The Popliteal Artery Entrapment Syndrome

Abstract

The purpose of this retrospective study was to evaluate the early and long-term results of vascular reconstruction for popliteal artery entrapment syndrome (PAES). Fourteen patients (18 legs) who underwent surgical treatment for PAES over a 10-year period were included. Seven patients underwent simple myotomy and remained symptom-free for a 5- to 96-month follow-up period. Seven patients underwent myotomy and vein graft: the graft remained patent in four cases, in one case the graft thrombosed and was successfully reoperated on, and two patients remain asymptomatic without palpable pulses. Of the three patients with a polytetrafluoroethylene (PTFE) graft, one is symptom-free with a patent graft, one continues to present with intermittent claudication (IC), whereas the third subsequently underwent above-knee amputation. PAES, a congenital abnormality, requires surgical treatment and any conservative management may be deleterious. Early diagnosis is of utmost importance because in the early stage, simple surgical procedure offers a permanent therapeutic result. Thus, every young sportsperson, with even minor lower extremity problems, should be examined by a vascular surgeon.

Popliteal entrapment syndrome

“…Eleven studies described a median proportion of 11% of limbs (range, 5%-67%) presenting with acute ischemia. 24,26,27,30,33,36,37,41,42,45,49 A median proportion of 38.25% of patients (range, 0%-100%) diagnosed with bilateral PAES was described in 26 studies. In 12 of 30 studies, a median proprtion of 17.5% of limbs (range, 6%-31%) diagnosed with PAES were asymptomatic, whereas this proportion was unclear in seven studies.…”

“…Of the 12 studies on PAES containing asymptomatic limbs, surgery was performed for all asymptomatic limbs in eight studies. 27,29,30,40,42,44,45,49 In one series, no surgery was performed in the single described asymptomatic limb. 24 In three studies, it was not possible to determine the proportion of asymptomatic limbs that underwent surgery.…”

“…33,35,[37][38][39][41][42][43][44][45][46][48][49][50] Amputation ("minor" in one, above knee in one, and level not specified in two) as a result of failed treatment was reported in four case series (one patient in each series). 38,43,45,48 Other complications described wound infection or hematoma in four studies (median frequency, 3%), wound seroma in one study (frequency, 4.6%), and deep vein thrombosis in one study (frequency, 11%).…”

“…40,42,45 Outcome measures. Successful resolution of symptoms after surgery for PAES was reported clearly in only 12 of 30 studies, with a median value of 77% (range, 70%-100%) 33,[37][38][39][40][41][42]45,46,[48][49][50] (Fig 6). Three of 30 studies used entirely subjective descriptions for outcomes, such as "good" or "excellent," and 15 of 30 studies did not clearly describe symptom resolution after surgery.…”

Surgical Treatment for Popliteal Artery Entrapment Syndrome

“…18) The patency rate of bypass surgery using vein grafts has been reported to be 57%-65% over a period of 8-10 years. 19,20) Levien, et al 17) reported a case series of 66 limbs that underwent musculotendinous section and 16 limbs that underwent segmental replacement of the occluded popliteal artery with a reversed saphenous vein. All limbs in the solely musculotendinous section group remained with a patent popliteal artery during the follow-up period (median, 3.9 years).…”