Surgery to release the calf muscle and artery usually does not affect leg function.(1)
Most commonly, popliteal artery entrapment syndrome is found in young sportsmen or soldiers with well-developed muscles, because the exercise and enlargement of muscles adjacent to the popliteal artery exacerbate the consequences of the anomalous relationship between muscle and artery. Therefore, military surgeons have taken a special interest in this disorder.(2)
How To Diagnose Popliteal Artery Entrapment Syndrome?
Diagnosis making of popliteal artery entrapment syndrome starts from history taking and clinical examination. The affected age group is mostly between 20 to 40 years with a history of leg pain while walking or performing some athletic activity. The pain increases with an increase in activities and gets relieved at rest. On clinical examination, there may be tenderness of the calf muscles, cyanosis of the limb, pallor of the limb, etc. To make the provisional diagnosis of popliteal artery entrapment syndrome, one must rule out all other causes of leg pain because it is a diagnosis of exclusion.(1)
After this, blood pressure measurement in the upper limb as well as the lower limb is done to compare them. If the blood pressure is low in the lower limb as compared to the upper limb then it is suspected that there may be blockage of the artery supplying the lower limb. For a more accurate comparison, the ratio of blood pressures at the ankle and the brachial region is considered which is also known as the ankle-brachial index.
To confirm the diagnosis of popliteal artery entrapment syndrome, a few of the radiological investigations are done which are very specific for this condition. A colored duplex Doppler is recommended of the affected leg which helps to identify the blood flow in the arteries. It also can demarcate the volume and pressure by which the blood is flowing in the popliteal artery.
Computed tomography angiography and magnetic resonance angiography are other radiological investigation which can be done to confirm the diagnosis of popliteal artery entrapment syndrome.
An invasive procedure known as catheter angiography can also be done in which there is a catheter placed in the artery lumen to see the patency of the artery directly. It is the most specific and sensitive method to diagnose this condition.(1)
What Is The Best Medicine For Popliteal Artery Entrapment Syndrome?
Medical treatment in the form of painkillers is given only in the initial phases when there is only pain which is not relieved on rest but it is not an effective mode of treatment in the long run. Surgical treatment is the only curative form of treatment for popliteal artery entrapment syndrome. The artery has to be released from the entrapment of popliteus muscle or there can be a bypass made by cutting the vessel and ligating it with another artery. Sometimes abnormal muscle insertion is also a cause and can be eliminated by disintegrating the insertion point of the muscle and reinserting it after the entrapment of the popliteal artery is removed.
Conclusion
The symptoms of the patient and its presentation are very much important in the diagnosis of this condition. The patient should seek medical advice as soon as the symptoms are experienced in such conditions because it is a dangerous condition and can even threaten the viability of the limb if it is ignored for a long period. Diagnosis can be made based on a few radiological investigations such as color Doppler, computed tomography scan, magnetic resonance angiography scans, etc. Catheter angiography is diagnostic as well as a curative form of investigation where if there is blockage found in the artery it can be removed on site.
The best form of treatment for popliteal artery entrapment syndrome is only surgical because it is a dangerous condition and needs to be corrected as soon as possible.
