Adductor canal syndrome (also known as adductor canal compression syndrome) is a rare, non-atherosclerotic cause of arterial occlusion and limb ischemia 1. There is compression of the superficial femoral artery (SFA) in the adductor canal.
External compression of the superficial femoral artery in the absence of atherosclerotic risk factors causing adductor canal syndrome is rare and available data is limited to case reports 1. The syndrome is most commonly reported in young males less than 45 years old 2.
Presentation can vary depending on the severity of the occlusion. The most severe present with symptoms of acute limb ischemia 1. Compression of the saphenous nerve without vascular involvement can cause pain over the medial aspect of the knee. Symptoms include 2:
- exercise-induced claudication
- edema (due to femoral vein compression)
- thrombosis leading to acute limb ischemia
There is chronic external compression of the superficial femoral artery as it courses through the adductor canal 1. This results in injury to the vessel, in situ thrombosis, limb ischemia, and potential limb loss 3,4. The sources of external compression may arise from either an anomalous musculotendinous band arising from the adductor magnus or hypertrophy of the adductor magnus or vastus medialis muscles 2,3,5.
Treatment and prognosis
Treatment is always surgical and involves resection or release of the external compressive forces 1. Angioplasty or bypass of the diseased superficial femoral artery may be required if the mechanical compression has caused vascular damage. Acute limb ischemia due to thrombosis from adductor canal syndrome requires immediate revascularization either via endovascular thrombolysis or thromboembolectomy 1. Diagnosis of adductor canal syndrome should prompt investigation for the same condition on the contralateral side 6.
- 1. Zhou Y, Ryer EJ, Garvin RP, et al. Adductor canal compression syndrome in an 18-year-old female patient leading to acute critical limb ischemia: A case report. (2017) International journal of surgery case reports. 37: 113-118. doi:10.1016/j.ijscr.2017.06.030 - Pubmed
- 2. Sapienza P, Tartaglia E, Venturini L, et al. Adductor canal compression syndrome: a forgotten disease. (2014) Annali italiani di chirurgia. Pubmed
- 3. Walensi M, Berg C, Piotrowski M, et al. 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. (2017) Annals of vascular surgery. 38: 319.e11-319.e15. doi:10.1016/j.avsg.2016.05.134 - Pubmed
- 4. Ehsan O, Darwish A, Edmundson C, et al. Non-traumatic lower limb vascular complications in endurance athletes. Review of literature. (2004) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 28 (1): 1-8. doi:10.1016/j.ejvs.2004.02.002 - Pubmed
- 5. Flavia De Oliveira, Ricardo Bragança De Vasconcellos Fontes, Josemberg Da Silva Baptista, William Paganini Mayer, Silvia De Campos Boldrini, Edson Aparecido Liberti. The connective tissue of the adductor canal – a morphological study in fetal and adult specimens. (2009) Journal of Anatomy. 214 (3): 388. doi:10.1111/j.1469-7580.2009.01047.x - Pubmed
- 6. Perlowski AA, Jaff MR. Vascular disorders in athletes. (2010) Vascular medicine (London, England). 15 (6): 469-79. doi:10.1177/1358863X10382944 - Pubmed