ORIGINAL REPORTS Iatrogenic Entrapment: Femoro-popliteal Vein Bypass Graft Manzoor Abbas, MS, FVES, B. Patrice Mwipatayi, MMed, FRACS, Donna Angel, RN, Elvie Haluszkiewicz, MIT, and Kishore Sieunarine, FRCS, FRACS Department of Vascular Surgery, Royal Perth Hospital, Perth, WA, Australia A rare cause of occlusive vascular disease is the “Popliteal Artery Entrapment Syndrome.” The most common cause of this prob- lem is abnormal position of the popliteal artery caused by ab- normal migration of the medial head of the gastrocnemius. An acquired form can occur because of tunneling defects by inad- vertent placement of venous bypass graft medial to the medial head of the gastrocnemius muscle. We present 2 cases of iatrogenic entrapment of the femo- ropopliteal bypass graft. Investigations revealed compression of the graftwith extension of the knee. Both cases were treated surgically. Intraoperatively there was evidence of compression of the graft between the tendons of the semi- tendinosus and the gracilis muscles and the medial head of the gastrocnemius muscle. Treatment involved division of the medial head of the gastrocnemius in 1 patient, and in the other,the tendons of gracilis and semitendinosus were di- vided.No compression of the graft was noted postopera- tively by noninvasive test. No significant mobility issues caused by the division of muscle or the tendons were present in the postoperative period. (Curr Surg 63:202-206. © 2006 by the Association of Program Directors in Surgery.) KEY WORDS:iatrogenic entrapment, femoro-popliteal, by- pass graft INTRODUCTION An uncommon iatrogenic complication in femoropopliteal by- pass grafting is entrapment. In the congenital form, the gastroc- nemius muscle originates from the calcaneus, migrating ceph- alad until it divides into a lateral and medial head. The lateral head attaches firstto the lateral epicondyle of the femur, whereas the medial head attaches later to the medial epicondyle. At the time of the attachment of the medial head, the popliteal artery has already formed and is in its normal anatomic loca- tion. If the popliteal artery develops late, or if the medial head migrates early, the artery is not in its normal location; instead, it is swept medially and impinged against the femur as th head attaches to the epicondyle, which results in the co form of popliteal entrapment. 1 A similar complication is ob- served when the graft is tunnelled superficially to the m head of the gastrocnemius muscle, leading to compression of the graft. 2,3 Correspondence: Inquiries to Manzoor Abbas, MS, FVES, Department of Vascular Surgery, RoyalPerth Hospital, Perth,WA 6000,Australia; fax:⫹61 8 92242625; e-mail: manzoorabbas@bigpond.com FIGURE 1. Preoperative arterial duplex shows (a) compression of the grafton active plantar extension or maximum passive dorsiflexion of the footand (b)patent grafton relaxation. CURRENT SURGERY • © 2006 by the Association of Program Directors in Surgery 0149-7944/06/$30.00 Published by Elsevier Inc. doi:10.1016/j.cursur.2005.08.012 202