To report on a case of popliteal artery entrapment that was treated. Functional popliteal artery entrapment syndrome paes is an important and possibly underrecognized cause of exertional leg pain. The popliteal artery is the dominant source of blood supply to the leg below the knee. It is characterized by various anomalous anatomic relationships between the muscle and arteries in the popliteal fossa, resulting in extrinsic arterial compression. Popliteal artery entrapment syndrome paes occurs when muscles that surround the popliteal artery in the area of the popliteal fossa, occlude the artery and sometimes the vein as well, and decrease blood flow to the lower leg. Popliteal artery entrapment syndrome radiology case.
The popliteal artery may be compressed behind the knee, due to congenital deformity of the muscles or tendon insertions of the popliteal fossa. May 24, 2017 popliteal entrapment syndrome is a rare vascular disease that leads to chronic leg ischemia. Pdf surgical treatment for popliteal artery entrapment. The anatomical anomaly is the result of abnormal embryological development of the popliteal artery or the musculotendi. The popliteal artery entrapment syndrome causes claudication and ischemia in young. Popliteal artery entrapment syndrome presenting as acute limb.
Popliteal artery entrapment syndrome sage journals. Popliteal artery entrapment syndrome lambert 1999 bjs. The abnormal relationship of the popliteal artery to the gastrocnemius muscle was first described by a medical student, t. Due to an abnormal course of the popliteal artery and the calf muscle group, the artery can be compressed and reduce blood flow.
Investigating functional paes is also fraught with potential problems and if it is. Pdf popliteal artery entrapment syndrome researchgate. Sep 07, 2014 functional popliteal artery entrapment syndrome paes is an important and possibly underrecognized cause of exertional leg pain. The features indicative of paes are outlined, as it can share features with other causes of elp. Five year outcomes of surgical treatment for popliteal artery.
Popliteal artery entrapment syndrome paes is an uncommon cause of lower limb claudication,1 most commonly affecting young athletes. Popliteal entrapment syndrome is a rare vascular disease that leads to chronic leg ischemia. Symptoms are similar to intermittent claudication but the patient cohort is markedly different, with young athletes being primarily affected. Endovascular treatment of popliteal artery entrapment.
Popliteal artery entrapment syndrome paes is a rare condition where the popliteal artery is compressed in the popliteal fossa during plantar flexion. It wasnt until the 1960s that the term popliteal artery entrapment syndrome, or paes, was first used, 24. The most common presenting symptoms include intermittent pain in the feet and calves on exercise 18. Compression of the artery restricts blood flow to the lower leg and can. Popliteal artery entrapment syndrome paes is a nonartherosclerotic cause of claudication and acute ischemia of the legs in young athletic individuals. Popliteal artery entrapment syndrome paes is an uncommon cause of lower extremity claudication that is often overlooked. Popliteal artery entrapment syndrome is a condition caused by direct compression of the popliteal artery as it passes within or exits the popliteal fossa.
This may be congenital or acquired through muscular hypertrophy. Popliteal artery entrapment syndrome paes is an uncommon congenital anomaly affecting young adults who present with symptoms of calf claudication. Popliteal artery entrapment syndrome paes is rare in young adults. Popliteal artery entrapment pain provoked by exertion. To report on a case of popliteal artery entrapment objective. Popliteal artery entrapment syndrome murray 1991 bjs. The authors present a new diagnostic procedure to quickly and noninvasively diagnose the popliteal artery entrapment syndrome. Chronic compression, histologic changes, and predisposing factors, such as vigorous exercise or hypercoagulability, play a role in these cases. Popliteal artery entrapment syndrome paes is a compression syndrome of the popliteal artery caused by musculotendinous structures in the popliteal fossa that was first described in 1879 by stuart. Jun 05, 2014 popliteal artery entrapment syndrome paes is a nonartherosclerotic cause of claudication and acute ischemia of the legs in young athletic individuals. It is surprisingly uncommon and usually affects young patients, typically men, and often presenting with symptoms of claudication, or more rarely acute limb ischemia, calf cramps, or a picture of compartment. This compression results in repetitive microtrauma and early atherosclerosis leading to popliteal artery stenosis or occlusion. Two cases of misdiagnosed popliteal artery entrapment. Findings are consistent with thrombotic occlusion of the left popliteal artery due to popliteal artery entrapment syndrome.
This repetitive trauma may result in stenotic artery degeneration, complete artery occlusion or even. Popliteal artery entrapment syndrome typically causes calf claudication in young active adults. Ct angiography and mri in patients with popliteal artery. Popliteal artery entrapment syndrome presenting as acute limb ischemia in pregnancy william sellers, do,a melissa obmann, do, bshivprasad nikam, md,b boyoung song, md, and david mariner, md,b wilkesbarre, pa abstract popliteal artery entrapment syndrome typically causes calf claudication in young active adults. Popliteal artery entrapment syndrome paes is an anomaly resulting in symptomatic extrinsic compression of the popliteal artery by the surrounding. The term popliteal artery entrapment syndrome was coined by love and whelan in 1965, and their modified classification system describes progressively worsening compression of the popliteal artery. It can present as an anatomical or congenital anomaly or as an acquired or functional form. This series outlines various types of popliteal vascular entrapment and documents successful surgical management. The most common presenting symptoms include intermittent pain in the feet and calves on exercise, resulting in lameness. Surgical treatment for popliteal artery entrapment syndrome. Of these, 30 studies were on popliteal artery entrapment syndrome paes. Acute limb ischemia from popliteal artery thrombosis, embolization, or aneurysmal degeneration is less common.
Cystic adventitial disease of the popliteal artery. These conditions, which may be common throughout the arterial system or exclusive to the popliteal artery, include atherosclerosis, popliteal artery aneurysm, arterial embolus, trauma, popliteal artery entrapment syndrome, and cystic adventitial disease. Popliteal artery entrapment syndrome is an uncommon cause of peripheral vascular disease in young fit individuals, presenting as progressive claudication or sudden limb ischaemia. The diagnosis of popliteal artery entrapment syndrome requires not only depiction of the arterial changes but also identification of the abnormal anatomic structures responsible for the entrapment. Any information contained in this pdf file is automatically generated from. Alternatively, popliteal artery entrapment syndrome triggers claudication via an aberrant arterial pathway or muscular hypertrophy. Popliteal artery entrapment syndrome paes is a nonatherosclerotic cause of claudication and acute ischemia of the legs in young individuals. Two cases of misdiagnosed popliteal artery entrapment syndrome. Paes can lead to popliteal artery thrombosis, stenosis, distal arterial. Cystic adventitial disease of the popliteal artery presenting. It most commonly occurs in young athletes without risk factors for peripheral vascular disease.
In a prospective study of 26 patients referred to doppler ultrasound examination with suspected popliteal artery entrapment syndrome, we have made doppler study of the popliteal artery of the diseased limb using 710 mhz. Popliteal artery entrapment syndrome paes is a rare anatomical abnormality that causes intermittent claudication in young active men without cardiovascular risk factors. What is popliteal entrapment syndromecausessymptoms. The popliteal artery is the main artery running behind the knee. Popliteal artery entrapment syndrome paes is an anomaly resulting in symptomatic extrinsic compression of the popliteal artery by the surrounding musculotendinous structures. Popliteal artery entrapment syndrome michigan medicine. Popliteal artery entrapment syndrome is a condition in which compression of the popliteal neurovascular structures results in symptoms of lower extremity claudication by. The popliteal artery entrapment syndrome is a rather uncommon pathology, which results in claudication and chronic leg ischemia. A new diagnostic approach to popliteal artery entrapment syndrome. Popliteal artery entrapment syndrome paes results from an anomalous relationship between the popliteal artery and the myofascial. The popliteal artery entrapment syndrome paes is the clinical result of extrinsic compression of the popliteal artery. Popliteal entrapment syndrome definition of popliteal. It is surprisingly uncommon and usually affects young patients, typically men, and often presenting with symptoms of claudication, or more rarely acute limb ischemia, calf cramps, or a picture of compartment syndrome. A large personal experience on the surgical treatment of such a disease 29 cases in 22 patients allowed us to focus on the optimal diagnostic procedure useful to detect this problem at an early stage.
Popliteal artery entrapment syndrome presenting as acute. Popliteal artery entrapment syndrome paes results from an anomalous relationship between the popliteal artery and the myofascial structures of the popliteal fossa 18. Popliteal artery entrapment syndrome paes refers to a condition in which the popliteal artery is compressed by one of the calf muscles. Symptoms are similar to intermittent claudication but the patient cohort is markedly different, with.
In this position, the artery is traumatized and repeatedly compressed between bone and contracting muscle. Popliteal artery entrapment syndrome paes is a condition caused when the popliteal artery becomes compressed by the medial head of the gastrocnemius proximally and fascial band of the soleus distally during activity, leading to painful. We report a rare case of a patient with bilateral popliteal artery entrapment who presented with the same symptom 11 years after his first experience of popliteal artery entrapment syndrome. Popliteal artery entrapment or chronic exertional compartment. Popliteal artery entrapment syndrome is a condition in which compression of the popliteal neurovascular structures results in symptoms of lower extremity claudication by way of a. Claudication of the young patient, which is often overlooked, is a very rare symptom for. Medial deviation of the popliteal artery seen angiographically is a classic finding, however, there might also be segmental occlusion of the midpopliteal artery.
If promptly diagnosed, a popliteal artery entrapment syndrome paes is the most common surgically correctable cause of leg claudication in. A case of overlooked popliteal artery entrapment syndrome. The tibioperoneal trunk further subdivides into the posterior tibial and peroneal arteries. The patient was a 46yearold hypertensive male diver who had been experiencing pain in his right leg for around six months. Popliteal artery entrapment syndrome evaluation with. It is classified in terms of the abnormal anatomical relationship between the popliteal artery and surrounding structures. Popliteal artery entrapment syndrome paes is a condition that affects the main artery called the popliteal artery in the leg below the knee. Popliteal artery entrapment syndrome is the compression of the popliteal artery and is the main cause of intermittent claudication in young patients. To report on a case of popliteal artery entrapment that was treated surgically. This syndrome is related to an abnormal embryological development with an aberrant anatomical relationship between the popliteal artery and its surrounding structures. We present a case of a 47yearold man who went undiagnosed for over 10 years despite multiple orthopedic, chiropractic, and neurosurgery consults.
A predisposing anatomical anomaly is seen with the popliteal artery located medial to the medial head of gastrocnemius mhg and separate to the popliteal vein. It occurs when the blood flow to the popliteal artery is squeezed compressed by the muscles and tendons. Functional popliteal artery entrapment syndrome paes is an important and possibly underrecognized cause of exertional leg pain elp. The popliteal artery is a relatively short vascular segment but is affected by a unique set of pathologic conditions. We present a case of a 47yearold man who went undiagnosed for over 10 years despite multiple orthopedic, chiropractic, and neurosurgery. When compression of the anterior tibial artery is present, restricting flow, involvement of this compartment is. Review article functional popliteal artery entrapment. Popliteal artery entrapment syndrome jama jama network. Pdf on feb 10, 2019, caitlin w hicks and others published popliteal artery entrapment syndrome find, read and cite all the research you. No relationship was found between duration of symptoms and the presence of. Popliteal artery entrapment syndrome caitlin w hicks.
Investigating functional paes is also fraught with potential. Jan 09, 2018 popliteal artery entrapment syndrome paes results from an anomalous relationship between the popliteal artery and the myofascial structures of the popliteal fossa. Popliteal artery entrapment syndrome military medicine abstract popliteal artery entrapment syndrome paes is a rare but important cause of leg. Pdf on feb 10, 2019, caitlin w hicks and others published popliteal artery entrapment syndrome find, read and cite all the research you need on researchgate. Popliteal artery entrapment syndrome paes is rare and may be underdiagnosed. The patient was a 46yearold hypertensive male diver who had been experiencing pain in his right leg for around six months, which worsened. Anatomical popliteal artery entrapment syndrome ncbi. The occlusion is unilateral however the anatomic anomaly is.
Bilateral popliteal artery entrapment syndrome with. Surgery is said to be the only treatment of popliteal entrapment syndrome, which requires the surgeon to release the entrapped artery thus providing relief. Paes can be further classified by anatomical type ivi, table 1. It shares many features with other causes of exertional leg pain, and more than one condition can be present at once, confusing the clinical picture. Surgical treatment for popliteal artery entrapment. Popliteal artery entrapment syndrome also presents with intermittent claudication primarily affecting muscle groups in the calf. Popliteal artery entrapment syndrome is recognized as a cause of lower leg claudication in patients younger than 50 years of age. Popliteal artery entrapment syndrome refers to intermittent claudication, usually in the young, produced by an anomalous course of the popliteal artery medial to the medial head of the gastrocnemius muscle. This report details the case of a middleaged male with cystic adventitial disease whose diagnosis was complicated by concurrent.
Popliteal artery entrapment syndrome paes is a condition caused when the popliteal artery becomes compressed by the medial head of the gastrocnemius proximally and fascial band of the soleus distally during activity, leading to painful claudication type symptoms and oftentimes paresthesias. The muscle and tendons near the knee are positioned so that they compress the popliteal artery the main artery that runs through and behind the knee. It is caused by an anomalous relationship of muscle and artery in the popliteal fossa resulting in extrinsic arterial compression. Diagnosis and treatment of peripheral arterial disease.
It can also present later in life with insidious symptoms relating to popliteal thrombosis or aneurysm. Popliteal artery entrapment syndrome caitlin w hicks 1, james h black iii and elizabeth v ratchford2 keywords compartment syndrome, popliteal artery entrapment syndrome paes, vascular disorders in athletes 1division of vascular surgery and endovascular therapy, johns hopkins university school of medicine, baltimore, md, usa. A retrospective study of all patients that underwent surgery for popliteal artery entrapment syndrome. Popliteal artery entrapment syndrome is an uncommon entity typically affecting young athletic males who present with symptoms of calf claudication.
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