P128. POPLITEAL ARTERY ENTRAPMENT SYNDROME: CURRENT CONCEPTS, SURGICAL STRATEGIES, AND LESSONS LEARNED

Abstract

PURPOSE: Popliteal Artery Entrapment Syndrome (PAES) occurs in younger patients, predominantly female athletes and results in complete popliteal artery occlusion with plantarflexion. It remains an underdiagnosed cause of exercise-induced pain. Our group has been treating this condition for over a decade and we will review our experience, outcomes, complications, and strategies that we have developed to achieve satisfactory outcomes. METHODS: A retrospective chart review is conducted to identify all patients that underwent surgical management for PAES at Boston Children’s Hospital and Beth Israel Deaconess Medical Center since 2010. Patient demographics, patient reported outcome measures, diagnostic workup and intraoperative details, complications and final outcomes are analyzed. RESULTS: A total of 40 consecutive patients underwent surgical decompression for PAES. A vast majority of patients presented with delayed diagnosis and had undergone prior surgery for presumed Exertional Compartment Syndrome. Dynamic ultrasound has been found to be the most reliable diagnostic modality. Intraoperative ultrasound and nerve stimulation have allowed us to delineate key maneuvers that are critical to successful decompression. The most common complication is superficial wound separation. Tibial nerve compression at the soleal sling remains an important differential diagnosis in this patient population. CONCLUSION: The diagnosis of PAES remains challenging due to its rarity and our lack of understanding of its pathophysiology. The management of these patients requires a collaborative multidisciplinary approach. Surgical management includes a thorough dissection of the popliteal fossa with excision of the deep head of the gastrocnemius muscle and plantaris, if present.