Popliteal vein compression
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Keywords and synonyms: poplitieal vein syndrome, popliteal vein entrapment
Overview
Popliteal vein compression is a disorder in which there is either anatomic or funcitonal compression of outflow from the popliteal vein.
Pathophysiology
Epidemiology and Demographics
This is a very rare disorder.
Diagnosis
Symptoms
- The patient may be asymptomatic and the disorder can go unrecognized.
- Muscle cramps with exertion
- Edema or swelling of the lower extremity that is positional
Positional compression of the popliteal vein syndrome, or popliteal vein entrapment, often goes unrecognized.
The clinical signs suggest its presence are: edema related to position, cramps associated with prolonged standing, exertional pain together with cramps and swelling of the calf muscle in athletes, and asymmetry of the circumference of the anterior and posterior tibialis muscles.
The most frequent circumstances in which this condition is detected are:
• Intensive muscle-building training in young women who practice high risk sports;
• Repeated recurrence of varicose veins in the area supplied by the short saphenous vein;
• Recurrent sural vein thrombosis outside of any context of thrombophilia.
Laboratory Findings
Duplex Ultrasound
The diagnosis is confirmed by duplex scanning investigation with active and passive maneuvers, whose aim is to detect the position that triggers this condition. Imaging methods supplement the workup: dynamic venography, and dynamic MRI (done).Surgery eliminates the compression at the cost of a relatively long incision to allow investigation of the vein along its entire length. A repeat check by perioperative maneuvers, possibly aided by electrical stimulation, confirms that the vein has been entirely freed in all positions.
Treatment
Although popliteal artery entrapment is a well-defined anatomic entity, whose treatment has received a broad consensus of approval, extrinsic compression of the popliteal vein syndrome, more recently recognized, is rarely systematically sought. Treatment of this condition is subject to differences in terms of methods and indications. Some have proposed the term “popliteal vein entrapment syndrome” to associate so-called “functional forms” and anatomical forms, observed more rarely. An anatomic form involves our ability to specifically see a muscle or fibrous tissue surrounding the vein or artery. A functional form involves our ability to see venous compression on imaging studies, but no evidence of a discrete abnormal structure compressing the vein.
At this time, I would have to characterize your lesion as a functional compression, i.e. the muscles on either side of the vein are in normal anatomic location, however when the muscle of the calf are tensed, the vein is compressed. What gives me pause in recommending what we should do next is the fact that a study has been done in asymptomatic subjects, where compression of the veins (as detected by ultrasound) has been documented in 25% of the cases. While MRI imaging is much more sensitive than ultrasound in detecting compression of venous structures and can clearly identify surround muscle that may be involved in venous compression, it is not entirely clear that compression is problem.
I would recommend that we explore the popliteal space of one leg and divide any fibrous tissue or muscle surrounding the vein, and see if this gives you some degree of relief in the postoperative period. There are risks of bleeding, infection, nerve damage, scar, blood clots associated with this procedure. You would likely be hospitalized for 24- 48 hours postoperatively. If you do feel relief, we could consider operation on the other leg.
I would be willing to discuss this with you and your family in person on a non clinical day ( Monday) or a Saturday (? This Saturday am around 9) in my office at the MGH.
Please let me know how you would like to proceed.