Two Cases of Popliteal Artery Entrapment Syndrome / 日本心臓血管外科学会雑誌

Popliteal artery entrapment syndrome (PAES) is a rare cause of intermittent claudication. Optimal strategies and management have been debated. We report two cases of PAES that were treated with respective different procedures. Case 1 : A 53-year-old male with intermittent claudication was referred to our department with PAES with a decrease in the ankle brachial index (ABI) with plantar flexion. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed medial deviation and compression of the popliteal artery by the medial head of the gastrocnemius muscle. The patient received excision of the medial head of the gastrocnemius muscle and thrombectomy of the popliteal artery. The diagnosis was confirmed as PAES type 2 during the procedure. Case 2 : A 37-year-old male presenting intermittent claudication and declining ABI in his left lower extremity was diagnosed with PAES by contrast CT. MRI and CT indicated that a fibrous band was compressing the popliteal artery. The findings of the imaging studies were confirmed during the subsequent surgical procedure and it was diagnosed as PAES type 4. In addition to removal of the band, popliteal artery interposition using a saphenous vein graft was performed due to severe stenosis with intimal hyperplasia. Pathological findings of the excised artery showed intimal hyperplasia and degeneration of elastic fibers in the media due to chronic compression. Although a large volume of retrospective data exists on PAES, recommendation of a particular operative procedure has not yet been derived. Thus, the treatment for PAES should be individually determined based on etiology and status of affected vessels.

Tuberculous Mycotic Pseudoaneurysm of the Abdominal Aorta / 日本心臓血管外科学会雑誌

A 54-year-old man with a sacral abdominal aortic aneurysm (4cm) complained of lower abdominal pain. An abdominal computed tomographic (CT) scan revealed a 1cm expansion in 2 weeks. The abdominal aorta was replaced with an <i>in situ</i> expanded polytetrafluoroethylene graft. Granulomatous lymphoadenitis was diagnosed in the aneurysm wall by histological examination. The patient's postoperative course was uneventful, and anti-tuberculosis medical drug therapy was given for 6 months.