A new diagnostic approach to popliteal artery entrapment syndrome

Williams, Charles E.; Kennedy, Dominic; Bastian-Jordan, Matthew; Hislop, Matthew; Cramp, Brendan; Dhupelia, Sanjay

doi:10.1002/jmrs.121

Cited by 36 publications

(25 citation statements)

References 9 publications

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“…The neutral position was used to visualize artery occlusion, aneurysm, popliteal vessels anomalies, and presence of collateral arteries. Repeated plantar exion until the individual becomes symptomatic may be necessary to demonstrate occlusion [5]. Popliteal artery with a peak systolic velocity ratio exceeding 200% indicates a positive result.…”

Section: Doppler Ultrasound Scanningmentioning

confidence: 99%

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

Zhong

Shao

et al. 2020

Preprint

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Background To retrospectively evaluate Doppler ultrasound findings for patients with popliteal vascular entrapment syndrome (PVES). Methods Twenty-four patients (30 legs) who underwent surgical intervention for PVES were included in this study. The popliteal artery, popliteal vein, and surrounding musculotendinous structures were explored in all symptomatic lower extremities using ultrasound. Intraoperative findings served as the gold standard. In the absence of popliteal artery occlusion, popliteal arteries were examined using Doppler ultrasound at rest and during a provocative maneuver. Results Ultrasonography in 25 cases (25/30, 83%) showed that gastrocnemius medial head or popliteal vascular anomalies were consistent with surgical photography results. According to Whelan and Rich classification, the classic type I was found in five limbs, type II in twelve limbs, type III in seven limbs, and type V in one limb. In the remaining five cases (5/30, 17%), no anatomical abnormalities of the popliteal fossa were discovered by the ultrasound examination. Among these, two cases (2/30, 7%) were misdiagnosed as lower extremity atherosclerosis and popliteal vascular depression was not found. In addition, increasing blood flow velocity was found in three cases (3/30, 10%) of compressed popliteal arteries using Duplex scanning during active plantar flexion, with decreasing flow at the distal end. Color Doppler ultrasound of the affected popliteal vessels showed varied degrees of vascular structure pathology, including arterial stenosis in ten limbs, occlusion in fifteen limbs, and aneurysm in two limbs. Conclusion Doppler ultrasound may have a high diagnostic rate in PVES. Due to its simplicity, repeatability, functional evaluation of blood flow, and non-invasiveness, it can be used as a primary screening examination modality in PVES. Provocative maneuvers could help clinicians diagnose PVES.

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Section: Doppler Ultrasound Scanningmentioning

confidence: 99%

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

Zhong

Shao

et al. 2020

Preprint

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“…Da diese jedoch meist erst etwas später auftreten als die klassische Claudicatio, erscheint hier das Fehldiagnostizieren des PAES ein naheliegender Pitfall für das auf die Angiografie geschulte Auge. Auch in der Sonografie ist eine Untersuchung in Provokationsstellung mit passiver maximaler Dorsalflexion und aktiver Plantarflexion des Fußes gegen Widerstand essenziell, um die Falsch-negativ-Rate zu minimieren [17]. Die unterschiedlichen Verläufe von Patient 1 und 3, die beide in ähnlich jungem Alter erstmals vorstellig wurden, zeigen, wie wichtig die generelle Erwägung eines PAES als Differenzialdiagnose bei jungen Patienten unabhängig ihrer Sportlichkeit oder Physiognomie ist.…”

Section: Diskussionunclassified

Poplitealarterien-Entrapment-Syndrom: 3 untypische Fälle mit 3 verschiedenen Diagnosewegen

et al. 2019

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Zusammenfassung Einleitung Das Poplitealarterien-Entrapment-Syndrom (PAES) beschreibt einen pathologischen Zustand, bei dem sich durch anatomische Anomalien der Lagebeziehung zwischen zumeist muskulären Weichteilstrukturen des Caput mediale des M. gastrocnemius (CMMG) und der A. poplitea (AP) eine mechanische Kompression und eine daraus folgende Schädigung der Gefäße bis zum Verschluss ergibt. Patienten In den Jahren 2012 bis 2018 wurden 3 männliche Patienten im Alter zwischen 17 und 48 Jahren wegen eines PAES an unserer Abteilung operiert. Der 1. Patient wurde bereits 2003 mit 23 Jahren einer femoropoplitealen Bypassoperation bei der Diagnose „PAVK II b posttraumatisch“ unterzogen. Nach mehrmaliger Revision fiel 2012 schließlich intraoperativ ein starker, nach lateral ziehender, die Gefäße einengender Sehnenzügel des CMMG auf. Nach Durchtrennung des Sehnenzügels wurde die aneurysmatische Bypassvene ersetzt. Der 2. Patient wurde 2014 mit der Diagnose „PAVK II b bei thrombosiertem Poplitealaneurysma“ nach intraarterieller Lyse mit wandhaftenden Restthromben vorstellig. Intraoperativ zeigte sich proximal des Aneurysmas ein zum CMMG ziehender Sehnenzug, welcher die AP einengte. Beim 3. Patienten trat 2018 eine Fußsohlen- und Wadenclaudicatio rechts mit abgeblasstem und pulslosem Unterschenkel auf. Bildgebend zeigte sich ein Verschluss der Poplitealarterien beidseits. Nach intraarterieller Lyse zeigte die HRMR-Untersuchung des Knies einen atypischen Verlauf der AP von medial das CMMG ventral kreuzend. Die operative Sanierung wurde durch Myotomie und Refixation des Muskels in physiologischer Position vorgenommen. Alle Patienten erhielten eine individuelle medikamentöse Re-Thromboseprophylaxe. Von der Operation der Gegenseite bei simultan bestehendem PAES wurde bei mangelndem Therapiewunsch der Patienten abgesehen. Schlussfolgerung Das PAES ist selten und wird i. d. R. mit jungen, sportlich aktiven, meist männlichen Patienten mit ausgeprägter Unterschenkelmuskulatur in Verbindung gebracht. Eine späte Diagnose des PAES kann, wie der 1. Fall zeigt, zu schweren Gefäßschäden, unnötigen Rezidiveingriffen und über Jahre protrahiertem Krankheitsverlauf führen. Bei jungen Patienten mit Wadenclaudicatio sollte daher stets auch unabhängig von der körperlichen Konstitution die Differenzialdiagnose PAES erwogen werden.

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“…Although fPAES is usually considered a rare cause of leg pain (3), the true incidence of this condition is unknown, and fPAES is likely underdiagnosed and underreported (4). A missed diagnosis may result in disease progression and the use of unnecessary invasive procedures (3), and untreated fPAES may lead to popliteal artery damage, embolization, and limb ischemia (5). Although a diagnostic method using a combination of dynamic ultrasound and MR imaging/MR angiography has been described for fPAES (5), to our knowledge, no investigational studies have been performed to assess the dynamic ultrasound findings in this entity.…”

mentioning

confidence: 99%

“…A missed diagnosis may result in disease progression and the use of unnecessary invasive procedures (3), and untreated fPAES may lead to popliteal artery damage, embolization, and limb ischemia (5). Although a diagnostic method using a combination of dynamic ultrasound and MR imaging/MR angiography has been described for fPAES (5), to our knowledge, no investigational studies have been performed to assess the dynamic ultrasound findings in this entity. This study sought to evaluate the usefulness of dynamic plantar flexion and dorsiflexion of the calf and the effect on the popliteal artery Doppler waveform in patients with clinically suspected fPAES and no structural abnormality.…”

mentioning

confidence: 99%

Functional Popliteal Artery Entrapment Syndrome: Investigation With Dynamic and Doppler Ultrasound

Delzell

Mofakham

Bullen

et al. 2019

Orthopaedic Journal of Sports Medicine

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A. Background Functional popliteal artery entrapment syndrome (fPAES), a cause of exertional leg pain, has a clinical presentation and clinical findings that are often indistinguishable from those of other leg pain causes (1). This condition may also coexist and overlap in symptomatology with other leg pain causes, further complicating the diagnosis (2). Although fPAES is usually considered a rare cause of leg pain (3), the true incidence of this condition is unknown, and fPAES is likely underdiagnosed and underreported (4). A missed diagnosis may result in disease progression and the use of unnecessary invasive procedures (3), and untreated fPAES may lead to popliteal artery damage, embolization, and limb ischemia (5). Although a diagnostic method using a combination of dynamic ultrasound and MR imaging/MR angiography has been described for fPAES (5), to our knowledge, no investigational studies have been performed to assess the dynamic ultrasound findings in this entity. This study sought to evaluate the usefulness of dynamic plantar flexion and dorsiflexion of the calf and the effect on the popliteal artery Doppler waveform in patients with clinically suspected fPAES and no structural abnormality. B. Methods We performed a retrospective review of ultrasound studies in patients who presented with clinically suspected PAES over a 3-year period. The ultrasound studies consisted of an anatomic survey of the popliteal. Dynamic nonresistant dorsiflexion and plantar flexion evaluations of the popliteal artery plus spectral Doppler evaluations of the popliteal artery obtained in neutral, plantar flexion, and dorsiflexion positions were performed before and after patients exercised. Patients with anatomic abnormalities were excluded. The following parameters were assessed: The proportion of symptomatic knees versus asymptomatic knees in which plantar flexion and/or dorsiflexion of the foot resulted in popliteal artery compression. The peak systolic velocity (PSV) of the popliteal artery in all positions for knees with and knees without dynamic popliteal artery compression. The absolute value change in PSV of the popliteal artery from neutral to plantar flexion and from neutral to dorsiflexion in the pre- and postexercise state for knees with and knees without dynamic popliteal artery compression. ROC analysis for clustered data was used to assess the ability of PSV to distinguish between knees with and knees without arterial compression. C. Results A total of 88 knees (77 symptomatic, 11 asymptomatic) in 45 patients were included in the study. Dynamic arterial compression was observed in 38% (29/77) of symptomatic knees. No compression seen in asymptomatic knees. Both pre-exercise and postexercise knees with arterial compression had significantly higher absolute changes in PSV from neutral to plantar flexion versus knees without arterial compression (Table). There was a smaller significant change in PSV from neutral to dorsiflexion in the pre-exercise state. There was no significant change in PSV in the postexercise state from neutral to dorsiflexion or with respect to PSV values at any position between knees with and knees without arterial compression. D. Conclusions/Significance In patients with clinically suspected PAES without anatomic abnormality, dynamic ultrasound demonstrated compression of the popliteal artery in 38% of knees. No dynamic arterial compression was seen in asymptomatic knees. There was a significant elevation in PSV from neutral to plantar flexion in pre- and postexercise states and from pre-exercise neutral to dorsiflexion positions in knees with arterial compression versus knees without arterial compression. Tables [Table: see text] References Joy SM, Raudales R. Popliteal artery entrapment syndrome. Curr Sports Med Rep. 2015;14(5):364-367. Hislop M, Kennedy D, Cramp B, Dhupelia S. Functional popliteal artery entrapment syndrome: poorly understood and frequently missed? A review of clinical features, appropriate investigations, and treatment options. J Sports Med (Hindawi Publ Corp). 2014;2014:105953. Gaunder C, McKinney B, Rivera J. Popliteal artery entrapment or chronic exertional compartment syndrome? Case Rep Med. 2017;2017:6981047 Hislop M, Brideaux A, Dhupelia S. Functional popliteal artery entrapment syndrome: use of ultrasound guided Botox injection as a non-surgical treatment option. Skeletal Radiol. 2017;46(9):1241-1248. Williams C, Kennedy D, Bastian-Jordan M, Hislop M, Cramp B, Dhupelia S. A new diagnostic approach to popliteal artery entrapment syndrome. J Med Radiat Sci. 2015;62(3):226-229.

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A new diagnostic approach to popliteal artery entrapment syndrome

Cited by 36 publications

References 9 publications

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

Doppler Ultrasound Evaluation of Patients with Popliteal Vascular Entrapment Syndrome

Poplitealarterien-Entrapment-Syndrom: 3 untypische Fälle mit 3 verschiedenen Diagnosewegen

Functional Popliteal Artery Entrapment Syndrome: Investigation With Dynamic and Doppler Ultrasound

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