슬와 동맥 포착증후군에서 동맥협착과 연관된 해부학의 3차원적 분석

Abstract

PURPOSE: To investigate the 3-dimensional (3D) anatomy of popliteal artery entrapment syndrome (PAES) in relation to the severity of arterial compromise.

MATERIALS AND METHODS: The lower extremity computed tomography (CT) angiograms of 22 patients (M:F = 21:1

mean age, 47.4 ± 19.9 years, 18~81years) with 31 limbs having PAES were retrospectively analyzed. Using a 3D workstation, two radiologists assessed the femoral attachment site of the medial head of the gastrocnemius muscle (MHGM) and determined whether the type of PAES was total or partial. Then, the degree of stenosis of the popliteal artery, the degree of medial displacement of the popliteal artery in the intercondylar space, and the distance from the inferomedial border of the MHGM attachment to the superolateral border of the medial femoral condyle (MHGM-condyle distance) were measured. Lesions with a stenosis of 50% or greater in diameter were considered significant. As an ancillary finding of PAES, the presence or absence of a retrocondylar fat pad sign was assessed. Thereafter, statistical analyses were performed to determine the relationship between the observed findings.

RESULTS: Among the 22 patients, 31 limbs had PAES (unilateral in 13 patients and bilateral in 9). Among the 31 limbs of PAES, the total type was found in 18 limbs (58.1%) and the partial type in 13 (41.9%). Significant stenosis of the popliteal artery was more frequently found in the total type than the partial type (94% vs. 38.5%, p = 0.0016). Popliteal artery stenosis was highly associated with the medial displacement of the popliteal artery (Spearman correlation coefficient = -0.726, p < 0.0001) and the MHGM-condyle distance (Spearman correlation coefficient = -0.556, p = 0.001). The total type showed more severe medial displacement of the popliteal artery (20.5 ± 10.0 vs. 57.4 ± 22.4, p < 0.0001) and shorter MHGM-condyle distance than the partial type (13.1 ± 4.6 vs 22.9 ± 7.2, p = 0.00038). The presence of a retrocondylar fat pad sign was more common in patients with significant popliteal artery stenosis than those without (91.0% vs. 33.3%, p = 0.0024).

CONCLUSION: The severity of popliteal artery stenosis in PAES was affected by the anatomical features related to the anomalous attachments of the MHGM. More severe stenosis can be expected in the total type, with more medial displacement of the popliteal artery in the intercondylar space, shorter MHGM-condyle distance, and a positive retrocondylar fat pad sign.