PMID- 31327599
OWN - NLM
STAT- MEDLINE
DCOM- 20200527
LR  - 20210915
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 70
IP  - 5
DP  - 2019 Nov
TI  - Surgical management of functional popliteal entrapment syndrome in athletes.
PG  - 1555-1562
LID - S0741-5214(19)30335-0 [pii]
LID - 10.1016/j.jvs.2019.01.068 [doi]
AB  - BACKGROUND: Functional popliteal artery entrapment syndrome (FPAES) is a rare 
      disorder described in young, physically active adults that can be limb or 
      performance threatening if untreated. We used provocative computed tomography 
      angiography (CTA) in these patients to guide partial debulking of the 
      anterolateral quadrant of the medial head of the gastrocnemius muscle for FPAES 
      and reviewed the outcomes of this technique in this highly specialized cohort. 
      METHODS: Athletes referred with symptoms of FPAES underwent a CTA protocol with 
      provocative plantarflexion and dorsiflexion to confirm compression and were 
      offered surgery. All patients underwent posterior approach operative exposure of 
      the popliteal artery, adhesiolysis, side branch ligation, and partial excision of 
      the gastrocnemius muscle with or without fasciotomies. Preoperative imaging, 
      operative findings, and midterm follow-up, including return to baseline function 
      and return to competitive function, as well as symptom recurrence, were 
      retrospectively reviewed. RESULTS: Thirty-six athletes had a total of 56 limbs 
      treated. The average patient age was 26.9 years and the majority were female 
      (56%). Thirty-one percent of patients were referred after already having 
      undergone prior fasciotomies. Sports involved included track and field or running 
      (47%), soccer (25%), water sports (8%), basketball (6%), lacrosse (6%), climbing 
      (3%), skiing (3%), and gymnastics (3%). Of the patients, 27 (75%) had bilateral 
      symptoms and evidence of entrapment; however, only 20 of the 36 (56%) underwent 
      bilateral surgical treatment for symptom resolution. The mean amount of 
      gastrocnemius muscle removed was 7.6 cm(3). Nine percent of limbs underwent a 
      bypass along with debulking owing to arterial occlusion at presentation. 
      Postoperatively, there were no nerve or vascular complications noted, although 
      two patients had wound/seroma complications (6%). At the first follow-up, all 
      patients reported mild symptom improvement, but at the midterm follow-up (mean 
      follow-up time, 16 months), six (17%) reported mild to moderate recurrence of 
      symptoms. Of the patients, 78% were able to fully return to their previous 
      competitive levels of sports. All patients were able to resume their athletic 
      endeavor at a recreational level. CONCLUSIONS: More than three-fourths of 
      athletes limited by FPAES demonstrate full return to prior competitive levels 
      with fasciotomy and surgical debulking of the anterolateral quadrant of the 
      medial gastrocnemius muscle. Provocative CTA protocols can help to guide the 
      location of muscle debulking to alleviate the functional entrapment that occurs 
      in these athletes with exercise. This technique is a viable option in athletes 
      with FPAES looking to return to competitive athletics.
CI  - Copyright (c) 2019 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Lavingia, Kedar S
AU  - Lavingia KS
AD  - Division of Vascular Surgery, Stanford University Medical Center, Stanford, 
      Calif.
FAU - Dua, Anahita
AU  - Dua A
AD  - Division of Vascular Surgery, Stanford University Medical Center, Stanford, 
      Calif.
FAU - Rothenberg, Kara A
AU  - Rothenberg KA
AD  - Division of Vascular Surgery, Stanford University Medical Center, Stanford, 
      Calif.
FAU - Fredericson, Michael
AU  - Fredericson M
AD  - Division of Sports Medicine, Stanford University Medical Center, Stanford, Calif.
FAU - Lee, Jason T
AU  - Lee JT
AD  - Division of Vascular Surgery, Stanford University Medical Center, Stanford, 
      Calif. Electronic address: jtlee@stanford.edu.
LA  - eng
PT  - Journal Article
DEP - 20190718
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
CIN - J Vasc Surg. 2019 Nov;70(5):1563. PMID: 31653376
CIN - J Vasc Surg. 2021 Jul;74(1):342-344. PMID: 34172193
CIN - J Vasc Surg. 2021 Jul;74(1):344. PMID: 34172195
MH  - Adolescent
MH  - Adult
MH  - Arterial Occlusive Diseases/diagnosis/physiopathology/*surgery
MH  - *Athletes
MH  - Computed Tomography Angiography/methods
MH  - Decompression, Surgical/*methods
MH  - Fasciotomy/methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Lower Extremity/blood supply/physiology
MH  - Male
MH  - Middle Aged
MH  - Muscle, Skeletal/blood supply/*surgery
MH  - Plethysmography
MH  - Popliteal Artery/*diagnostic imaging/physiopathology
MH  - Recovery of Function
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Athlete
OT  - Decompression
OT  - Entrapment
OT  - Popliteal
EDAT- 2019/07/23 06:00
MHDA- 2020/05/28 06:00
CRDT- 2019/07/23 06:00
PHST- 2018/10/23 00:00 [received]
PHST- 2019/01/31 00:00 [accepted]
PHST- 2019/07/23 06:00 [pubmed]
PHST- 2020/05/28 06:00 [medline]
PHST- 2019/07/23 06:00 [entrez]
AID - S0741-5214(19)30335-0 [pii]
AID - 10.1016/j.jvs.2019.01.068 [doi]
PST - ppublish
SO  - J Vasc Surg. 2019 Nov;70(5):1555-1562. doi: 10.1016/j.jvs.2019.01.068. Epub 2019 
      Jul 18.