Erdoes L S, Devine J J, Bernhard V M, Baker M R, Berman S S, Hunter G C
Section of Vascular Surgery, University of Arizona Health Sciences Center Tucson.
J Vasc Surg. 1994 Dec;20(6):978-86. doi: 10.1016/0741-5214(94)90236-4.
Positional popliteal artery obstruction is believed to be an important factor contributing to popliteal artery entrapment syndromes. This study was undertaken to define the positional anatomy and physiologic condition of the vessels in the popliteal fossa in groups of highly trained and normally active young men and women. We postulate that at least some symptom-free individuals can occlude the popliteal artery with leg positioning.
Seventy-two limbs were evaluated in 36 subjects. Symptom-free subjects were recruited in four groups: normally active men, normally active women, male competitive runners, and female competitive runners. All subjects underwent noninvasive testing that included resting segmental limb pressures and Doppler waveforms and color-flow duplex imaging with the leg in the neutral position and then with knee extension with active and passive dorsiflexion and plantar flexion of the foot. Subjects unable to occlude the popliteal artery with positioning were then exercised, and studies were repeated. Magnetic resonance imaging, with magnetic resonance angiography, was conducted on 14 subjects, with each leg studied in the neutral position and with active positioning.
Positional popliteal arterial occlusion occurred in 38 of 72 limbs (53%). No intergroup comparisons were statistically significant. The response of each leg was symmetric in 89% of subjects. No subject who could not occlude the popliteal artery at rest was able to do so with exercise. Magnetic resonance imaging disclosed normal anatomy in all subjects and showed the location of popliteal occlusion to be at the level of the soleal sling, with positional compression by the soleus muscle, the lateral head of the gastrocnemius, the plantaris, and popliteus muscles.
Popliteal arterial occlusion can be induced in 53% of subjects with simple leg positioning caused by myofascial compression. This must be considered when evaluating patients for intervention on the basis of physiologic testing of the popliteal vessels.
腘动脉位置性梗阻被认为是导致腘动脉受压综合征的一个重要因素。本研究旨在明确经过高度训练的年轻男性和女性以及正常活动的年轻男性和女性群体中腘窝血管的位置解剖结构和生理状况。我们推测至少一些无症状个体可通过腿部姿势使腘动脉闭塞。
对36名受试者的72条肢体进行评估。无症状受试者分为四组：正常活动的男性、正常活动的女性、男性竞技跑步者和女性竞技跑步者。所有受试者均接受无创检测，包括静息时肢体节段压力和多普勒波形，以及腿部处于中立位、然后膝关节伸展并主动和被动背屈及跖屈足部时的彩色血流双功成像。无法通过姿势使腘动脉闭塞的受试者随后进行运动，之后重复检测。对14名受试者进行了磁共振成像及磁共振血管造影，每条腿分别在中立位和主动姿势下进行研究。
72条肢体中有38条（53%）出现腘动脉位置性闭塞。组间比较无统计学显著差异。89%的受试者每条腿的反应是对称的。静息时不能使腘动脉闭塞的受试者运动后也无法做到。磁共振成像显示所有受试者解剖结构正常，并显示腘动脉闭塞部位在比目鱼肌吊带水平，受比目鱼肌、腓肠肌外侧头、跖肌和腘肌的位置性压迫。
53%的受试者可通过肌筋膜压迫导致的简单腿部姿势诱发腘动脉闭塞。在根据腘血管生理检测评估患者是否需要干预时，必须考虑这一点。
