I t I t t such as the lateral head of the gastrocnemius or the soleal sling are relatively rare. Compression of the vein by the tibial nerve may occur rarely.
The compressed vein segment often becomes sclerosed and stenotic. Both prestenotic and poststenotic dilatations occur, occasionally large enough to be classified as aneurysms. A thick perivenous fascia attached to the gastrocnemius muscle is an integral part of the compressive mechanism, which may explain the varied location of vein compression noted on venography. The entrapment mechanism likely involves prolonged spasm of the vein initiated by external compression by adjacent muscle. Elevation of the popliteal vein pressure persists long after cessation of active muscle contraction (see Figure 62.3). Entrapment may eventually lead to popliteal valve reflux2 and perforator incompetence.20 Unlike in popliteal artery entrapment, anatomic course variations of the popliteal vein are relatively rare.
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