significant. Moreover, the length of time required for the laparoscopic procedures was 35 percent longer than for the open procedures. Although these results may improve as more cases are performed, dramatic differences in rates of postoperative recovery have not yet been realized. In conclusion, L-TAC, while technically feasible, dose not appear to offer any immediately recognizable benefits to the patient as compared with standard laparotomy.     

Popliteal entrapment syndrome and age

On the occasion of diagnosing a popliteal entrapment syndrome in a 59-year old man with no cardiovascular risk factors, who developed acute ischemic leg pain during long distance running, we give an overview on this entity with emphasis on patients' age. The different types of the popliteal artery compression syndrome are summarized. The diagnostic and therapeutic approaches are discussed. The most important clinical sign of a popliteal entrapment syndrome is the lack of atherosclerotic risk factors in patients with limited walking distance. Not only in young athletes but also in patients more than 50 years old the popliteal entrapment syndrome has to be taken into account.     

腹腔镜探查对腹部疑难疾病的诊治价值

目的 探讨和评价腹腔镜探查在腹部疑难疾病诊治中的临床价值.方法 回顾分析接受腹腔镜探查术的64例腹部疑难疾病患者的临床资料.腹部疑难疾病患者的纳入标准为临床诊断困难,具有腹痛、腹水、腹部包块、肠梗阻或小肠出血的一种或多种表现.结果 64例患者腹腔镜探查后病理确诊62例,确诊率96.9％,其中对腹水、腹部包块、肠梗阻和小肠出血的确诊率分别为93.3％ (28/30)、100.0％(13/13)、100.0％ (16/16)和6/6.腹腔镜探查术中发生并发症1.6％(1/64).该组患者中14例(主要为肠梗阻和小肠出血者)在腹腔镜探查术中同时进行治疗性手术,其中8例完成腹腔镜下手术,6例中转开腹完成手术治疗,术后无并发症.结论 腹腔镜探查诊治腹部疑难疾病安全、有效,具有较高的临床应用价值.     

Laparoscopic appendectomy for chronic right lower quadrant abdominal pain

Purpose

The appendix can be a rare cause for chronic right lower quadrant abdominal pain (RLQAP), even though no objective disorder can be determined to the appendix. This condition can be described as chronic appendicitis or (neurogenic) appendicopathy. After careful selection, elective appendectomy is performed in our centre for this group of patients.

Methods

All patients that underwent an elective appendectomy between 2006 and 2013 were prospectively analysed. Inclusion criterion was chronic RLQAP without abnormalities seen on imaging. Exclusion criterion was pain after conservative treatment of (complicated) appendicitis or an abnormal appendix on imaging like a mass, mucocoele or faecolith. Primary outcome was the effect on the pain postoperatively.

Results

In the period of the study, ten patients met the inclusion criteria and underwent an appendectomy for chronic RLQAP. Average preoperative pain score assessed with visual analogue scale (VAS) was 8.6. Preoperative work-up showed no abnormalities. No macroscopic abnormalities were seen during surgery in any of the patients. Histopathological analysis was obtained and showed limited abnormalities in eight of ten patients, mostly suspicion of previous inflammation. Postoperatively, no complications occurred, and at revision after 3 weeks, average VAS was 1.0. Long-term follow-up showed that patients remained free of symptoms; average VAS after a median of 33 months was 1.0.

Conclusions

A significant reduction of pain was achieved after an appendectomy in all patients suffering from chronic RLQAP in this series. Seven out of ten patients were completely free of pain.     

Popliteal artery entrapment syndrome: implications for nursing care.

Popliteal artery entrapment syndrome is an extremely rare phenomenon, with only 249 cases in the English literature over the past 30 years. Obstruction of the popliteal artery caused by abnormal anatomic development results in diminished blood supply to the extremity. Unlike more common vascular problems, this syndrome often produces claudication and symptoms of arterial insufficiency in young, healthy, even athletic individuals with no other apparent vascular risk factors. Accurate assessment and monitoring are critical in identifying this syndrome, minimizing complications, and preventing long-term adverse effects on activities of daily living.     

Laparoscopic adrenalectomy for adrenocorticotropin-dependent Cushing's syndrome

Bilateral adrenalectomy is indicated for the treatment of ACTH-dependent Cushing's syndrome when the tumorous source of ACTH hypersecretion cannot be identified or removed. Potential advantages of laparoscopic over open adrenalectomy include shorter hospitalization, decreased requirement for postoperative analgesia, and decreased postoperative morbidity due to incisional complications. Bilateral laparoscopic adrenalectomy performed for the treatment of ACTH-dependent Cushing's syndrome was attempted in 19 patients at our institution between 1995 and 1998. Conversion to an open procedure was required in three patients. All patients who underwent bilateral laparoscopic adrenalectomy were subsequently followed to assess the outcome of this intervention. Twelve patients with pituitary-dependent Cushing's syndrome and four with ectopic ACTH syndrome underwent successful bilateral laparoscopic adrenalectomy. All patients experienced resolution of the signs and symptoms (e.g. proximal myopathy, hirsutism, and emotional lability) of Cushing's syndrome as well as weight loss, improved glucose tolerance, and improved control of blood pressure. No residual cortisol secretion was detected in the patients. Bilateral laparoscopic adrenalectomy is a safe and effective treatment for Cushing's syndrome when the ACTH-secreting neoplasm cannot be removed.     

Popliteal artery entrapment syndrome. Case report

Popliteal artery entrapment syndrome (PAES) is an uncommon pathological entity, due to segmental popliteal artery compression by the surrounding myofascial structures. Clinical symptoms may appear acutely, with temporary ischemic attacks, or chronically, with claudicatio intermittens of the involved calf and for 30% bilateral. Treatment, generally, is surgical by simple freeing of the popliteal artery from the surrounding myofascial structures or by autologous vein (saphenous v.) interposition grafting and patching, or bypass without vessel resection. The case of a 44-year female with left calf acute pain symptoms, cold skin at the thermotouch, hypo-paresthesia with fifth toe cyanosis and walking inability is reported. The surgical treatment, because of early diagnosis, consisted of simple cut of myofibrous bundle starting from the medial head of the left gastrocnemious muscle and compressing the popliteal artery, with clinical complete resolution.     

The "functional" popliteal entrapment syndrome

A patient with bilateral entrapment syndrome is reported, he only had symptoms of intermittent claudication with running. The "neutral angiograms" were normal, but the "dynamic angiographies" taken in the sustained active plantar flexion showed a complete occlusion of both popliteal arteries. No abnormalities, no anatomical trap were discovered at the time of surgery. The entrapment syndrome was caused by the muscular hyperdevelopment in this intensively trained athlete. That leads to the concept of "functional entrapment" versus "organic, anatomical entrapment". The diagnostic value of the invasive and non invasive techniques is discussed. Surgical exploration is diagnostic: this is the only means to rule out any organic anatomical entrapment. In a "functional entrapment" surgery may or may not be therapeutic.     

The embolic type of popliteal entrapment syndrome

The authors describe their experience with two patients who presented with clinical extremes of popliteal entrapment syndrome. One patient presented with acute ischemia and the second patient presented with a chronic Buergerian-like syndrome. The common denominator for both of them was embolic phenomena originating at the site of entrapment. Discussion is centered on pathogenesis of the embolic phenomenon, prevalence of distal arterial degradation and its clinical manifestation. The clue for differentiation from true Buerger disease is the angiographic pattern demonstrating apparently healthy distal arterial segments, confirmed by mandatory arterial biopsy. It is emphasized that in cases having acute embolic presentation the primary pathology should be treated concomitantly to revascularization.     

Popliteal artery entrapment syndrome in our experience

Six cases of popliteal entrapment syndrome are presented with emphasis on the diagnostic difficulties related to this disease in its initial functional phase. The utility of Doppler ultrasonography associated with dynamic angiography is underlined. Normally surgical treatment of the disease is problem-free. The important determining factor seems to be medial gemellus hypertrophy. In this case the procedure of choice is thought to be vascular reconstruction associated with the disinsertion of this muscle followed by its reimplantation in a lower and medial position on the semi-membranous tendon muscle in order to avoid any secondary arterial compression.