PMID- 36936395
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230321
IS  - 2468-4287 (Print)
IS  - 2468-4287 (Electronic)
IS  - 2468-4287 (Linking)
VI  - 9
IP  - 1
DP  - 2023 Mar
TI  - Intravascular ultrasound imaging for diagnosis and characterization of the 
      popliteal compression syndrome.
PG  - 101076
LID - 10.1016/j.jvscit.2022.11.013 [doi]
LID - 101076
AB  - OBJECTIVE: Functional popliteal artery entrapment syndrome (fPAES) is a rare form 
      of nonatherosclerotic claudication most often seen in young athletic patients. 
      Diagnosis remains challenging, with various imaging modalities showing equivocal 
      or subtle findings that may be missed. We sought to critically examine and 
      quantitate the utility of intravascular ultrasound (IVUS) imaging, a common 
      diagnostic tool for vascular compression syndromes, in diagnosis and 
      characterization of fPAES. METHODS: Patients presenting to a single tertiary care 
      center between 2019 and 2022 with symptoms of PAES but without an anatomic 
      etiology or equivocal workup were selected. Angiogram and IVUS with maneuvers 
      were performed on affected extremities at rest, active 
      plantarflexion/dorsiflexion, and plantarflexion/dorsiflexion against resistance. 
      IVUS examination was recorded using a pull-back technique from the tibial vessels 
      to the superficial femoral artery. The degree, length, and anatomic location of 
      compression using the two imaging modalities were compared. RESULTS: Angiogram 
      and IVUS with maneuvers were performed on 17 lower extremities (9 left, 8 right) 
      in 15 patients (88% female; mean age, 21.2 years). Evidence of arterial 
      compression on angiography was noted in 88.2% (n = 15) of limbs (66.7% complete 
      contrast cessation and 20% popliteal artery tapering); 13.3% (n = 2) only 
      demonstrated sluggish flow as possible evidence of compression. Arterial 
      compression was seen on IVUS imaging in 15 of 17 limbs, and all completely 
      compressed around the IVUS catheter. The IVUS-measured mean length of compression 
      was 10.5 cm +/- 4.2 (median, 11 cm; range, 4-23 cm). Compression involved only the 
      popliteal vessels in 86.7% (n = 13); one patient had both popliteal and 
      tibioperoneal trunk compression, whereas another had tibioperoneal trunk and 
      peroneal artery compression. Popliteal vein compression was 100%. The contrast 
      cessation point on angiography and the proximal point of compression on IVUS 
      imaging differed in 80% of cases (P < .05). The distal extent of compression was 
      unable to be determined by angiogram findings but was clearly delineated by IVUS 
      imaging in all cases. CONCLUSIONS: IVUS imaging is a more sensitive diagnostic 
      and descriptive imaging modality compared with angiogram in patients with 
      possible fPAES. IVUS and angiogram findings are greatly discordant; moreover, 
      IVUS imaging can provide detailed information such as the precise extent and 
      anatomic location of the arterial compression, which may be useful in aiding 
      surgical planning. IVUS imaging should be considered the gold standard for 
      diagnosing and characterizing fPAES before intervention planning.
FAU - Hall, Michael R
AU  - Hall MR
AD  - University of Maryland School of Medicine, Baltimore, MD.
FAU - Vyas, Yamini
AU  - Vyas Y
AD  - University of Maryland School of Medicine, Baltimore, MD.
FAU - Kang, Jeanwan
AU  - Kang J
AD  - University of Maryland School of Medicine, Baltimore, MD.
FAU - Nagarsheth, Khanjan
AU  - Nagarsheth K
AD  - University of Maryland School of Medicine, Baltimore, MD.
FAU - Sarkar, Rajabrata
AU  - Sarkar R
AD  - University of Maryland School of Medicine, Baltimore, MD.
LA  - eng
PT  - Journal Article
DEP - 20221212
PL  - United States
TA  - J Vasc Surg Cases Innov Tech
JT  - Journal of vascular surgery cases and innovative techniques
JID - 101701125
PMC - PMC10017414
OTO - NOTNLM
OT  - Compression syndromes
OT  - Functional popliteal entrapment
OT  - Intravascular ultrasound
EDAT- 2023/03/21 06:00
MHDA- 2023/03/21 06:01
PMCR- 2022/12/12
CRDT- 2023/03/20 03:46
PHST- 2022/08/09 00:00 [received]
PHST- 2022/11/15 00:00 [accepted]
PHST- 2023/03/20 03:46 [entrez]
PHST- 2023/03/21 06:00 [pubmed]
PHST- 2023/03/21 06:01 [medline]
PHST- 2022/12/12 00:00 [pmc-release]
AID - S2468-4287(22)00224-6 [pii]
AID - 101076 [pii]
AID - 10.1016/j.jvscit.2022.11.013 [doi]
PST - epublish
SO  - J Vasc Surg Cases Innov Tech. 2022 Dec 12;9(1):101076. doi: 
      10.1016/j.jvscit.2022.11.013. eCollection 2023 Mar.