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CASE 39


An athletic 21-year-old man presented with a complaint of pain and weakness in his right leg when jogging. The pain and weakness intensified with continued activity but dissipated at rest. There was no history of trauma to his right lower limb and no family history of diabetes mellitus or other diseases that would lead to accelerated atherosclerosis. Lab results for cholesterol and triglycerides were normal. The dorsalis pedis arterial pulse was normal but disappeared with dorsiflexion of the right foot. Doppler measurement of blood flow velocity in the dorsalis pedis artery showed diminished velocity with dorsiflexion of the right foot and plantar flexion against resistance. Measurements in the left dorsalis pedis artery were normal. Angiography showed medial deviation of the popliteal artery with poststenotic dilatation. The patient was diagnosed with popliteal artery entrapment syndrome and it was treated surgically.



HOW DOES THE POPLITEAL ARTERY DEVELOP?


Embryologically, the popliteal artery is derived from three sources:


• The proximal segment of the popliteal artery is formed by the fusion of the femoral arterial plexus and the popliteal portion of the primitive axial (ischiadic) artery.

• The middle segment directly forms from the primitive axial artery.

• The original distal segment of the popliteal artery, which lies deep to the popliteus muscle, is a continuation of the primitive axial artery. This artery disappears at the beginning of the fetal period and is replaced by the union of two new arteries. The fusion of the vessels occurs superficial to the popliteus muscle and after the medial head of the gastrocnemius muscle has moved through the popliteal fossa.


WHAT ARE THE POSSIBLE CAUSES OF POPLITEAL ARTERY ENTRAPMENT SYNDROME?


The most frequent cause of popliteal artery entrapment is compression by a congenital abnormality of the medial head of the gastrocnemius muscle causing the popliteal artery to deviate medially. Another cause may be fibrosis of the tunica intima of the popliteal artery resulting from repetitive flexion-extension movements of the knee joint.


Six types of popliteal artery entrapment syndrome have been described. Five of these have an embryologic basis and the sixth is considered to be functional. The five embryologic types are:


• Type 1. In this type, which is the most common, development of the distal popliteal artery occurs before the medial head of the gastrocnemius muscle migrates toward its origin. As a result, the superior migration of the medial head of the gastrocnemius muscle will move the popliteal artery medially.

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Jun 16, 2016 | Posted by in ANATOMY | Comments Off on 39

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