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Das popliteale Entrapment-Syndrom

Popliteal entrapment syndrome

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Zusammenfassung

Popliteale Kompressionssyndrome sind seltene Ursachen von Gefäßpathologien und sind vor allem bei jungen athletischen Männern mit Claudicatio-Symptomatik differenzialdiagnostisch zu bedenken. Zugrunde liegt eine Kompression durch hypertrophierte Muskulatur (funktionelles Entrapment) oder aberrierende Verläufe der Gefäße oder umgebender Muskel- oder Sehnenstrukturen. Im Median vergehen 12 Monate vom Symptombeginn bis zur Diagnosestellung. Dauerhafte Schäden der Arterienwand mit Stenosen oder Okklusionen bis zur poststenotischen Aneurysmabildung mit thrombembolischen Verschlüssen können die Folgen sein. Diagnostisch stellt das popliteale Entrapment-Syndrom (PAES) eine Herausforderung dar und wird häufig verkannt. Während klinische Symptome mit Claudicatio intermittens, Waden‑/Fußschmerzen oder Dysästhesien meist unspezifisch sind, können funktionelle Tests mit Pulsverlust bei Dorsalflexion/Plantarflexion oder ein abgeschwächter ABI nach Belastung hinweisend sein. Funktionsteste in der apparativen Diagnostik wie Duplexsonographie und MR-Angiographie sind wegweisend, die digitale Subtraktionsangiographie bei inkonklusivem Befund zielführend. Eine operative Sanierung ist bei symptomatischen PAES erforderlich. Die Prognose ist bei rechtzeitiger Diagnostik günstig. Bei bereits eingetretenen Schäden der Gefäßwand sind vaskuläre Rekonstruktionen erforderlich.

Abstract

Popliteal compression syndromes are a rare cause of vascular pathology and should be considered in the differential diagnosis of young athletic men with claudication symptoms. The underlying cause is compression by hypertrophied muscles (functional entrapment) or aberrant courses of the vessels or surrounding muscle or tendon structures. The median time from onset of symptoms to diagnosis is 12 months. Permanent damage to the arterial wall with stenosis or occlusions up to poststenotic aneurysm formation with thromboembolic occlusions can be the consequence. Diagnostically, popliteal artery entrapment syndrome (PAES) is challenging and often unrecognized. While clinical symptoms with intermittent claudication, calf/foot pain or dysesthesia are usually non-specific, functional tests with loss of pulse during dorsiflexion/plantar flexion or a weakened ABI after exercise can be indicative. Functional tests, such as duplex sonography and magnetic resonance angiography (MRA) are useful and digital subtraction angiography is useful in the case of inconclusive findings. Surgical treatment is necessary in symptomatic PAES. The prognosis is favorable with a timely diagnosis but vascular reconstruction is required if damage to the vessel wall has already occurred.

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Authors and Affiliations

  1. Abteilung für Gefäß- und Endovaskularchirurgie, Krankenhaus Buchholz, Steinbecker Straße 44, 21244, Buchholz, Deutschland

    Holger Diener & Julius Petermann

  2. Abteilung für Physiotherapie, Städtisches Klinikum Lüneburg, Bögelstrasse 1, 21339, Lüneburg, Deutschland

    Maren Diener

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  1. Holger Diener
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  2. Maren Diener
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  3. Julius Petermann
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Correspondence to Holger Diener.

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Interessenkonflikt

H. Diener, M. Diener und J. Petermann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Diener, H., Diener, M. & Petermann, J. Das popliteale Entrapment-Syndrom. Gefässchirurgie 27, 20–27 (2022). https://doi.org/10.1007/s00772-021-00850-5

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