Presentation, diagnosis, and management of popliteal artery entrapment syndrome: 11 years of experience with 61 legs

Abstract

Popliteal artery entrapment syndrome (PAES) is still underdiagnosed yet it may significantly interfere with lifestyle, especially among young sportspeople, with symptoms like intermittent claudication. Although case reports and small case series are sometimes published, studies with larger populations are quite rare. This study summarizes our experience with PAES on 61 limbs (35 patients) over a period of 11 years, describing the demographics, the disease, and the diagnostic and therapeutic methods used with PAES patients. In a population of 327 consecutive explored symptomatic sportspersons, PAES was confirmed in 35 patients on 61 pathologic limbs. The median time with the symptoms before diagnosis was 34 months (range, 3-180 months). The mean age of patients was 30.5 years (range, 17-52 years) with 83% of males. The proportion of patients diagnosed with bilateral PAES was 74%. The main sports practiced were running (15 patients, 43%), soccer (nine patients, 26%), rugby (two patients), and athletics (two patients). Among 21 patients, intra-compartmental pressure measurements (ICP) found 18 (86%) to have an associated chronic exertional compartment syndrome (CECS). Among the patients followed up after PAES surgery, 80% were able to resume sport at a level comparable to that before the onset of pain. PAES could be sought earlier in young sportspeople who experience unexplained leg pain during exercise to diagnose the disease and avoid complications in a timely manner. Compartmental pressures should systematically be measured in the search for an associated CECS.

Popliteal Artery Entrapment Syndrome (PAES) in a 17-Year-Old Adolescent

“…This case report is about a patient with PAES Type II that became symptomatic on the right limb and remained asymptomatic on the left limb. Studies report the proportion of bilateral entrapment of the PA ranging between 30 and 74 percent [8, 10, 11], highly emphasizing the need for bilateral diagnostic work-up.…”

Popliteal Artery Entrapment or Chronic Exertional Compartment Syndrome?

“…Various imaging modalities exist in the work-up of PAES. Some institutions have implemented dynamic color duplex ultrasonography (CDUS) as a screening method in all athletes complaining of chronic leg pain during exercise [ 9 ]. Others call for the combination of Doppler US and Magnetic Resonance Angiography in all suspected cases [ 10 ].…”

“…Some institutions report high false-positive rates with use of ultrasound [ 11 – 13 ]. However, in their review of 61 cases of PAES, Corneloup et al report a specificity of 76% for dynamic CDUS when used only in symptomatic patients with a high threshold (complete cessation of flow in the popliteal artery during dynamic maneuver) [ 9 ]. For patients with suspected PAES following CDUS, confirmation with CTA or MR angiography (MRA) is still recommended [ 9 – 11 , 14 ].…”

“…In contrast, CTA is preferred by some for its accessibility and short acquisition time. While CTA has long been the classical screening and diagnostic tool in functional PAES, newer methods of screening and diagnosis such as dynamic US and MRA have proven their usefulness in recent years and should be considered in the work-up for functional PAES [ 9 – 11 , 14 ].…”

O papel da ressonância magnética no diagnóstico da síndrome compartimental crônica do exercício

“…Embora invasiva, a angiografia digital é, tradicionalmente, o método padrão-ouro. 38,39 Além disso, valores normais de manometria favorecem o diagnóstico de SAAP, 40 embora alguns trabalhos [39][40][41] relatem não ser incomum a associação entre SCCE e SAAP.…”