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Incidence, diagnosis and treatment of popliteal artery entrapment syndrome in current vascular practice in Japan

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Abstract

Few data regarding popliteal artery entrapment syndrome (PAES) is available in Japan. In this study, we investigated incidence, diagnosis and treatment of PAES in current vascular practice. A retrospective analysis of all patients with PAES visiting 31 participating institutes between 2003 and 2015 was conducted. Thirty-five limbs (28 patients) were identified during the 13-year study period, and the incidence of PAES was 0.12% of all peripheral artery disease cases revascularized. Mean age was 32.0 ± 16.9 years old, and 60 and more years old was 10.7%. Also, 92.9% were male and 39.3% were athletes. Most frequent initial symptoms were intermittent claudication in 23 limbs (65.7%); 4 limbs (11.4%) had chronic limb-threatening ischemia. CT scan was most frequently (94.3%) used for the diagnostic imaging followed by MRI (45.7%) and duplex ultrasound (45.7%). Stress test such as dorsal flexion during duplex ultrasound was used only in 28.6%. Thirty-two limbs (91.4%) received surgical treatment, including 23 arterial reconstructions (71.9%); there were no major perioperative complications. All patients achieved improvement of their symptoms, and the average ankle brachial index increased from 0.69 ± 0.22 to 1.00 ± 0.14 post-surgery. The average postoperative follow-up period was 26.0 months with only one reintervention during the follow-up. In conclusion, PAES was a rare condition and traditional surgical treatment was solid. However, given a broad spectrum of clinical feature of PAES and less usage of diagnostic duplex ultrasound with stress test, there might be a miss- or delayed diagnosis of PAES even in the current vascular practice.

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References

  1. Sinha S, Houghton J, Holt PJ, Thompson MM, Loftus IM, Hinchliffe RJ. Popliteal entrapment syndrome. J Vasc Surg. 2012;55:252–62.

    Article  Google Scholar 

  2. Hicks CW, Black JH 3rd, Ratchford EV. Popliteal artery entrapment syndrome. Vasc Med. 2019;24:190–4.

    Article  Google Scholar 

  3. Kawarada O, Zen K, Hozawa K, Ayabe S, Huang H, Choi D, et al. Contemporary critical limb ischemia: Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care. Cardiovasc Interv Ther. 2018;33:297–312.

    Article  CAS  Google Scholar 

  4. Levien LJ, Veller MG. Popliteal artery entrapment syndrome: more common than previously recognized. J Vasc Surg. 1999;30:587–98.

    Article  CAS  Google Scholar 

  5. Marzo L, Cavallaro A, Mingoli A, Sapienza P, Tedesco M, Stipa S. Popliteal artery entrapment syndrome: the role of early diagnosis and treatment. Surgery. 1997;122:26–31.

    Article  CAS  Google Scholar 

  6. Altinsoy HB, Alatas O, Khalil E, Kara KA, Okten CC, Dogan OF. A very rare cause of lower limb ischemia in young people: popliteal artery entrapment. Open Cardiovasc Med J. 2018;12:18–28.

    Article  Google Scholar 

  7. Kwon YJ, Kwon TW, Gwon JG, Cho YP, Hwang SJ, Go KY. Anatomical popliteal artery entrapment syndrome. Ann Surg Treat Res. 2018;94:262–9.

    Article  Google Scholar 

  8. Liu Y, Sun Y, He X, Kong Q, Zhang Y, Wu J, et al. Imaging diagnosis and surgical treatment of popliteal artery entrapment syndrome: a single-center experience. Ann Vasc Surg. 2014;28:330–7.

    Article  Google Scholar 

  9. Zund G, Brunner U. Surgical aspects of popliteal artery entrapment syndrome: 26 years of experience with 26 legs. Vasa. 1995;24:29–33.

    CAS  PubMed  Google Scholar 

  10. Kim SY, Min SK, Ahn S, Min SI, Ha J, Kim SJ. Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion. J Vasc Surg. 2012;55:90–7.

    Article  Google Scholar 

  11. Lejay A, Delay C, Georg Y, Gaertner S, Ohana M, Thaveau F, et al. Five year outcomes of surgical treatment for popliteal artery entrapment syndrome. Eur J Vasc Endovasc Surg. 2016;51:557–64.

    Article  CAS  Google Scholar 

  12. di Marzo L, Cavallaro A, Sciacca V, Mingoli A, Tamburelli A. Surgical treatment of popliteal artery entrapment syndrome: a ten-year experience. Eur J Vasc Surg. 1991;5:59–64.

    Article  Google Scholar 

  13. Yamamoto S, Hoshina K, Hosaka A, Shigematsu K, Watanabe T. Long-term outcomes of surgical treatment in patients with popliteal artery entrapment syndrome. Vascular. 2015;23:449–54.

    Article  Google Scholar 

  14. Igari K, Sugano N, Kudo T, Toyofuku T, Jibiki M, Inoue Y, et al. Surgical treatment for popliteal artery entrapment syndrome. Ann Vasc Dis. 2014;7:28–33.

    Article  Google Scholar 

  15. Hirokawa M, Iwai T, Inoue Y, Sato S. Surgical treatment of popliteal vein entrapment causing symptoms. Phlebology. 2002;17:103–7.

    Article  Google Scholar 

  16. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26:517–38.

    Article  CAS  Google Scholar 

  17. Motaganahalli RL, Smeds MR, Harlander-Locke MP, Lawrence PF, Fujimura N, DeMartino RR, et al. A multi-institutional experience in adventitial cystic disease. J Vasc Surg. 2017;65:157–61.

    Article  Google Scholar 

  18. Stanley JC, Rhodes EL, Gewertz BL, Chang CY, Walter JF, Fry WJ. Renal artery aneurysms. Significance of macroaneurysms exclusive of dissections and fibrodysplastic mural dilations. Arch Surg. 1975;110:1327–33.

    Article  CAS  Google Scholar 

  19. Smeds MR, Duncan AA, Harlander-Locke MP, Lawrence PF, Lyden S, Fatima J, et al. Treatment and outcomes of aortic endograft infection. J Vasc Surg. 2016;63:332–40.

    Article  Google Scholar 

  20. Lawrence PF, Harlander-Locke MP, Oderich GS, Humphries MD, Landry GJ, Ballard JL, et al. The current management of isolated degenerative femoral artery aneurysms is too aggressive for their natural history. J Vasc Surg. 2014;59:343–9.

    Article  Google Scholar 

  21. Rich NM, Collins GJ Jr, McDonald PT, Kozloff L, Clagett GP, Collins JT. Popliteal vascular entrapment. Its increasing interest. Arch Surg. 1979;114:1377–84.

    Article  CAS  Google Scholar 

  22. Bouhoutsos J, Daskalakis E. Muscular abnormalities affecting the popliteal vessels. Br J Surg. 1981;68:501–6.

    Article  CAS  Google Scholar 

  23. Gibson MH, Mills JG, Johnson GE, Downs AR. Popliteal entrapment syndrome. Ann Surg. 1977;185:341–8.

    Article  CAS  Google Scholar 

  24. Hameed M, Coupland A, Davies AH. Popliteal artery entrapment syndrome: an approach to diagnosis and management. Br J Sports Med. 2018;52:1073–4.

    Article  Google Scholar 

  25. Levien LJ. Popliteal artery entrapment syndrome. Semin Vasc Surg. 2003;16:223–31.

    Article  Google Scholar 

  26. Casscells SW, Fellows B, Axe MJ. Another young athlete with intermittent claudication. A case report. Am J Sports Med. 1983;11:180–2.

    Article  CAS  Google Scholar 

  27. Iwai T, Konno S, Soga K, Hatano R, Sato S, Yamada T, et al. Diagnostic and pathological considerations in the popliteal artery entrapment syndrome. J Cardiovasc Surg (Torino). 1983;24:243–9.

    CAS  Google Scholar 

  28. Lopez Garcia D, Arranz MA, Tagarro S, Camarero SR, Gonzalez ME, Gimeno MG. Bilateral popliteal aneurysm as a result of vascular type IV entrapment in a young patient: a report of an exceptional case. J Vasc Surg. 2007;46:1047–50.

    Article  Google Scholar 

  29. di Marzo L, Cavallaro A. Popliteal vascular entrapment. World J Surg. 2005;29:S43–S4545.

    Article  Google Scholar 

  30. Meier TO, Schneider E, Amann-Vesti BR. Long-term follow-up of patients with popliteal artery entrapment syndrome treated by endoluminal revascularization. VASA. 2010;39:189–95.

    Article  CAS  Google Scholar 

  31. Lavingia KS, Dua A, Rothenberg KA, Fredericson M, Lee JT. Surgical management of functional entrapment syndrome in athletes. J Vasc Surg. 2019;70:1555–622.

    Article  Google Scholar 

  32. Society for Vascular Surgery Lower Extremity Guidelines Writing Group, Conte MS, Pomposelli FB, Clair DG, Geraghty PJ, McKinsey JF, et al. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 2015;61:2S–41S.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Takuro Shirasu, MD, Department of Surgery, Asahi General Hospital, Toshifumi Kudo, MD, PhD, Division of Vascular and Endovascular Surgery, Tokyo Medical and Dental University, Koichi Morisaki, MD, PhD, Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Daijirou Akamatsu, MD, PhD, Division of Vascular Surgery, Tohoku University Hospital, Tatsuya Shimogawara, MD, Department of Vascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Keita Hayashi, MD, Department of Surgery, Hiratsuka City Hospital, Hiroshi Sasajima, MD, Department of Cardiovascular Surgery, Kyorin University Hospital, Keisuke Miyake, MD, PhD, Department of Vascular Surgery, Asahikawa Medical University, Takashi Nakamura, MD, PhD, Department of Vascular Surgery, Osaka Rosai Hospital, Daisuke Fukui, MD, PhD, Department of Cardiovascular Surgery, Sinshu University Hospital, Hidemitsu Ogino, MD, Department of Surgery, Shonan Kamakura General Hospital, Naoki Unno, MD, PhD, Second Department of Surgery, Hamamatsu University School of Medicine, Norio Uchida, MD, PhD, Department of Surgery, Mito Red Cross Hospital, Yasuhito Sekimoto, MD, PhD, Department of Surgery, Tokyo Medical Center, Susumu Watada, MD, PhD, Department of Surgery, Kawasaki Municipal Hospital, Togo Norimatsu, MD, Department of Vascular Surgery, Sakakibara Memorial Hospital, Takahiro Ohmine, MD, PhD, Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hirotoki Ohkubo, MD, PhD, Department of Cardiovascular Surgery, Kitasato University School of Medicine, Ryoichi Kyuragi, MD, PhD, Division of Vascular Surgery, National Hospital Organization Kyushu Medical Center, and Tsuyoshi Shibata, MD, Department of Cardiovascular Surgery, Hakodate Municipal Hospital, Peter F. Lawrence, MD, Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, for their contribution to this study.

Funding

No financial support was provided by any entity for the conduct of this study.

Author information

Authors and Affiliations

  1. Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan

    Naoki Fujimura

  2. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Naoki Fujimura, Kyousuke Hosokawa & Hideaki Obara

  3. Division of Vascular and Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Kimihiro Igari

  4. Division of Vascular Surgery, Tohoku University Hospital, Miyagi, Japan

    Daijirou Akamatsu

  5. Department of Surgery, Keiyu Hospital, Kanagawa, Japan

    Hidetoshi Matsumoto

  6. Department of Surgery, Saitama Municipal Hospital, Saitama, Japan

    Atsunori Asami

  7. Department of Vascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan

    Shintaro Shibutani

  8. Department of Surgery, Hiratsuka City Hospital, Kanagawa, Japan

    Takurin Akiyoshi

  9. Department of Cardiovascular Surgery, Kyorin University Hospital, Tokyo, Japan

    Masao Nunokawa

  10. Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan

    Hirohisa Harada

  11. Department of Cardiovascular Surgery, Kobe Rosai Hospital, Hyogo, Japan

    Kyozo Inoue

  12. Department of Vascular Surgery, Asahikawa Medical University, Hokkaido, Japan

    Atsuhiro Koya

  13. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Tadashi Furuyama

  14. Department of Surgery, Hamamatsu Red Cross Hospital, Shizuoka, Japan

    Daisuke Sagara

  15. Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan

    Tsunehiro Shintani

  16. Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan

    Terutoshi Yamaoka

  17. Department of Surgery, Tachikawa Hospital, Tokyo, Japan

    Yoshinobu Akiyama

  18. Ambulatory Vascular Surgical Clinic Tokyo, Tokyo, Japan

    Yoshinori Inoue

  19. Department of Surgery, Division of Vascular Surgery, The University of Tokyo, Tokyo, Japan

    Katsuyuki Hoshina

Authors
  1. Naoki Fujimura
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  2. Kyousuke Hosokawa
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  12. Kyozo Inoue
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  14. Tadashi Furuyama
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  15. Daisuke Sagara
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  16. Tsunehiro Shintani
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  17. Terutoshi Yamaoka
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  18. Yoshinobu Akiyama
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  19. Yoshinori Inoue
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  20. Katsuyuki Hoshina
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Corresponding author

Correspondence to Hideaki Obara.

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All authors declare no association with any individual, company, or organization having a vested interest in the subject mentioned in this article.

IRB information

The study’s protocol was reviewed and approved by the institutional review board at each hospital, but was first reviewed and approved in the institutional review board at Keio University School of Medicine (20150007).

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Fujimura, N., Hosokawa, K., Obara, H. et al. Incidence, diagnosis and treatment of popliteal artery entrapment syndrome in current vascular practice in Japan. Cardiovasc Interv and Ther 36, 506–513 (2021). https://doi.org/10.1007/s12928-020-00710-1

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  • DOI: https://doi.org/10.1007/s12928-020-00710-1

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