Zhou Yi, Ryer Evan J, Garvin Robert P, Irvan Jeremy L, Elmore James R
Department of Vascular and Endovascular Surgery, Geisinger Medical Center, Danville, PA, United States.
Department of Vascular and Endovascular Surgery, Geisinger Medical Center, Danville, PA, United States.
Int J Surg Case Rep. 2017;37:113-118. doi: 10.1016/j.ijscr.2017.06.030. Epub 2017 Jun 17.
Adductor canal compression syndrome is a rare non-atherosclerotic cause of arterial occlusion and limb ischemia.
The patient is an 18-year-old healthy female who presented to the emergency department with acute left lower extremity ischemia. Her symptoms began as sudden onset mild foot pain approximately two months ago. Over the 72h prior to presentation, she developed severe pain, pallor, paralysis, loss of pedal pulses, paresthesia, and poikilothermia. Due to her advanced ischemia, she was taken immediately to the operating room for angiography and intervention. Initial angiography demonstrated distal superficial femoral and popliteal artery occlusions along with lack of tibial or pedal artery blood flow. She underwent percutaneous mechanical thrombectomy and initiation of catheter directed thrombolysis. After 48h of catheter directed thrombolysis and repeat mechanical thrombectomy, computed tomography (CT) was performed and demonstrated external compression of the superficial femoral artery in the adductor canal and residual chronic thrombus. Echocardiography and CT of the thoracic aorta was also performed, and were negative, therefore excluding other potential sources of arterial embolism. She next underwent surgical exploration, division of an anomalous musculotendinous band compressing the left superficial femoral artery and thromboendarterectomy of the distal left superficial femoral artery. The patient recovered well without any post-operative complications and could return to her daily activities 3 weeks following surgery.
Knowledge of rare non-atherosclerotic vascular disorders, such as adductor canal compression syndrome, is paramount when treating patients who present with limb ischemia and lack traditional risk factors.
内收肌管压迫综合征是一种罕见的非动脉粥样硬化性动脉闭塞和肢体缺血原因。
患者为一名18岁健康女性，因急性左下肢缺血就诊于急诊科。她的症状始于约两个月前突发的轻度足部疼痛。在就诊前的72小时内，她出现了严重疼痛、苍白、麻痹、足背动脉搏动消失、感觉异常和体温调节障碍。由于她的缺血情况严重，立即被送往手术室进行血管造影和干预。初始血管造影显示股浅动脉远端和腘动脉闭塞，以及胫动脉或足背动脉无血流。她接受了经皮机械血栓切除术并开始导管定向溶栓。在导管定向溶栓48小时并重复机械血栓切除术后，进行了计算机断层扫描（CT），显示内收肌管内股浅动脉受到外部压迫以及残留慢性血栓。还进行了超声心动图和胸主动脉CT检查，结果均为阴性，因此排除了动脉栓塞的其他潜在来源。接下来，她接受了手术探查，切断了一条压迫左股浅动脉的异常肌腱带，并对左股浅动脉远端进行了血栓内膜切除术。患者恢复良好，无任何术后并发症，术后3周即可恢复日常活动。
在治疗出现肢体缺血且缺乏传统危险因素的患者时，了解诸如内收肌管压迫综合征等罕见的非动脉粥样硬化性血管疾病至关重要。
