Popliteal artery entrapment syndrome
 Discussion of Popliteal artery entrapment syndrome
- Popliteal artery entrapment syndrome (PAES) is a developmental abnormality that results from an abnormal relationship of the popliteal artery to the gastrocnemius muscle or, rarely, an anomalous fibrous band or the popliteus muscle.
- The abnormal position causes deviation and compression of the artery.
- Patients are typically young (60% <30 years old), healthy males (15:1 male predilection).
- Bilateral popliteal artery involvement has been reported in 22%–67% of presenting patients.
- Patients with PAES usually present with calf claudication and, rarely, with ischemia due to thrombosis.
- At physical examination, these patients may have normal pulses that disappear or decrease with plantar flexion or dorsiflexion of the foot.
- If left untreated, PAES almost invariably progresses to permanent narrowing of the popliteal artery due to repeated microtrauma to the vessel, with subsequent fibrosis making the vessel susceptible to thrombosis.
- Surgical release of the muscle or tendon is the ultimate treatment for PAES.
- Thrombolysis of the distal popliteal and runoff vessels can be very important prior to surgical correction.
 Imaging Findings for Popliteal artery entrapment syndrome
- Duplex US may demonstrate stenosis at color imaging and increased velocities with the flexion maneuvers.
- MR imaging can demonstrate the vessel lumen as well as the surrounding anatomy to help determine if the artery-muscle relationship is normal.
- Stress angiography (ie, angiography performed in the neutral position as well as with the foot in either dorsiflexion or plantar flexion to elicit the compression) is usually performed to confirm the diagnosis prior to surgery.
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 References for Popliteal artery entrapment syndrome
- Lonnie B. Wright, W. Jean Matchett, Carlos P. Cruz, Charles A. James, William C. Culp, John F. Eidt, and Timothy C. McCowan. Popliteal Artery Disease: Diagnosis and Treatment. RadioGraphics 2004 24: 467-479.