Two Cases of Mis-diagnosed Popliteal Artery Entrapment Syndrome

Lamb, Carla; Davies, C.G.; Whitbread, T.

doi:10.1016/j.ejvs.2010.05.021

Cited by 5 publications

(8 citation statements)

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“…This is the longest reported misdiagnosed PAES. 5 , 6 In this case, the acute presentations, without prior symptoms of arterial stenosis, or compression, precluded adequate pre-operative testing. In addition, the patient's history of a traumatic arterial injury and subsequent thrombosis did not immediately lead to the correct diagnosis (PAES).…”

Section: Discussionmentioning

confidence: 91%

“… 5 , 9 In some cases, patients even underwent unnecessary surgery for presumed chronic compartment syndrome, later diagnosed as PAES. 6 …”

Section: Discussionmentioning

confidence: 99%

“… 3 , 4 In previous studies, the mean duration of symptoms before surgical treatment ranged from two to 216 months, 5 and there are reports of misdiagnosis for up to 15 years. 6 Prompt diagnosis is important. When PAES is recognised early, and the artery remains undamaged, myotomy alone can be performed.…”

Section: Introductionmentioning

confidence: 99%

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Trapped by the Entrapment

Longchamp

Besson

et al. 2020

EJVES Vascular Forum

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Introduction Popliteal entrapment syndrome results from extrinsic compression of the popliteal artery by the surrounding musculotendinous structures and is a rare cause of limb ischaemia. The purpose of this report is to highlight potential mistakes in the management of popliteal entrapment. Report In 2000, a 23 year old man underwent a popliteal to popliteal artery bypass surgery for what was initially diagnosed as a traumatic popliteal artery thrombosis. After being initially lost to follow up for 13 years, this “unspecified traumatic” thrombosis led to several inappropriate endovascular and open procedures misinterpreted as being caused by late graft failure. These included thrombectomy, aneurysmorrhaphy, polytetrafluoroethylene covered stent graft, a redo femoropopliteal bypass, and bypass thrombolysis. The diagnosis was reached 19 years after the initial surgery, when the patient underwent a redo bypass using a retrogeniculate approach. An abnormal lateral insertion of the gastrocnemius muscle medial head, and its accessory slip, constricted the artery, and also involved the popliteal vein (Type V), thus explaining previous revascularisation failures. Surgery consisted of resecting the accessory slip and the aneurysmal bypass. The artery was reconstructed with the cephalic vein. The patient was discharged on clopidogrel 75 mg, with no further complication, and a patent bypass at six months. Based on post-operative imaging (duplex ultrasound and magnetic resonance imaging), with forced plantarflexion and dorsiflexion, asymptomatic popliteal entrapment was also present on the contralateral side. Discussion The finding of an isolated popliteal artery lesion in a young individual should be considered to be caused by popliteal artery entrapment, unless proven otherwise. Definitive surgical release of the popliteal artery should be favoured over other strategies.

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Section: Discussionmentioning

confidence: 91%

“… 5 , 9 In some cases, patients even underwent unnecessary surgery for presumed chronic compartment syndrome, later diagnosed as PAES. 6 …”

Section: Discussionmentioning

confidence: 99%

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Trapped by the Entrapment

Longchamp

Besson

et al. 2020

EJVES Vascular Forum

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“…Doppler ultrasonography is a useful inexpensive and noninvasive initial investigation to suggest the diagnosis [ 14 , 15 ]. However, Doppler US without the use of provocative maneuvers can result in false negatives [ 11 , 15 ]. Imaging in a relaxed position, as well as in resisted plantar flexion, or imaging after exercise once the symptoms are redemonstrated can improve sensitivity and decrease false negatives [ 15 , 16 ]; however, this may result in false positives, so clinical correlation becomes extremely pertinent [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Avoiding the Trap of Misdiagnosis: Valuable Teaching Points Derived from a Case of Longstanding Popliteal Artery Entrapment Syndrome

Wady

Badar

Farooq

et al. 2018

Case Reports in Medicine

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Popliteal artery entrapment syndrome (PAES), a condition predominantly affecting young individuals, is a rare clinical entity that can result in significant morbidity. The presence of lower limb pain and claudication in young, physically active individuals should prompt consideration for PAES. Early diagnosis and management is crucial to prevent long-term complications; however, diagnosis is fraught with challenges due to the rarity of the disease and its similar clinical presentation with more common conditions. We present a case of a young female with PAES who was misdiagnosed and underwent a tarsal tunnel release for suspected tarsal tunnel syndrome and subsequent fasciotomies for presumed chronic exertional compartment syndrome (CECS) without any relief. We outline the insidious undiagnosed course of her condition over a period of 12 years, discuss teaching points of how to recognize key differences of PAES and associated conditions, and provide recommendations for how to make the right diagnosis.

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“…Non-treated popliteal artery entrapment can lead, in the anatomical form, to complications, such as stenosis, embolism, post-stenotic dilatation and arterial thrombosis, and in the functional form, to incapacity to practice physical exercises 9,15 . The most common symptoms are: intermittent claudication 9,11,12,16 , in 40% of the patients 11 , and feet and calf pain, which appear after physical exertion 9,17 . Intermittent claudication -complaints of pain only while walking -can occur 9 .…”

Section: Discussionmentioning

confidence: 99%

Síndrome do aprisionamento da artéria poplítea: relato de caso

Bettega

Szeliga

Hagemann³

et al. 2011

J. vasc. bras.

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A síndrome do aprisionamento da artéria poplítea caracteriza-se pela compressão desta artéria sendo a principal causa de claudicação intermitente em jovens. Homem, 18 anos, branco, apresentava parestesia, frialdade e palidez do pé direito, iniciada 24 horas após exercício físico. Em membro inferior direito, ausência de pulsos tibial posterior e dorsal do pé. À flexão dorsal e flexão plantar forçadas, houve diminuição dos pulsos tibial posterior e dorsal do pé à esquerda. Tratado cirurgicamente, o paciente apresentou pulso em ambas as artérias. A síndrome é mais frequente em homens e a prevalência varia entre 0,16 e 3,5%. O aprisionamento da artéria poplítea tipo III é mais comum. A falta de tratamento pode levar à embolia, trombose e aneurismas pós-estenóticos. Esta síndrome deve ser lembrada como causa de dor na perna, especialmente em homens jovens e de prática esportiva intensa.

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Two Cases of Mis-diagnosed Popliteal Artery Entrapment Syndrome

Abstract: We present a case of acute ischaemia of the lower limb due to a spontaneous dissection of the superficial femoral artery successfully revascularised with an emergency surgical bypass.

Cited by 5 publications

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Trapped by the Entrapment

Trapped by the Entrapment

Avoiding the Trap of Misdiagnosis: Valuable Teaching Points Derived from a Case of Longstanding Popliteal Artery Entrapment Syndrome

Síndrome do aprisionamento da artéria poplítea: relato de caso

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