Popliteal arterial entrapment syndrome


Primarily seen in young, active individuals, with minimal or no cardiovascular risk factors.

Complications can be lead to long-term morbidity, with amputation.

Usually affects young, athletic men, presenting as intermittent claudication.

Due to abnormal positioning of the popliteal artery in relation to the popliteus and gastrocnemius muscles of the popliteal fossa causing compression leading to vascular and neurogenic symptoms.

Classification broadly be divided into two groups, anatomical and functional.

In the anatomical type, there is an ab2242ant anatomical defect or malformation leads to occlusion of the popliteal artery.

In the functional disorder no clear anatomic abnormality is noted that can explain the claudication.

Dynamic occlusion can be seen on duplex ultrasound (US) imaging even in asymptomatic patients, with a prevalence ranging from 25%-80%.

Attempts to provoke symptoms by asking the patient to hop or perform plantar and dorsiflexion while standing on the edge of a step.

Non-invasive imaging modalities such as Doppler ultrasound (US) may provide additive diagnostic value.

Doppler US. is the recommended first-line diagnostic modality for PAES.

Provocative maneuvers such as sustained passive dorsiflexion and plantar flexion of the foot leading to loss of dorsalis pedis pulse or the posterior tibial pulse on Doppler US may be highly suggestive of PAES.

Contrast arteriography has been the definitive test for diagnosis of PAES.

Additional imaging modalities include computed tomography (CT) angiography and magnetic resonance imaging (MRI) angiography.

MRI angiography is useful in detecting abnormal insertion of the medial head of the gastrocnemius, displacement and level of occlusion of the popliteal artery, and helps differentiate intrinsic vascular disease from extrinsic compression.

The use of intravascular ultrasound can provide information on the exact location of the obstruction in addition to assessing the quality of the affected vessel wall.

There are limitations with each modality, so that these tools should be used in the appropriate clinical setting and in conjunction with each other.

In symptomatic patients, surgical intervention is the treatment of choice to reestablish normal anatomy and vascular flow to the distal extremity.

In anatomical variants of this condition, the progression of the occlusive disease is much more rapid, requiring urgent management, and may require exploration, fasciotomy, and myotomy.

The progression of disease is much slower in function PAES, allowing for longitudinal follow-up, and surgery may eventually be required.

Surgical intervention is not as successful in functional PAES as in anatomical PAES.

About 77% experiencing complete resolution of symptoms after surgery in functional PAES.

Leave a Reply

Your email address will not be published. Required fields are marked *