Clinical Outcomes Of A Diagnostic And Management Protocol For Popliteal Artery Entrapment Syndrome At A Large Referral Center

Abstract

<h3>OBJECTIVE</h3> Popliteal Artery Entrapment Syndrome (PAES) is a rare clinical entity without a standardized algorithm for diagnosis. Our objective was to evaluate clinical outcomes using a unique diagnosis and management algorithm for PAES. <h3>METHODS</h3> We retrospectively reviewed patients diagnosed with PAES at a single institution between 2013 and 2021. Demographics, physical exam findings, non-invasive imaging results, and angiographic images were assessed to validate a diagnostic and management algorithm (Figure 1). <h3>RESULTS</h3> Thirty extremities in 20 patients were treated for PAES (Table 1). Physical exam revealed a pulse decrement with provocative maneuvers in 90% of treated limbs. Noninvasive studies to include treadmill exercise testing revealed a mean ABI drop of 0.27 and positional duplex demonstrated peak systolic velocity increase by a mean ratio of 1.72 with provocative maneuvers. DiagnosticImage, figure 1 arteriography was performed in all patients and revealed well-developed collaterals in 100% of treated limbs and complete effacement of the popliteal artery with active provocative maneuvers. Surgical exposure occurred via a posterior approach using a longitudinal incision and intraoperative duplex was performed in all cases. Staged bilateral PAES release occurred in 10 patients and type III PAES was diagnosed in 90%. Wound complications occurred in 4 limbs and included seroma and hypertrophic scarring. All patients experienced symptomatic relief with median follow-up of 4 months. <h3>CONCLUSIONS</h3> We report 100% technical and clinical success in patients with PAES diagnosed and managed using our clinical algorithm. Dynamic angiography to confirm the diagnosis and intraoperative duplex to confirm complete surgical release are essential for successful clinical outcome.Image, table 1Image, table 1