Popliteal artery entrapment syndrome: an approach to diagnosis and management

Hameed, Maira; Coupland, Alexander; Davies, Alun H.

doi:10.1136/bjsports-2017-098704

Cited by 24 publications

(14 citation statements)

References 6 publications

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“…Surgical decompression is crucial to relieve the aberrant anatomic causes of arterial compression. Earlier treatment likely consists only of musculotendinous release, rather than additional arterial bypass, which may be required once severe vascular damage has occurred, with inferior results (3). For the patient with emergent symptoms of acute limb ischemia, assessment should be made according to the Rutherford criteria (44).…”

Section: Treatmentmentioning

confidence: 99%

Popliteal artery entrapment syndrome

Bradshaw¹,

Habibollahi²,

Soni³

et al. 2021

Cardiovasc Diagn Ther

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Popliteal artery entrapment syndrome (PAES) is a rare vascular disorder defined as compression of the popliteal artery by aberrant myotendinous structures in the popliteal fossa. PAES was first identified by Stuart, a medical student in 1879, who noted an anomalous course of the popliteal artery medial to the medial gastrocnemius muscle in an amputated leg (1). PAES often presents as exertional claudication in a young, otherwise healthy individual. These atypical symptoms should raise suspicion and prompt diagnostic workup. While uncommon, early diagnosis of PAES is crucial to prevent chronic vascular injury resulting in arterial stenosis, thrombosis, and possible amputation (2). Anatomy and pathophysiologySymptoms of PAES arise from the compression of the neurovascular bundle within the popliteal fossa by the surrounding musculotendinous structures. Popliteal vein and/or tibial nerve compression may exist alone or in combination with arterial pathology (3). The syndrome exists in six forms, divided into two categories: anatomic/ congenital and functional. Anatomic PAES results from abnormal embryological development of the popliteal artery, gastrocnemius muscle, or other myofascial structures

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Section: Treatmentmentioning

confidence: 99%

Popliteal artery entrapment syndrome

Bradshaw¹,

Habibollahi²,

Soni³

et al. 2021

Cardiovasc Diagn Ther

View full text Add to dashboard Cite

show abstract

“…Patients may present with hypertrophy of the lower limbs [4]. There may be a loss of the dorsalis pedis or posterior tibial pulse on resisted plantar or dorsiflexion with the knees extended [20,21]. A drop in the Ankle-Brachial Index (ABI) or significant flattening of a plethysmography waveform with these same maneuvers is considered a positive "entrapment test" [16].…”

Section: Clinical Features Of Functional Paesmentioning

confidence: 99%

“…Potential long-term sequelae of anatomical PAES stem from the effects of repetitive arterial micro-trauma on the popliteal artery and include distal embolization, dissection, acute limb ischemia secondary to acute thrombosis, post-stenotic dilatation and aneurysm formation [4,7,21]. This repetitive micro-trauma can be divided into three phases: in the first phase there is damage to the arterial adventitia; in the second, damage to the media; and in the third, the intima.…”

Section: Clinical Features Of Functional Paesmentioning

confidence: 99%

Functional Popliteal Artery Entrapment Syndrome: An Approach to Diagnosis and Management

2021

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Popliteal Artery Entrapment Syndrome (PAES) is an uncommon syndrome that predominantly affects young athletes. Functional PAES is a subtype of PAES without anatomic entrapment of the popliteal artery. Patients with functional PAES tend to be younger and more active than typical PAES patients. A number of differential diagnoses exist, the most common of which is chronic exertional compartment syndrome. There is no consensus regarding choice of investigation for these patients. However, exercise ankle-brachial indices and magnetic resonance imaging are less invasive alternatives to digital subtraction angiography. Patients with typical symptoms that are severe and repetitive should be considered for intervention. Surgical intervention consists of release of the popliteal artery, either via a posterior or medial approach. The Turnipseed procedure involves a medial approach with a concomitant release of the medial gastrocnemius and soleal fascia, the medial tibial attachments of the soleus and excision of the proximal third of the plantaris muscle. Injection of botulinum A toxin under electromyographic guidance has recently shown promise as a diagnostic and/or therapeutic intervention in small case series. This review provides relevant information for the clinician investigating and managing patients with functional PAES.

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“…Therefore, the physical exam is usually normal. 2 The first step in making the diagnosis is the exercise ankle-brachial index (ABI). This non-invasive blood flow test is performed before and after exercise.…”

Section: How Is Paes Diagnosed?mentioning

confidence: 99%

“…People who do activities that promote rapid muscle growth, such as weight resistance training or high-intensity circuit training, are at the highest risk. Although PAES can affect both men and women, 83% of cases occur in men, 2 probably due to the rapid muscle growth that occurs during puberty in this group.…”

Section: Who Is At Risk For Popliteal Entrapment?mentioning

confidence: 99%