Is There A Surgery For Popliteal Artery Entrapment Syndrome?

PAES can be defined as symptomatic popliteal artery occlusion or compression⁽¹⁾ Popliteal artery entrapment syndrome might happen due to developmental abnormality of the popliteal artery in the sense of positioning relative to its neighboring structures. It may also evolve in the later stages of life owing to excessive workout of the muscles.

The condition develops most commonly in young athletes with a 15 to 12 male to female ratio. About 60% of the cases happen to people below 30 years of age.^(2,3)

Surgery is the most effective and possible choice for PAES management.^(4,5)

When diagnosed in the initial stage popliteal artery entrapment syndrome is mostly curable.

Research indicates that only about 3% of individuals are born with this disorder. In the majority of the cases, the patients are symptomatic. Early diagnosis makes popliteal artery entrapment syndrome mostly curable.

PAES management is mostly centered on whether symptoms are present or not. Management is primarily focused on asymptomatic patients with chanced identification of the syndrome as these patients have no symptoms or progression of the disease. However, for all the patients including the asymptomatic ones, surgical intervention is the preferred mode of treatment. So, surgery is the best way to manage PAES patients. The most common surgeries to release the popliteal artery thereby re-establishing the normal anatomy of the said artery and surrounding tissues. In most cases, the surgery is successful. Your doctor can assess the condition of the artery and decide whether a bypass is needed. Neighboring muscle reconstructions may not be always needed as there are often no functional limitations of these muscles.

The best outcomes are experienced by open surgical processes in popliteal artery entrapment syndrome management. It also helps the doctors in the assessment of whether a bypass or an artery repair is required. If the arterial wall is extensively damaged or there are signs of aneurysm or occlusion it is advisable to go for bypass grafting. Usually, the autogenous vein is used for bypass surgery.^(4,5)

PAES or Popliteal artery entrapment syndrome is the symptomatic popliteal artery occlusion or compression due to the developmental abnormality of the popliteal artery in the sense of positioning relative to its neighboring structures for example, with the gastrocnemius medial head or less frequently with fibrous or popliteus bands 1.⁽⁶⁾

Prognosis For Popliteal Artery Entrapment Syndrome

The early detection of PAES is vital and the prognosis of the disease highly depends on this. Timely detection of Popliteal artery entrapment syndrome can make management while late detection of the condition may lead to significant damage to the arteries. The patient is severe arterial damage that may develop permanent claudication and in the worst case, limb loss. However, it is extremely rare for patients to lose a limb due to PAES as the progression of the disease is very slow.^(4,5)

Epidemiology Of Popliteal Artery Entrapment Syndrome

The abnormalities in anatomy can be observed in 3 to 3.5% of individuals. The condition is usually bilateral (around 80% of cases). In the majority of cases, the condition remains asymptomatic. Typical symptoms are not very common among the sufferers. The chance of experiencing symptoms is more people with highly developed muscles.

This is why the disorder is more prominent in young athletes (about 60% of the cases happen to people below 30 years of age with 15 to 12 male to female ratio).^(2,3)

Clinical Presentation Of Popliteal Artery Entrapment Syndrome

The symptoms of popliteal artery entrapment syndrome are similar to intermittent claudication. Your doctor can find compromised arteries after the physical examination of plantar-flexed ankles (in particular). You may develop acute thrombus and ischemia (often limb-threatening) if you have persistent and chronic arterial compression. People whose collateral vessels are not well developed have more risk of limb loss.^(1,6)

Pathology Of Popliteal Artery Entrapment Syndrome

Chronic vascular microtrauma can take place due to arterial compression. You may also develop thrombus formation and premature local arteriosclerosis. This may lead to distal ischemia. Formation of the aneurysm and post-stenotic ectasia may result from turbulent flow and stenosis.^(1,6)

What May Result In Popliteal Artery Entrapment Syndrome?

Popliteal artery entrapment syndrome might take place either at birth (Known as inherited) or acquired in later stages of life due to muscle overuse or any particular injury. Patients experiencing these abnormalities have decreased flow of blood in the affected legs triggering numbness, cold foot, and pain during exercise in the legs. The disorder is more prevalent in men with the ratio between males and females is 15:12.^(1,6)

References:

Grimm N, Danilkowicz R, Shortell C, Toth A. Popliteal Artery Entrapment Syndrome. JBJS reviews. 2020;8(1):e0035.
Gaunder C, McKinney B, Rivera J. Popliteal artery entrapment or chronic exertional compartment syndrome? Case reports in medicine. 2017;2017.
Shahi N, Arosemena M, Kwon J, Abai B, Salvatore D, DiMuzio P. Functional Popliteal Artery Entrapment Syndrome: A Review of Diagnosis and Management. Annals of vascular surgery. 2019.
Dovell G, Hinchliffe R. Surgery for popliteal artery entrapment syndrome: use of an intraoperative tibial nerve stimulator and duplex ultrasound. The Annals of The Royal College of Surgeons of England. 2017;100(1):78-79.
Yamamoto S, Hoshina K, Hosaka A, Shigematsu K, Watanabe T. Long-term outcomes of surgical treatment in patients with popliteal artery entrapment syndrome. Vascular. 2015;23(5):449-454.
Hameed M, Coupland A, Davies AH. Popliteal artery entrapment syndrome: an approach to diagnosis and management. British journal of sports medicine. 2018;52(16):1073-1074.

Also Read:

Is There A Surgery For Popliteal Artery Entrapment Syndrome?