FUNCTIONAL POPLITEAL ARTERY ENTRAPMENT SYNDROME: INVESTIGATION WITH DYNAMIC AND DOPPLER ULTRASOUND

Patricia B. Delzell; Fatemeh Abdollahi Mofakham; Jennifer Bullen; Jason Genin

摘要

A. Background Functional popliteal artery entrapment syndrome (fPAES), a cause of exertional leg pain, has a clinical presentation and clinical findings that are often indistinguishable from those of other leg pain causes (1). This condition may also coexist and overlap in symptomatology with other leg pain causes, further complicating the diagnosis (2). Although fPAES is usually considered a rare cause of leg pain (3), the true incidence of this condition is unknown, and fPAES is likely underdiagnosed and underreported (4). A missed diagnosis may result in disease progression and the use of unnecessary invasive procedures (3), and untreated fPAES may lead to popliteal artery damage, embolization, and limb ischemia (5). Although a diagnostic method using a combination of dynamic ultrasound and MR imaging/MR angiography has been described for fPAES (5), to our knowledge, no investigational studies have been performed to assess the dynamic ultrasound findings in this entity. This study sought to evaluate the usefulness of dynamic plantar flexion and dorsiflexion of the calf and the effect on the popliteal artery Doppler waveform in patients with clinically suspected fPAES and no structural abnormality. B. Methods We performed a retrospective review of ultrasound studies in patients who presented with clinically suspected PAES over a 3-year period. The ultrasound studies consisted of an anatomic survey of the popliteal. Dynamic nonresistant dorsiflexion and plantar flexion evaluations of the popliteal artery plus spectral Doppler evaluations of the popliteal artery obtained in neutral, plantar flexion, and dorsiflexion positions were performed before and after patients exercised. Patients with anatomic abnormalities were excluded. The following parameters were assessed: The proportion of symptomatic knees versus asymptomatic knees in which plantar flexion and/or dorsiflexion of the foot resulted in popliteal artery compression. The peak systolic velocity (PSV) of the popliteal artery in all positions for knees with and knees without dynamic popliteal artery compression. The absolute value change in PSV of the popliteal artery from neutral to plantar flexion and from neutral to dorsiflexion in the pre- and postexercise state for knees with and knees without dynamic popliteal artery compression. ROC analysis for clustered data was used to assess the ability of PSV to distinguish between knees with and knees without arterial compression. C. Results A total of 88 knees (77 symptomatic, 11 asymptomatic) in 45 patients were included in the study. Dynamic arterial compression was observed in 38% (29/77) of symptomatic knees. No compression seen in asymptomatic knees. Both pre-exercise and postexercise knees with arterial compression had significantly higher absolute changes in PSV from neutral to plantar flexion versus knees without arterial compression (Table). There was a smaller significant change in PSV from neutral to dorsiflexion in the pre-exercise state. There was no significant change in PSV in the postexercise state from neutral to dorsiflexion or with respect to PSV values at any position between knees with and knees without arterial compression. D. Conclusions/Significance In patients with clinically suspected PAES without anatomic abnormality, dynamic ultrasound demonstrated compression of the popliteal artery in 38% of knees. No dynamic arterial compression was seen in asymptomatic knees. There was a significant elevation in PSV from neutral to plantar flexion in pre- and postexercise states and from pre-exercise neutral to dorsiflexion positions in knees with arterial compression versus knees without arterial compression. Tables Table – Absolute change in PSV (cm/s) for knees with and knees without arterial compression Knees without visual compression of artery (n=59) Knees with visual compression of artery (n=29) P value Absolute change in PSV from neutral to plantar flexion (pre-exercise) 13 (±10) 32 (±29) 0.007 Absolute change in PSV from neutral to plantar flexion (postexercise) 15 (±14) 40 (±26) &0.001 Absolute change in PSV from neutral to dorsiflexion (pre-exercise) 12 (±8) 18 (±12) 0.049 Absolute change in PSV from neutral to dorsiflexion (postexercise) 15 (±13) 17 (±13) 0.431 References Joy SM, Raudales R. Popliteal artery entrapment syndrome. Curr Sports Med Rep. 2015;14(5):364-367. Hislop M, Kennedy D, Cramp B, Dhupelia S. Functional popliteal artery entrapment syndrome: poorly understood and frequently missed? A review of clinical features, appropriate investigations, and treatment options. J Sports Med (Hindawi Publ Corp). 2014;2014:105953. Gaunder C, McKinney B, Rivera J. Popliteal artery entrapment or chronic exertional compartment syndrome? Case Rep Med. 2017;2017:6981047 Hislop M, Brideaux A, Dhupelia S. Functional popliteal artery entrapment syndrome: use of ultrasound guided Botox injection as a non-surgical treatment option. Skeletal Radiol. 2017;46(9):1241-1248. Williams C,

机译：A.背景功能Popliteal动脉夹紧综合征（FPAES），患有腿部疼痛的原因，具有临床介绍和临床发现，通常与其他腿部疼痛引起的那些难以区分（1）。这种情况也可能与其他腿部疼痛引起的症状和重叠在症状和重叠，进一步使诊断（2）复杂化。虽然FPAES通常被认为是少数腿部疼痛的原因（3），但这种情况的真正发生率未知，并且FPAES可能是下降和遭受的（4）。错过的诊断可能导致疾病进展和使用不必要的侵入性手术（3），并且未经处理的FPAES可能导致Popliteal动脉损伤，栓塞和肢体缺血（5）。尽管已经描述了使用动态超声和MR血管造影的组合的诊断方法已经针对FPAES（5），但我们的知识已经没有进行调查，以评估该实体中的动态超声检查。该研究试图评估小牛动力跖屈曲和背屈的有用性以及临床疑似FPAES患者患有Popliteal动脉多普勒波形的效果，没有结构异常。 B.方法我们对在3年期间患有临床疑似PAES的患者的超声研究进行了回顾性审查。超声研究包括对Popliteal的解剖学调查。在患者行使之前和之后，进行动态非孕腺加号Popliteal动脉加上Popliteal动脉加上光痘动脉的光痘动脉的光谱多普勒评估。排除了解剖学异常的患者。评估以下参数：症状膝关节的比例与脚跖屈曲和/或脚的背屈导致Popliteal动脉压缩。在没有动态Popliteal动脉压缩的情况下，所有位置的Popliteal动脉的峰值收缩速度（PSV）在膝盖和膝关节中的所有位置。从中性到Plantar屈曲的PAPV屈曲的绝对值变化，并在没有动态Popliteal动脉压缩的膝盖和膝关节中的膝盖和膝关节中的中性和中性。群集数据的ROC分析用于评估PSV区分膝盖与膝关节的能力，没有动脉压缩。 C.结果共有88名膝关节（77例症状，11例无症状），涉及该研究。在38％（29/77）的症状膝盖中观察到动态动脉压缩。无症状膝盖没有压缩。预锻炼和后期膝盖患有动脉压缩，PSV的绝对变化显着从中性到VALLARAR屈曲而没有动脉压缩（表）。在运动状态下，PSV与中性较小的显着变化较小。从中性到背裂或在没有动脉压缩的膝盖之间的任何位置的任何位置的PSV值中没有显着变化。 D.结论/意义在没有解剖异常的临床疑似PAES的患者中，动态超声证明了38％的膝盖中popliteal动脉的压缩。在无症状的膝盖中没有看到动态动脉压缩。 PSV中的显着高度从中性到Prossarar屈曲，在Pre-andexecise状态下，并且从膝盖上的膝盖上的膝盖上的锻炼位置与膝盖相比，没有动脉压缩。表表 - 对于没有动脉压缩膝盖的膝盖和膝盖的PSV（cm / s）的绝对变化，没有动脉（n = 59）膝盖，具有动脉（n = 29）P值从中性的p值绝对变化跖屈（预锻炼）13（±10）32（±29）0.007从中性到Plantar屈曲（第二±14）40（±26）＆ 0.001来自中性的PSV的绝对变化对背裂（锻炼）12（±8）18（±12）0.049从中性到背离的PSV（±13）17（±13）0.431参考Joy Sm，Raudales R. popliteal动脉夹紧综合征。 Curr Sports Med Rep。2015; 14（5）：364-367。 Hislop M，肯尼迪D，Cramp B，Dhupelia S.功能性Popliteal动脉夹带综合征：明白和经常错过？审查临床特征，适当调查和治疗方案。 J Sports Med（Hindwi Publ Corp）。 2014; 2014年：105953。 Gaunder C，McKinney B，Rivera J. Popliteal动脉夹紧或慢性抵押室综合征？案例Rep Med。 2017年; 2017：6981047 Hislop M，Brideaux A，Dhupelia S.功能性Popliteal动脉夹带综合征：使用超声引导肉毒杆菌注射作为非手术治疗选择。骨骼放射性。 2017; 46（9）：1241-1248。威廉姆斯C，

FUNCTIONAL POPLITEAL ARTERY ENTRAPMENT SYNDROME: INVESTIGATION WITH DYNAMIC AND DOPPLER ULTRASOUND

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