Venous Volumetric Flow in the Diagnosis of Popliteal Vein Compression Syndrome
Hao Pham, MD, Fedor Lurie, MD, Andrew Seiwert, MD.
Jobst Vascular Institute, Toledo, OH, USA.
OBJECTIVES: Popliteal vein compression is a rare, debilitating disease that can present with swelling, pain, and venous changes in the lower extremities. Diagnosis of this entity is done mainly with axial imaging with provocative lower extremity maneuvers; however, benign compression with this modality is commonplace. We describe venous volumetric flow as a physiologic examination to evaluate popliteal vein compression and to assess effectiveness of surgical popliteal vein decompression. METHODS: This case report was prepared from information gathered from the medical records and the surgical team that cared for the patient. RESULTS: A 26 year old youth basketball coach presented to the clinic with left leg pain, swelling, and discoloration especially after prolonged standing and strenuous activity, which was interfering with her job. She was previously on a trial of compression but did not find relief. The patient had a history of greater saphenous vein reflux which was ablated two years ago and also underwent bilateral lower extremity fasciotomy seven years prior for exertional compartment syndrome. The patient underwent an extensive workup with axial imaging and ultrasound. Axial imaging demonstrated bilateral vein compression with provocative maneuvers, more severe on the symptomatic left leg. Ultrasound demonstrated normal venous volume flow pattern at rest with dominant flow through the femoral vein (FV). Provocative maneuvers caused decrease in flow volume through the femoral vein (FV) and increase in flow through the greater saphenous (GSV) and profunda femoris veins (PFV). The figure represents preoperative venous volume flow at rest (A), and then plantar flexion (B), and then one month post operation with plantar flexion (C).
The patient underwent decompression of the left popliteal vein with subsequent relief of her symptoms. Postoperative examination one month after the surgery did not show volumetric change even with provocative maneuvers.
CONCLUSIONS: Presented case demonstrates the utility of venous volumetric flow in workup and subsequent follow up in patients with popliteal vein compression.
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