Eventually, an irreversible lesion of the popliteal artery can manifest itself as aneurysmal dilatation, thrombosis, or embolism and can result in ischemia, threatening limb viability.(1)
Despite technical advances in arterial repair, trauma to the popliteal artery continues to be associated with a relatively high amputation rate in most civilian and military experiences.(1)
Is Popliteal Artery Entrapment Syndrome A Serious Condition?
Popliteal artery entrapment syndrome is a very serious condition usually manifesting in the younger age group especially between 20 to 40 years. There is progressive compression of the popliteal artery by the muscles of the posterior compartment of the lower leg. These muscles include popliteus, gastrocnemius, soleus, etc. which can compress the popliteal artery if their insertion is faulty. Sometimes the course of the popliteal artery is also unusual leading to getting trapped between the insertions of these muscles.
The entrapment may lead to hindrance of the blood flow in the artery and also in the areas supplied by it. It further causes ischemia of the muscles and soft tissue of the lower leg leading to degeneration and breakdown of those tissues. If not diagnosed early, it may lead to gangrenous changes in the leg threatening the limb viability. It is usually unilateral but in very few cases it may also be bilateral.
In the initial phases, there is only pain which is aggravated on exercising and usage of lower leg muscles. When the ischemia progresses, the pain starts occurring even at rest which is known as claudication. It is intermittent and gets resolved automatically after some time.
If popliteal artery entrapment syndrome is still not diagnosed, the ischemia progresses leading to gangrene formation. If there is an infection of the gangrenous area, it may become wet gangrene but usually, it is dry gangrene which completely makes the tissue unviable. The muscles and the other tissue of the leg die and eventually, the leg has to cut down to stop the infection and progression of the disease. It has to be amputated as soon as possible. Even after the dry gangrene has formed, the condition is ignored then it may lead to sepsis, and the patient may eventually die.
Can Popliteal Artery Entrapment Syndrome Be Reversed?
The treatment for popliteal artery entrapment syndrome is pretty straight forward and easy if it is diagnosed appropriately in its early phases. The only mode of treatment which is curative of the disease is surgical. Surgery has to be done to remove the insertion of the affecting muscle and has to be reinserted after the popliteal artery is saved.(2)
If the course of the popliteal artery is abnormal then either the surrounding tissue is cut to relieve the popliteal artery or sometimes its path may also be relocated for a small length to manage the condition. Medical treatment is only for pain relief in the earlier condition when there is no claudication developed and ischemia is also not there.
Conclusion
Popliteal artery entrapment syndrome is a pretty serious condition if not diagnosed properly and ignored for a long period. It may lead to compartment syndrome due to the bursting of aneurysm developed in the popliteal artery.(3) It may also lead to gangrene formation and sepsis once the ischemia has set up in the tissue supplied by the popliteal artery. There may be a requirement of leg amputation in the gangrene cases which makes this condition a very dangerous one.
The condition can be reversed easily with the help of surgical treatment. A general surgeon or an orthopedician removes the insertion of the popliteus muscle and reinsert it at a different position where it does not lead to compression of the popliteal artery.
