Investigations

Popliteal vein compression on ascending venography is sensitive, but not specific. Popliteal vein compression should be demonstrated on active plantar flexion; passive dorsiflexion may also reproduce the lesion in some (see Figure 62.1). The site of compression is variable (high popliteal 11%, mid popliteal 39%, low popliteal 18%, and diffuse 32%), thus suggesting varied compressive mechanisms.

Like venography, duplex with ankle maneuvers can also demonstrate popliteal vein compression without any inference to causality of symptoms.1 Associated popliteal artery compression with ankle maneuvers is present in about half of the limbs without clinical features of arterial insufficiency. Demonstration of arterial compression does not signify functionally significant associated venous compression.

Magnetic resonance imaging1819 may display abnormal features of the gastrocnemius muscle that is frequently a part of the compressive mechanism, and it can help rule out other causes of compression such as the Baker's cyst.914

Abnormalities on ambulatory venous pressure measurement (pedal vein) and outflow fraction by occlusive ple-thysmography may be suggestive, but these tests are neither sensitive nor specific.2 Similar comments apply to ejection

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