Gerkin T M, Beebe H G, Williams D M, Bloom J R, Wakefield T W
Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0329.
J Vasc Surg. 1993 Nov;18(5):760-6. doi: 10.1067/mva.1993.48846.
This report describes popliteal vein entrapment in three patients and demonstrates that it may present with manifestations of typical venous disease.
This report was compiled from a review of inpatient and outpatient records.
In the first case, a 28-year-old woman was seen with left leg popliteal and calf deep vein thrombosis without obvious cause. She described long-standing calf discomfort, and passive dorsiflexion of the left foot caused disappearance of arterial pulsations at the pedal level. She was given the anticoagulants heparin and sodium warfarin (Coumadin) followed by surgical exploration. The popliteal vein and artery were entrapped by a fibrous extension of the medial head of the gastrocnemius muscle attaching to the lateral femoral condyle. After band lysis, the patient has been symptom free for 6 years. The second patient, a 37-year-old man, was seen with bilateral chronic venous insufficiency (CVI). Passive dorsiflexion and active plantar flexion of the feet did not diminish the pedal pulses; impedance plethysmography suggested mild outflow obstruction. Ascending venography demonstrated entrapment at the midportion of duplicated popliteal veins with no postthrombotic changes. He was treated with compression stockings and has done well during an 18-month follow-up. The third patient, a 17-year-old male, was seen with severe symptoms of right leg CVI and venous obstruction since 3 years of age. Air plethysmography revealed ambulatory venous hypertension, whereas venography demonstrated reflux down to the knee with an extrinsic narrowing at the midpopliteal vein. During operation, an abnormal origin of the lesser saphenous vein (LSV) from the popliteal vein was found; the LSV took a medial route, compressed the tibial nerve, and caused severe distortion and narrowing of the popliteal vein. Division of the LSV resulted in release of popliteal venous compression and immediate relief of symptoms.
The three cases presented demonstrate that popliteal venous entrapment may begin with symptoms of deep vein thrombosis and CVI. Popliteal venous entrapment must be considered in the differential diagnosis of venous disease in younger patients in whom common predisposing factors are absent.
本报告描述了3例腘静脉受压病例，并证明其可能表现为典型的静脉疾病症状。
本报告通过回顾住院和门诊记录编撰而成。
第一例，一名28岁女性，出现左腿腘静脉和小腿深静脉血栓形成，无明显病因。她自述长期小腿不适，被动背屈左脚会导致足部动脉搏动消失。给予她肝素和华法林钠（香豆素）抗凝治疗，随后进行手术探查。腘静脉和动脉被腓肠肌内侧头附着于股骨外侧髁的纤维延伸部分压迫。束带松解术后，患者6年无症状。第二例，一名37岁男性，出现双侧慢性静脉功能不全（CVI）。足部被动背屈和主动跖屈并未减弱足部脉搏；阻抗体积描记法提示轻度流出道梗阻。上行静脉造影显示双支腘静脉中段受压，无血栓形成后改变。给予他弹力袜治疗，在18个月的随访期间情况良好。第三例，一名17岁男性，自3岁起出现右腿严重CVI和静脉梗阻症状。空气体积描记法显示动态静脉高压，而静脉造影显示反流至膝部，腘静脉中段有外在狭窄。手术中发现小隐静脉（LSV）异常起源于腘静脉；LSV走行于内侧，压迫胫神经，并导致腘静脉严重扭曲和狭窄。切断LSV后，腘静脉压迫得以解除，症状立即缓解。
所呈现的3例病例表明，腘静脉受压可能始于深静脉血栓形成和CVI症状。对于无常见易感因素的年轻患者，在静脉疾病的鉴别诊断中必须考虑腘静脉受压。
