POPLITEAL ARTERY ENTRAPMENT SYNDROME - ANATOMIC AND EMBRYOLOGIC BASES, DIAGNOSTIC AND THERAPEUTIC CONSIDERATIONS FOLLOWING A SERIES OF 15 CASES WITH A REVIEW OF THE LITERATURE

We report 15 examples of popliteal artery entrapment syndrome observed in 11 patients. The anatomical causes were as follows: in one case, t he popliteal artery presented an aberrant course medially to the media l head of the gastrocnemius muscle. In 5 cases, there was a small fibr ous band linking the medial head of the gastrocnemius muscle to the la teral condyle and crossing behind the popliteal artery; in 5 cases thi s anomaly was also found in association with an abnormally high and/or internal insertion of the medial head of gastrocnemius muscle. In the last 4 cases, there was a muscular insertion anomaly associated with muscular hypertrophy causing arterial compression. Arteriography perfo rmed in the 11 patients showed evocative signs of the diagnosis in all cases where the artery was patent. Two popliteal arteries were occlud ed. CT scan and MRI examination of the popliteal fossa enabled us to d efine the muscular origin of the popliteal compression. All of the pat ients were operated upon; two received a reversed saphenous bypass and all of the others were treated by liberation of the popliteal artery and/or vein by a posterior approach. Followup in all patients at long term showed good prognosis. All of the patients were able to take up t heir previous physical activities without sequelae. Our review of the Literature, which is based on 374 cases of popliteal artery entrapment observed in 280 patients, made it possible to define the frequency of the various anomalies observed, their symptoms and the different ther apeutic possibilities. The multiple anatomical classifications as well as the arterial and muscular embryology are also described.