Obesity and chronic venous disease the popliteal compression connection

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Obesity and chronic venous disease the
popliteal compression connection

• Rodney Lane, Michael Cuzzilla, Mark Phillips,
  John Coroneos
• Department of Vascular Surgery, Royal North
  Shore Hospital
• North Shore Vein Clinic
• Dalcross Private Hospital
• Sydney, Australia.

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Background

• Popliteal vein obstruction may be found in up to
  10 of the normal population (Leon M et al, 1992)
• 30 of patients presenting to a vascular practice
  with venous stasis oedema have no evidence of
  venous obstruction (Royal J et al, 1995).
• Popliteal Vein Obstruction
• Partial or complete obstruction of the popliteal
  vein which only occurs when the knee joint is
  locked
• Knee Locking (normal standing)
• Extension of knee joint followed by internal
  rotation of the femur against a fixed tibia.

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Method
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Method

• POPLITEAL COMPRESSION
• 50 consecutive patients with signs and symptoms
  of venous disease with evidence of popliteal vein
  compression
• CONTROLS
• 40 consecutive patients with signs and symptoms
  of venous disease without evidence of popliteal
  vein compression

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Patient presentation

• Classic venous symptoms and signs however
  investigations show minimal abnormalities
• Symptoms worsen after previous venous surgery
  (GSV stripping)
• Possible arterial claudication

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Patient details male, 37 years, BMI 39
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(No Transcript)
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Operative Method

• POPLITEAL DECOMPRESSION
• Division of popliteal fascia
• Removal of excess adipose tissue
• Release of muscular bands
• Posterior tibial fasciotomy
• Closure of wound without reconstitution of fascia

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Patient presentation
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Results surgical outcomes
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Results surgical outcomes
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Suggested Mechanism

• Popliteal fascia becomes tight with the rotation
  associated with knee locking (extension)
• Tension in the popliteal fascia causes increase
  in pressure in the popliteal fossa
• Fat content of popliteal fossa is commonly high
• Obese patients have hypertrophied calf muscle for
  mobility. When standing gastrocnemius moves
  upward into popliteal fossa

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Conclusions

• Obesity, chronic venous disease, and popliteal
  vein compression are related
• Simple surgical popliteal fasciotomy provides
  relief of signs and symptoms when conservative
  treatment fails
• The mechanism is thought to be due to crowding of
  the popliteal fossa by relaxed but hypertrophied
  calf muscles and increased adipose tissue
• Popliteal compression should be suspected if
  patient presentation worsens following ablative
  surgery (GSV stripping) as the GSV may be acting
  as a bypass