Popliteal artery entrapment syndrome: an approach to diagnosis and management

Popliteal artery entrapment syndrome (PAES) is an anomaly resulting in symptomatic extrinsic compression of the popliteal artery by the surrounding musculotendinous structures; most frequently the medial head of the gastrocnemius muscle. This may be congenital or acquired through muscular hypertrophy. PAES can be further classified by anatomical type (I–VI, table 1). It may exist alone or in combination with popliteal vein and/or tibial nerve compression as part of popliteal entrapment syndrome. View this table: Table 1 Popliteal entrapment syndrome classification (Popliteal Vascular Entrapment Forum)6 PAES is a frequent cause of intermittent claudication in an otherwise healthy, often athletic cohort, with potentially severe adverse sequelae and can represent a diagnostic challenge. A 38-year-old female competitive ‘ironman triathlete’ athlete with no medical history presented with exertional left calf pain. On examination, the patient had a full complement of lower-limb pulses. A lower-limb arterial duplex scan detected bilateral popliteal artery occlusion on forced plantar flexion. As there were unilateral symptoms, a CT angiogram was performed which detected no abnormality. A bilateral lower-limb angiogram initially demonstrated normal arterial anatomy. However, on forced plantar flexion, complete occlusion of both popliteal arteries was evident (figure 1). Figure 1 Lower-limb arterial angiogram at rest (left) and during forced plantar flexion demonstrating bilateral popliteal artery occlusion (right). The patient was diagnosed with bilateral PAES and underwent staged popliteal artery releases. At 1 year …