Popliteal Vein Entrapment: An Overlooked Source of Lower Extremity Swelling and Pain

Retrospective chart review identified two patients who were diagnosed and treated for popliteal vein entrapment between October 2022 and March 2023. Baseline demographic data was obtained including patient age, past medical history, preoperative diagnoses, clinical symptoms, and imaging. Postoperatively clinical symptoms were examined through chart review.

Results:

The patients were aged 65- and 77-years-old.  Both had suffered with unilateral lower extremity fatigue and swelling. Neither patient had prior lower extremity thrombus or trauma. Both patients suffered from hypertension, osteoarthritis, and one had diabetes. Initially, both were evaluated and treated for venous insufficiency with compression stockings. Duplex ultrasound revealed no superficial venous insufficiency. Venogram was performed that showed normal popliteal vein flow in neutral position (Figure 1), and near occlusion at the level of the patella with forced dorsiflexion (Figure 2). Both patients underwent lower extremity popliteal fossa decompression with partial resection of medial head of the gastrocnemius muscle and extensive venolysis. Postoperatively they were maintained in a knee brace for 4 weeks then transitioned to working with physical therapy for 3 months. Swelling and leg fatigue resolved in both patients.

Conclusions:

Popliteal vein entrapment is a potentially under-reported form of PES and the diagnosis can be mistaken for venous insufficiency. In patients with no venous reflux and unilateral lower extremity swelling without history of thrombus, popliteal vein entrapment should be considered as a differential diagnosis.