Rutherford's 144: Nonatheromatous Popliteal Artery Disease скачать в хорошем качестве

Rutherford's 144: Nonatheromatous Popliteal Artery Disease

#PoplitealArteryEntrapmentSyndrome #PAES #AdventitialCysticDisease #ACD #Nonatheromatous #VascularDisease #LegPain #Claudication #YoungAthletes #Diagnosis #Treatment #VascularSurgery #RutherfordChapters #DrGregoryWeir Drawing from Rutherford's Vascular Surgery textbook, this video explores two non-atherosclerotic causes of leg pain, particularly in younger, active individuals: Popliteal Artery Entrapment Syndrome (PAES) and Adventitial Cystic Disease (ACD). PAES is a congenital anatomical anomaly where the popliteal artery is compressed by surrounding muscles or fibrous bands behind the knee. While the anomaly is present from birth, symptoms usually appear later due to chronic compression. It affects young men most commonly, accounting for up to 60% of claudication in this group. Key signs include atypical claudication patterns and the disappearance or weakening of foot pulses with specific ankle/foot movements (plantarflexion/dorsiflexion). Diagnosis involves clinical suspicion and imaging like duplex ultrasound, CTA, and MRA. Treatment for symptomatic anatomical types is typically surgical release (myotomy), or bypass if the artery is significantly damaged. Endovascular therapy is generally limited. Outcomes are usually good, especially with early intervention. ACD is much rarer, involving the formation of a fluid-filled cyst within the adventitia (outer layer) of the artery wall, compressing the lumen (inner channel). The cause is debated, with theories including developmental remnants or joint fluid leakage. It predominantly affects slightly older males than PAES, typically in their mid-40s, presenting with often sudden-onset calf claudication. A distinct physical sign is the Ishikawa sign: pulses disappearing with hip-knee flexion. Diagnosis relies on imaging, with duplex ultrasound, CTA, or MRA preferred to visualize the cyst and its effects. Treatment involves surgical cyst evacuation for narrowing, or resection and bypass for complete blockage or degeneration. Recurrence is a known issue, necessitating long-term surveillance. Both conditions highlight the importance of considering non-atherosclerotic causes in younger patients with leg symptoms.