Popliteal vein compression syndrome: Obesity, venous disease and the popliteal connection

Objectives: Obesity and venous disease are commonly encountered together. The aetiological relationship, however, has not been clear. Popliteal venous compression (PVC) has been encountered both on ultrasound and venographically. In this study, patients with symptoms and/or signs of chronic venous hypertension with PVC were investigated and the relationship to obesity was defined. Methods: A total of 89 patients were included in the study, of which 49 limbs were classified as having PVC defined as a greater than 90% reduction in the maximum internal diameter (ID) of the popliteal vein (POPV) with knee locking. Forty consecutive limbs with venous disease with no evidence of PVC were used as controls. The body mass index (BMI) of each group was calculated and the clinical symptoms and signs were documented. After the failure of conservative treatment, 30 of the 49 underwent open popliteal decompression. Results: Patients with PVC were found to have a BMI of 34.6±6.2 compared with 25.3±3.0 of the controls. The POPV ID in the PVC group before and after knee locking changed from 11.7±5.0 to 1.0±2.1 mm, respectively. Postoperatively, the POPV ID before and after knee locking changed from 10.2±2.2 to 9.0±1.5 mm, respectively. At 16.2±12.1 months follow-up, all the major clinical parameters improved at a statistically significant level. Conclusions: There appears to be a relationship between obesity, chronic venous disease and PVC. POPV compression syndrome may clarify the previously unexplained venous presentations. Surgical decompression provides good results in patients unresponsive to conservative treatment.