Naert Mackenzie N, Glassberg Brittany, Han Daniel, Truglio Joseph
Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Internal Medicine-Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA.
Cureus. 2021 Mar 5;13(3):e13723. doi: 10.7759/cureus.13723.
Popliteal entrapment syndrome is an uncommon cause of intermittent claudication in young patients lacking atherosclerotic risk factors. ZS is a 16-year-old cisgender female with type 1 diabetes complicated by microalbuminuria, obesity (body mass index (BMI) = 45.86 kg/m²), and a history of perinatal stroke with residual right-sided hemiparesis, who presented with six months of worsening bilateral, exertional lower extremity pain. Common causes of chronic bilateral lower extremity pain include peripheral vascular disease and diabetic neuropathy. Less common etiologies include trauma, infection, or juvenile idiopathic arthritis. Given her risk factors, the patient's pain was initially managed as a diabetic neuropathy with pregabalin. Symptoms failed to improve, and she re-presented with positional coolness of the right lower extremity, diminished pulses of the bilateral lower extremities, and weakness in her toes. CT angiography demonstrated occlusion of the right distal superficial femoral and popliteal arteries and diffused tibial disease. Ultimately, the patient was discovered to have right-sided femoral-popliteal occlusion, and she required urgent femoral-tibial bypass. Despite an initial improvement in symptoms postoperatively, she continued to have lower extremity pain and recurrent arterial thrombi, even with antiplatelet and anticoagulation therapy. Eventually, the patient required a right-sided below the knee amputation. This case highlights the high index of suspicion that clinicians must have in young patients with lower extremity pain, both with and without atherosclerotic risk factors, as early intervention facilitates better outcomes. Introduction.
腘动脉压迫综合征是年轻患者间歇性跛行的罕见原因，这些患者缺乏动脉粥样硬化风险因素。ZS是一名16岁的顺性别女性，患有1型糖尿病，并发微量白蛋白尿、肥胖（体重指数（BMI）=45.86kg/m²），有围产期卒中病史并遗留右侧偏瘫，她因双侧下肢进行性疼痛加重6个月前来就诊。慢性双侧下肢疼痛的常见原因包括外周血管疾病和糖尿病性神经病变。较不常见的病因包括创伤、感染或幼年特发性关节炎。鉴于她的风险因素，患者的疼痛最初被当作糖尿病性神经病变用普瑞巴林进行治疗。症状未见改善，她再次就诊时出现右下肢位置性发凉、双侧下肢脉搏减弱以及脚趾无力。CT血管造影显示右股浅动脉远端和腘动脉闭塞以及胫部弥漫性病变。最终，发现该患者存在右侧股-腘动脉闭塞，她需要紧急进行股-胫搭桥手术。尽管术后症状最初有所改善，但即使进行了抗血小板和抗凝治疗，她仍持续存在下肢疼痛和复发性动脉血栓形成。最终，该患者需要进行右侧膝下截肢。本病例强调了临床医生对于有或没有动脉粥样硬化风险因素的下肢疼痛年轻患者必须保持高度怀疑，因为早期干预有助于获得更好的结果。引言。
