Bilateral Popliteal Artery Entrapment Syndrome: An Approach to Diagnosis and Salvage.

Aman Berry Williams

doi:10.1155/2020/2403280

Abstract

Popliteal artery entrapment syndrome (PAES) is a rare cause of limb-threatening vascular disease. Usually, it arises from aberrant embryological development or acquired dysfunctionality of the popliteal artery and its surrounding musculotendinous structures in the popliteal fossa. Here, we present a case report of a young woman with relatively sudden-onset short-distance claudication and paraesthesia affecting her right leg primarily. She had no recent traumatic history and no atherosclerotic risk factors and was otherwise previously very active. She had a feeble right popliteal artery pulse and no foot pulses. Nerve conduction studies demonstrated no electrophysiological abnormalities. Following computed tomography angiography and magnetic resonance imaging, it was determined she had type 2 PAES. Subsequently, the patient underwent surgical division of a lateralised head of her medial gastrocnemius, resection of her fibrosed popliteal artery, and repair with a reversed long saphenous vein interposition graft. Following surgery, her symptoms resolved, and she remains on aspirin and ultrasound surveillance.

Highlights

Popliteal artery entrapment syndrome (PAES) is a rare cause of limb-threatening vascular disease. It arises from aberrant embryological development or acquired dysfunctionality of the popliteal artery and its surrounding musculotendinous structures in the popliteal fossa
Popliteal artery entrapment syndrome (PAES) is a rare cause of potentially limb-threatening vascular disease. It arises from aberrant embryological development or acquired traumatic dysfunctionality of the popliteal artery secondary to surrounding musculotendinous structures in the popliteal fossa [2]
Though usually devoid of other cardiovascular risk factors, as a result of repetitive injury, these patients are prone to further complications such as popliteal artery stenosis, thrombosis, aneurysmal change, and distal lower limb thromboembolic shower— with potential for acute limb ischaemia [4]

Summary

Aman Berry Williams

Received 6 January 2020; Revised 12 September 2020; Accepted 14 September 2020; Published 19 September 2020. We present a case report of a young woman with relatively sudden-onset short-distance claudication and paraesthesia affecting her right leg primarily She had no recent traumatic history and no atherosclerotic risk factors and was otherwise previously very active. Nerve conduction studies were performed, which demonstrated no electrophysiological abnormalities To quantify her disease further, computed tomography angiography (CTA) was conducted confirming in-fact bilateral short-segment popliteal artery disease, with a total occlusion on the right, a high-grade stenosis on the left, and three vessel run-offs bilaterally (Figure 1). Magnetic resonance (MR) angiography was performed, demonstrating an abnormal medial deviation of bilateral popliteal arteries secondary to an unusually lateral insertion of the medial heads of the gastrocnemius at the superior aspect of the intercondylar notches (Figure 2) This demonstrated a type 2 PAES using the Whelan and Love classification [1]

Biceps femoris

Findings

Discussion