A CASE REPORT OF BILATERAL POPLITEAL ARTERY ENTRAPMENT SYNDROME -IMPORTANCE OF SURGICAL TREATMENT OF POPLITEAL ARTERY ENTRAPMENT SYNDROME IN AN EARLY STAGE-

We have successfully managed a 34-year-old man with popliteal artery entrapment syndrome by a left popliteal artery bypass operation for intermittent left calf claudication; and by prophylactic transection of the right medial head of the right gastrocnemius muscle for the asymptomatic right lower extremity. Because the lower right extremity did not show ischemic symptoms in particular, but the popliteal artery showed interruption upon stress-angiography. Popliteal artery entrapment syndrome is an uncommon congenital disorder of the artery, caused by faulty insertion of the mediate gastrocnemius muscle caput or popliteal muscle. It is possible to inhibit progression of the disease by conservative therapy, but a cure cannot be expected. The choice of surgical procedure depends entirely upon the condition of the popliteal artery. When the popliteal artery has had no permanent structural changes, myotomy may prove to be curative. When structural changes have already occurred, in addition to the correction of the anatomic abnormalities, replacement of the artery with a vein or by thromboendarterectomy angioplasty may be required to restore flow. Most case reports indicate that unilateral correction is sufficient, but it is essential to examine both limbs, since bilateral corrections may be necessary. From our experience with this patient, we recognized the importance of a positive operative indication, because the prognosis for immediate restoration of flow to the extremity is excellent.