Fujimura Naoki, Hosokawa Kyousuke, Obara Hideaki, Igari Kimihiro, Akamatsu Daijirou, Matsumoto Hidetoshi, Asami Atsunori, Shibutani Shintaro, Akiyoshi Takurin, Nunokawa Masao, Harada Hirohisa, Inoue Kyozo, Koya Atsuhiro, Furuyama Tadashi, Sagara Daisuke, Shintani Tsunehiro, Yamaoka Terutoshi, Akiyama Yoshinobu, Inoue Yoshinori, Hoshina Katsuyuki
Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan.
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
Cardiovasc Interv Ther. 2021 Oct;36(4):506-513. doi: 10.1007/s12928-020-00710-1. Epub 2020 Sep 28.
Few data regarding popliteal artery entrapment syndrome (PAES) is available in Japan. In this study, we investigated incidence, diagnosis and treatment of PAES in current vascular practice. A retrospective analysis of all patients with PAES visiting 31 participating institutes between 2003 and 2015 was conducted. Thirty-five limbs (28 patients) were identified during the 13-year study period, and the incidence of PAES was 0.12% of all peripheral artery disease cases revascularized. Mean age was 32.0 ± 16.9 years old, and 60 and more years old was 10.7%. Also, 92.9% were male and 39.3% were athletes. Most frequent initial symptoms were intermittent claudication in 23 limbs (65.7%); 4 limbs (11.4%) had chronic limb-threatening ischemia. CT scan was most frequently (94.3%) used for the diagnostic imaging followed by MRI (45.7%) and duplex ultrasound (45.7%). Stress test such as dorsal flexion during duplex ultrasound was used only in 28.6%. Thirty-two limbs (91.4%) received surgical treatment, including 23 arterial reconstructions (71.9%); there were no major perioperative complications. All patients achieved improvement of their symptoms, and the average ankle brachial index increased from 0.69 ± 0.22 to 1.00 ± 0.14 post-surgery. The average postoperative follow-up period was 26.0 months with only one reintervention during the follow-up. In conclusion, PAES was a rare condition and traditional surgical treatment was solid. However, given a broad spectrum of clinical feature of PAES and less usage of diagnostic duplex ultrasound with stress test, there might be a miss- or delayed diagnosis of PAES even in the current vascular practice.
在日本，关于腘动脉压迫综合征（PAES）的数据很少。在本研究中，我们调查了当前血管外科实践中PAES的发病率、诊断和治疗情况。对2003年至2015年间就诊于31家参与研究机构的所有PAES患者进行了回顾性分析。在为期13年的研究期间，共识别出35条肢体（28例患者），PAES的发病率占所有接受血管重建的外周动脉疾病病例的0.12%。平均年龄为32.0±16.9岁，60岁及以上患者占10.7%。此外，92.9%为男性，39.3%为运动员。最常见的初始症状是23条肢体（65.7%）出现间歇性跛行；4条肢体（11.4%）出现慢性肢体威胁性缺血。CT扫描是最常用的（94.3%）诊断成像方法，其次是MRI（45.7%）和双功超声（45.7%）。双功超声检查时进行背屈等压力试验仅在28.6%的病例中使用。32条肢体（91.4%）接受了手术治疗，其中包括23例动脉重建（71.9%）；围手术期无重大并发症。所有患者症状均得到改善，术后平均踝肱指数从0.69±0.22提高到1.00±0.14。术后平均随访期为26.0个月，随访期间仅进行了一次再次干预。总之，PAES是一种罕见疾病，传统手术治疗效果可靠。然而，鉴于PAES的临床特征广泛，且诊断性双功超声检查结合压力试验的使用较少，即使在当前的血管外科实践中，PAES仍可能存在漏诊或诊断延迟的情况。
