- Popliteal artery entrapment syndrome is not a very common disease or condition.(1)
- This disease affects about 0.17 to 3.5% of individuals in the US(2)
- This is a serious condition causing disability to young athletes and adults.
- This relatively uncommon condition is caused by an aberrant connection of the popliteal artery and the neighboring fossa myofascial frameworks.(3)
- Uncomplicated Popliteal artery entrapment syndrome management usually encompasses surgical options.(2,4)
Popliteal artery entrapment syndrome, often known as PAES is an important but rare cause of severe disability in young adults, particularly in athletes with abnormal anatomical relationships between the artery and the surrounding tendon structure.
In young individuals, PAES has the symptom as claudication, which is usually overlooked. In elderly patients, doctors can presume atherosclerotic claudication, but in young patients, PAES should be considered when encountered with claudication.(1)
How Common Is Popliteal Artery Entrapment Syndrome Or Is It A Rare Disease?
PAES is not a common condition and around 0.17 to 3.5 percent of the population of the United States suffers from this disorder.
This abnormal development is due mainly to the unnatural relationship between the artery and the myofascial structure of the surrounding muscles. Ironically, with no history of cardiovascular risk factors, PAES primarily affects young active people. Furthermore, patients with Popliteal artery entrapment syndrome complain mostly of intermittent foot and calf pain, which usually takes place after exercise and disappears at rest. Additionally, radiological advances have made contours of Popliteal artery entrapment syndrome detection clearer and more sensitive. The combination of MRI or magnetic resonance imaging and arteriography has proven to be one of the most effective methods of diagnosing PAES.
Also, simple treatment of Popliteal artery entrapment syndrome typically requires surgical exploration such as fasciotomy, myotomy, or artery release. But, if left untreated, PAES can cause stenosis and thrombosis of the popliteal artery (PAS or PAT), or distal arterial thromboembolism, often known as DAT.(2)
Popliteal Artery Entrapment Syndrome Evaluation
PAES diagnosis presents considerable clinical challenges because a good interpretation of the clinical and radiological aspects of this rare clinical entity is required. In radiology, the combination of radiological examination not only develops the function and anatomical state of the popliteal artery but also the detailed structures of popliteal fossa can be visualized. This allows a higher sensitivity for the detection of Popliteal artery entrapment syndrome. A recent study that explored the best method of diagnosing Popliteal artery entrapment syndrome, stressed the combination of MRI and DU (duplex ultrasound) to be much superior in PAES detection.
Additionally, duplex arterial ultrasound using provocative movements (legs first kept in a neutral position and then placed in plantar flexion) provides a quick, inexpensive, and non-invasive initial screening test. Popliteal artery entrapment syndrome diagnosis was prompted by the discovery of damaged or obvious collateral arteries in the region.(3)
Popliteal Artery Entrapment Syndrome Treatment
Surgical treatment in the event of an anatomical compression is required. In the absence of arterial alteration, the intervention may only relate to the treatment of the musculotendinous part at the origin of the compression. During an arterial attack, it will be a question of proposing a vascular intervention, for example, in the form of bypass surgery. In acute ischemia, an approach initially through thrombolysis may be necessary. The option of endoluminal revascularization has been described, during occlusion of the popliteal and leg arteries treated initially by local lysis, with strict follow-up by echo-Doppler due to the risk of reclusion, or even development of a popliteal aneurysm.
Regarding interventional abstention, a recent review mentions cases whose development has been characterized by a recurrence of thrombosis (patient refusing decompressive surgery after thrombolysis of a first occlusive episode), or even ischemia requiring amputation. The loss of a sufficiently functional run-off led to the impossibility of carrying out a bypass.
Regarding the functional popliteal compression, the attitude varies according to the importance of the symptomatology. It is known that popliteal vascular compression can be triggered in asymptomatic subjects and without anatomical alteration, and an interventional attitude is not indicated in this case. It is on the other hand possible in symptomatic subjects, although cases with a resolution of the symptomatology have been described during the cessation of the causal physical activity. The use of Doppler ultrasound during surgery can help confirm a sufficient and appropriate muscle resection (partial resection of the medial head of the gastrocnemius muscle).(3,4)
- di Marzo L, Rich NM. Popliteal Artery Entrapment 24. Vascular Surgery: Cases, Questions and Commentaries. 2018:275.
- Gokkus K, Sagtas E, Bakalim T, Taskaya E, Aydin AT. Popliteal entrapment syndrome. A systematic review of the literature and case presentation. Muscles, ligaments and tendons journal. 2014;4(2):141.
- 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.
- Gaunder C, McKinney B, Rivera J. Popliteal artery entrapment or chronic exertional compartment syndrome? Case reports in medicine. 2017;2017.