Running Through the Pain: Interesting Presentation in a High School Track Star

Article Citation:

Robert Schwartz, John Lesser, and Timothy M. Sullivan (2017) Running Through the Pain: Interesting Presentation in a High School Track Star. Journal of the Minneapolis Heart Institute Foundation: January 2017, Vol. 1, No. 1, pp. 76-78.

Case Report

Robert Schwartz, MD, John Lesser, MD, and Timothy M. Sullivan, MD

Minneapolis Heart Institute, Minneapolis, MN

Address for correspondence:
Robert Schwartz
Minneapolis Heart Institute
920 E 28th Street #300
Minneapolis, Minnesota 55407
Tel: 612-863-3900

E-mail: rschwartz_1999@yahoo.com

INTRODUCTION

A 17-year-old female high school track star had sudden right calf pain with exertion while running hurdles and couldn’t finish the track season due to pain. She had claudication with ambulation and went to a local hospital, where right popliteal artery entrapment and occlusion was found and treated by lytics and stenting just above the knee. She returned 1 month later with stent thrombosis and had repeat lytic therapy. She was sent to the Minneapolis Heart Institute (MHI) where she was found to have rest pain and critical limb ischemia with severe foot pallor and a cyanotic right leg. She was otherwise healthy. Computed tomographic angiography (Figures 1, 2) at MHI found the previously placed stent was crushed (arrows), and the entrapment was from a congenital anomaly with the medial gastrocnemius head inserting laterally (Figure 3, white arrow), entrapping the popliteal artery. She underwent successful surgical removal of the stent, division of the aberrant gastrocnemius muscle head, and saphenous vein patch repair of the popliteal artery (Figure 4).

FIGURE 1
Transverse images of right popliteal artery with crushed stent (arrows).

FIGURE 2
Volume rendering technique 3-dimensional images showing stent crush.

FIGURE 3
Anatomy of the anomaly in this case.

FIGURE 4
Surgical procedure and summary of the muscular anomalies.

DISCUSSION

Popliteal artery entrapment syndrome (PAES) is a rare cause of exercise-induced leg pain. The popliteal fossa is diamond-shaped and bordered superiorly by the biceps femoris tendon, superomedially by the semimembranosus muscle, and inferiorly by the medial and lateral heads of the gastrocnemius. The popliteal artery runs between the gastrocnemius medial and lateral heads. The artery can be trapped by the muscles and tendons from congenital variations of these structures. The anatomic abnormalities causing PAES are classified into 5 types (Figure 4, bottom). Local mechanical arterial trauma leads to premature, focal atherosclerosis, and thrombosis may result. Popliteal artery entrapment syndrome occurs in males more often than females (85% versus 15%, respectively), with mean age at diagnosis of 28 years. It occurs bilaterally in 25% of cases, presenting with claudication and acute/chronic ischemia. Popliteal artery entrapment syndrome must be treated surgically, as endovascular therapy fails if the entrapment is not fixed. Surgery consists of releasing the vessel by extracting the muscle that causes entrapment, and reconstructing the narrowed lumen by endarterectomy or bypass grafting. Surgical therapy is clearly the optimal therapy of this anomaly, as the stent in this case was easily crushed. Surgery it is typically curative and is the treatment of choice.

REFERENCES

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2475-0190
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