Bilateral popliteal entrapment syndrome in a young athlete diagnosed with ultrasound

Abstract

Popliteal artery entrapment syndrome (PAES) occurs when the popliteal artery is compressed by abnormally developed or hypertrophied muscles adjacent to the popliteal fossa. When symptomatic, it most frequently presents with leg cramping while walking or running. We describe the case of an 18-year-old female runner presenting with claudication and exercise intolerance. After MRI was non-diagnostic, diagnostic ultrasound demonstrated that she had functional (Type VI) PAES. She subsequently underwent popliteal artery release surgery. Type VI PAES should be considered in young, healthy patients who present with claudication, particularly athletes.

Improving duplex ultrasound methods for diagnosing functional popliteal artery entrapment syndrome

“…10 The idea of graded plantar-flexion compression at rest, at 25% of full plantar-flexion, and at 50%-100% of full plantar-flexion has been utilized to establish functional PAES severity. 4,9 Whilst a high sensitivity for functional PAES diagnosis has been reported for provocative MRI/ MRA (94%) and provocative duplex ultrasound coupled with ABPIs (90%), the reliability of MRI/MRA has been brought into question due to the inability of subjects to maintain sustained provocative loading maneuvers (MRI scans take >30 mins) in addition to the presence of motion artifact. 12 As previously noted, popliteal artery occlusions were recorded across all three groups when performing flexion maneuvers in the prone position.…”

“…Type VI, commonly known as functional PAES, differs in that POPA compression occurs due to nonanatomical‐related variants 2 . Hypertrophy of the medial gastrocnemius muscle observed in athletes has been widely linked to functional PAES, with approximately 60% of reported cases affecting young athletes under 30 years 3,4 …”

“…2 Hypertrophy of the medial gastrocnemius muscle observed in athletes has been widely linked to functional PAES, with approximately 60% of reported cases affecting young athletes under 30 years. 3,4 Functional PAES typically causes lower extremity claudication and paresthesia in people with no underlying atherosclerotic disease, which is relieved on cessation of exercise. Importantly, rapid detection of PAES can prevent progressive arterial damage, with early detection associated with a favorable long-term clinical outcome.…”

Diagnostic Challenges in an Athlete with Popliteal Artery Entrapment Syndrome: A Case Report

“…Early diagnosis and treatment are important as PAES can be progressive and lead to distal ischemia. However, PAES is a diagnostic challenge and may require one or more imaging studies such as ultrasound, Duplex ultrasound (DUS), arterial-brachial indices (ABIs), angiography, magnetic resonance angiography (MRA), or computed tomography angiography (CTA) (1–3). Mild cases are monitored and conservatively managed with activity modifications.…”