title: Adductor Canal Compression Syndrome in a 46-Year-Old Female Patient Leading to Acute External Iliac, Femoral, and Popliteal Artery Thrombosis and Critical Ischemia: A Case Report.
abstract: The adductor canal compression syndrome is one of the several rare nontraumatic causes of arterial occlusions, which may lead to critical ischemia of the lower limb. We report the case of a 46-year-old athletic woman, who suffered from activity-related paresthesia and sharp pain in the left upper and lower leg for 2 years. Imaging and neurological investigations of the spine remained without pathological findings that would explain the patient's complaints. Actually, the patient presented with symptoms of critical lower limb ischemia. Magnetic resonance angiography revealed nearly complete thrombotic occlusion of the common femoral artery and the arteries of the lower leg. An emergency surgery was performed, revealing an external compression of the superficial femoral artery in the adductor canal. Subsequently, a thrombectomy was performed and a venous bypass graft was installed. No postoperative complications occurred, the patient recovered well and could return to her activities of daily living about 3 weeks after the surgery. The adductor canal compression syndrome results from a local anomalous musculotendinous band or hypertrophic musculature surrounding the passing structures. It mainly occurs in athletes exposed to repetitive stress, especially runners and skiers, and may lead to thrombosis followed by critical lower extremity ischemia. The lack of obvious symptoms during routine physical examination often impedes rapid diagnosis and timely therapy. Considering the high thrombotic risk, attention should be paid to this rare cause of lower limb pain to prevent the patient from critical lower extremity ischemia and potential limb loss due to consecutive acute thrombotic occlusions.
authors.affiliation: Clinical Trial Unit, Hirslanden Private Hospital Group, Klinik Hirslanden, Zurich, Switzerland. Electronic address: mikolaj.walensi@hirslanden.ch.
authors.forename: Mikolaj
authors.initials: M
authors.lastname: Walensi
authors.affiliation: Division of Angiology, Endocrinology and Diabetology, Department of Internal Medicine, Hospital of Mettmann, Mettmann, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Berg
authors.affiliation: Department of Emergency Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Piotrowski
authors.affiliation: Division of Angiology, Department of Internal Medicine, University Hospital of Essen, Essen, Germany.
authors.forename: Franz-Eduard
authors.initials: FE
authors.lastname: Brock
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University Hospital of Essen, Essen, Germany.
authors.forename: Johannes N
authors.initials: JN
authors.lastname: Hoffmann
mesh_terms: D000208:Acute Disease; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001706:Biopsy; D016638:Critical Illness; D019299:Decompression, Surgical; D004630:Emergencies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012501:Saphenous Vein / Q000637:transplantation; D017131:Thrombectomy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome