Settembre N, Bouziane Z, Bartoli M A, Nabokov V, Venermo M, Feugier P, Malikov S
Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France.
Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France.
Eur J Vasc Endovasc Surg. 2017 Apr;53(4):576-582. doi: 10.1016/j.ejvs.2016.12.032. Epub 2017 Feb 17.
Popliteal artery entrapment syndrome (PAES) is an uncommon anatomical anomaly, frequently described in adults. The most common symptom is claudication. Acute limb ischaemia (ALI) in children is rare, but it may evolve and lead to limb loss or lifelong complications. Clinical and surgical experience of PAES in children is reported. Data from the literature are analysed in order to assess the severity of this disease and to identify the factors characterising the diagnosis and the outcome of treatment in paediatric patients.
Four children (aged 7-16 years) were referred with ALI due to PAES. Among the 439 articles reporting cases of PAES, 55 patients under 18 years of age were the focus. The PAES cases were classified according to the Love and Whelan classification modified by Rich.
Data from 79 children (106 limbs, 27 bilateral PAES) were collected and analysed. Type I PAES was present in 41 (39%), Type II in 23 (22%), Type III in 24 (23%), Type IV in 12 (11%), and Type V in two (2%) limbs. A functional PAES was present in one patient bilaterally. In two cases, the type of PAES was not reported. Claudication occurred in 68 cases (64%), and ALI in 19 (18%). In 60 cases (57%), revascularisation with or without myotomy was required; myotomy alone was performed in 41 cases (39%).
Symptomatic PAES in children should be considered a severe condition requiring urgent investigation in order to avoid any delays in the treatment. Early diagnosis and treatment are essential to prevent serious complications. The long-term outcomes of surgical treatment with the correction of the anatomical anomaly and vascular reconstruction are satisfactory with a low complication rate.
腘动脉压迫综合征（PAES）是一种罕见的解剖异常，常见于成年人。最常见的症状是间歇性跛行。儿童急性肢体缺血（ALI）很少见，但可能会发展并导致肢体丧失或终身并发症。本文报告了儿童PAES的临床和手术经验。分析文献数据以评估该疾病的严重程度，并确定儿科患者诊断和治疗结果的特征因素。
4例7至16岁的儿童因PAES导致ALI前来就诊。在439篇报告PAES病例的文章中，55例18岁以下患者成为研究重点。PAES病例根据Rich修改的Love和Whelan分类法进行分类。
收集并分析了79例儿童（106条肢体，27例双侧PAES）的数据。I型PAES有41例（39%），II型有23例（22%），III型有24例（23%），IV型有12例（11%），V型有2例（2%）。1例患者双侧存在功能性PAES。2例未报告PAES类型。68例（64%）出现间歇性跛行，19例（18%）出现ALI。60例（57%）需要进行血管重建，伴或不伴肌肉切开术；仅进行肌肉切开术的有41例（39%）。
儿童有症状的PAES应被视为一种严重疾病，需要紧急检查以避免治疗延误。早期诊断和治疗对于预防严重并发症至关重要。通过纠正解剖异常和血管重建进行手术治疗的长期效果令人满意，并发症发生率低。
