Popliteal Artery Entrapment Syndrome Research Articles

Case Report: Popliteal artery entrapment syndrome as a cause of deep vein thrombosis and subsequent popliteal artery occlusion

Case Report: Popliteal artery entrapment syndrome as a cause of deep vein thrombosis and subsequent popliteal artery occlusion

Popliteal Artery Entrapment Syndrome (PAES)—a Missed Diagnosis

Popliteal Artery Entrapment Syndrome (PAES)—a Missed Diagnosis

Surgical management of popliteal artery entrapment syndrome

IntroductionPopliteal artery entrapment syndrome (PAES) is a rare condition in which the popliteal artery becomes compressed by adjacent soft tissue structures causing progressive claudication. Due to its low incidence, this disorder and its surgical management is poorly described in the literature. This study presents our institutional data surrounding PAES management to further optimize care of this syndrome. MethodsThis retrospective study gathered demographic, surgical, and outcome data of all patients with PAES who underwent surgical decompression at our institution from 2015 to 2022. Patients were identified using CPT and ICD-9/10 codes. Summary statistics were calculated, with Chi-squared and T-test used for subgroup analysis. Results50 surgical patients with PAES were identified. On average, they were young (mean age: 20.7 years), mostly female (78 %), and predominately white (68 %). The vast majority were physically active, with 13 of the 50 patients being runners (26 %). Medically, the cohort was otherwise healthy, with 74 % reporting no comorbidities. Diagnosis was often delayed, with patients on average seeing 4.5 physicians over 2.0 years prior to arriving at our institution for care. In addition to popliteal artery release, the second most performed procedure was fasciotomy (82 %). Postoperatively, there was significant long-term subjective improvement, with 91 % of patients reporting they would repeat the operation and 65 % reporting improved activity. ConclusionPAES is a rare condition affecting the lower limb that requires a nuanced surgical approach. From diagnosis to outcome, we hope to better inform surgeons of PAES so that these patients may receive the highest quality care.

Poplitea Artery Entrapment Syndrome

Popliteal artery entrapment syndrome (PAES) is a rare pathological compression of the popliteal artery, mostly unilateral. Its diagnosis is a challenge due to low recurrence and confusion with other injuries that affect the lower limb. Delay in its repair can cause arterial stenosis, emboli, aneurysm, inability to perform physical activities, thromboembolism and acute limb ischemia. Young men without comorbidities who may exercise regularly with intermittent claudication that affects their daily activities should draw attention to research and treatment of the syndrome. Investigation is extremely important to rule out differential diagnoses, such as chronic compartment syndrome, neurogenic claudication, peripheral atherosclerosis and cystic disease of the popliteal artery.

Surgical Treatment for Popliteal Artery Entrapment Syndrome in Japan: A Retrospective, Multicentre Study Using a National Clinical Registry

Surgical Treatment for Popliteal Artery Entrapment Syndrome in Japan: A Retrospective, Multicentre Study Using a National Clinical Registry

Long-term evaluation of surgery for functional popliteal artery entrapment syndrome

Long-term evaluation of surgery for functional popliteal artery entrapment syndrome

Dynamic Imaging is the Ideal Modality for the Diagnosis of Popliteal Artery Entrapment Syndrome

Popliteal Artery Entrapment Syndrome (PAES) is a rare vascular condition with significant equipoise on how to properly diagnose and evaluate relevant imaging. This can lead to misdiagnosis and delay in surgical management. The objective of this study is to describe and compare distinct imaging features of dynamic versus static images to help determine the ideal imaging modality for diagnosis of PAES. This is a retrospective review of patients referred for PAES at a single institution. We reviewed non-invasive imaging studies, diagnostic arteriograms, and cross-sectional images which include computed tomography angiography (CTA) or magnetic resonance angiography (MRA). For each affected and unaffected extremity, the characteristic collaterals for PAES were named and measured on arteriogram using Picture Archiving and Communication Software (PACS). Available cross-sectional images were also analyzed and compared with arteriogram and intraoperative findings during surgical exploration. There were 23 patients referred for PAES who underwent diagnostic evaluation and surgical management between 2013 and 2022. All patients had a duplex ultrasound that revealed a mean popliteal peak-systolic velocity (PSV) of 78 cm/sec at rest. With forced plantar flexion, the PSV increased to a mean 175 cm/sec. A total of 12 extremities had complete loss of flow with provocation during duplex ultrasound. All patients underwent diagnostic angiography of 46 extremities. All limbs with PAES (n=35) exhibited complete popliteal artery occlusion during angiography with forced plantar flexion. Distinct angiographic findings on resting images included a well-developed medial sural artery in 100% of limbs with PAES with a mean diameter of 2.7 mm. In limbs without PAES, only 80% had a visualized medial sural artery on arteriogram with a mean diameter of 2.0 mm (p=0.1). A lateral sural artery was seen in 85% of affected extremities (mean diameter of 1.8 mm) while an anterior tibial recurrent artery was seen in 59% of affected extremities (mean diameter of 1.3 mm). In unaffected limbs, there were no visible lateral sural or anterior tibial recurrent arteries. The mean contrast used with diagnostic arteriograms was 58 milliliters (range 10-100 milliliters). Axial imaging was available for 9 affected extremities. Five had a previous MRA with only 1 being truly positive for arterial compression. Four extremities had previous CTA with 3 being falsely negative despite having type 3 PAES discovered during surgical exploration. Dynamic imaging with angiography provides immediate surgeon feedback by visualizing popliteal artery compression and enlarged sural collaterals during resting arteriography. The medial sural collateral is enlarged in patients with PAES and often the lateral sural and anterior tibial recurrent arteries can be visualized as well. CTA and MRA are associated with high false-negative rates and therefore cause delays in diagnosis and surgical management of PAES. Dynamic imaging should therefore be the gold standard for the diagnosis of PAES.

Long-Term Functional Outcomes After Surgery of Functional Popliteal Artery Entrapment Syndrome

Functional popliteal artery entrapment syndrome (fPAES) is a subtype of PAES without anatomic abnormalities entrapment of the popliteal artery. One of the management of symptomatic fPAES is surgical exploration of the popliteal region with popliteal artery release with lysis of fibrous bands. There is a lack of data regarding the long term functional results of this surgery, most of the studies focusing on vascular patency in anatomical PAES. The aim of this study was to assess the efficacy of surgery in functional PAES, focusing on long term physical activity return after surgery with the Tegner activity scale. All patients that underwent surgery for fPAES from January 1st 2010 to December 31th 2020 were searched. After ethical approved, all patients were called to evaluate physical activity since surgery. The Tegner activity scale is a numerical scale with each value (0 to 10) representing specific activity. The aim was to evaluate everyday activity limitations and participation restriction after surgery. The results for each patient were recorded: « before symptoms », « before surgery » and « after surgery ». Over the study period, 33 patients were included with 61 symptomatic legs. The mean time between surgery and phone call was 38.6± 21.9 months. The median score of the Tegner activity scale "before symptoms" was 7 (4-7), the median score "before surgery" was 3 (2-3) and the median score at the time of the phone call, "after surgery" was 5 (3-7). P-value was <0.0001 by comparing results "before surgery" and "after surgery". Results demonstrated that the sport activity and intensity level is significantly higher after surgery even if patients did not reach their initial sport activity level.

Surgical Treatment for Popliteal Artery Entrapment Syndrome in Japan: a Retrospective, Multicentre Study Using a National Clinical Registry

Surgical treatment is an established method for popliteal artery entrapment syndrome (PAES), which, however, mainly derives from single centre experiences where PAES cases are centralised and treated periodically. This study evaluated clinical outcomes of surgical treatment for PAES in a clinical setting where PAES cases were not centralised. Multicentre, retrospective cohort study using a national clinical registry. From a Japanese nationwide clinical registry, data for patients who underwent surgical treatment for PAES between 2013 and 2018, including 58 limbs from 41 institutes, were retrieved and evaluated. Patency was analysed using Kaplan-Meier curves. The mean patient age was 36 ± 19 years, 78% were male, and the incidence of PAES was 0.24 limbs/centre/year, reflecting a clinical setting where PAES cases are not centralised. The most frequent arterial symptom was intermittent claudication (90%). Computed tomography was performed in 57 limbs (98%) for the diagnosis, however active manoeuvres such as dorsiflexion and plantarflexion during the examination was performed in only 13 limbs (22%), and occlusion of the popliteal artery was present in 38 limbs (66%) at diagnosis. Regarding surgical treatment, myotomy alone was performed in only seven limbs (12%), and other limbs were revascularised. Mean follow up was 26 ± 20 months, and surgical treatment was effective as it relieved symptoms in > 96% of limbs, with five year primary and secondary patency of the surgical treatment for PAES of 72% and 93%, respectively. Results of surgical treatment were acceptable even in a clinical setting where PAES cases were not centralised. However, a low incidence of active manoeuvres performed during the examination and a high incidence of occlusion at diagnosis suggests there may be delayed or underdiagnosis of PAES in Japan, and increased awareness for PAES is warranted.

Intravascular ultrasound imaging for diagnosis and characterization of the popliteal compression syndrome.

Functional popliteal artery entrapment syndrome (fPAES) is a rare form of nonatherosclerotic claudication most often seen in young athletic patients. Diagnosis remains challenging, with various imaging modalities showing equivocal or subtle findings that may be missed. We sought to critically examine and quantitate the utility of intravascular ultrasound (IVUS) imaging, a common diagnostic tool for vascular compression syndromes, in diagnosis and characterization of fPAES. Patients presenting to a single tertiary care center between 2019 and 2022 with symptoms of PAES but without an anatomic etiology or equivocal workup were selected. Angiogram and IVUS with maneuvers were performed on affected extremities at rest, active plantarflexion/dorsiflexion, and plantarflexion/dorsiflexion against resistance. IVUS examination was recorded using a pull-back technique from the tibial vessels to the superficial femoral artery. The degree, length, and anatomic location of compression using the two imaging modalities were compared. Angiogram and IVUS with maneuvers were performed on 17 lower extremities (9 left, 8 right) in 15 patients (88% female; mean age, 21.2years). Evidence of arterial compression on angiography was noted in 88.2% (n= 15) of limbs (66.7% complete contrast cessation and 20% popliteal artery tapering); 13.3% (n= 2) only demonstrated sluggish flow as possible evidence of compression. Arterial compression was seen on IVUS imaging in 15 of 17 limbs, and all completely compressed around the IVUS catheter. The IVUS-measured mean length of compression was 10.5cm± 4.2 (median, 11cm; range, 4-23cm). Compression involved only the popliteal vessels in 86.7% (n= 13); one patient had both popliteal and tibioperoneal trunk compression, whereas another had tibioperoneal trunk and peroneal artery compression. Popliteal vein compression was 100%. The contrast cessation point on angiography and the proximal point of compression on IVUS imaging differed in 80% of cases (P< .05). The distal extent of compression was unable to be determined by angiogram findings but was clearly delineated by IVUS imaging in all cases. IVUS imaging is a more sensitive diagnostic and descriptive imaging modality compared with angiogram in patients with possible fPAES. IVUS and angiogram findings are greatly discordant; moreover, IVUS imaging can provide detailed information such as the precise extent and anatomic location of the arterial compression, which may be useful in aiding surgical planning. IVUS imaging should be considered the gold standard for diagnosing and characterizing fPAES before intervention planning.

Optimizing the diagnostic approach of functional popliteal artery entrapment syndrome: Presented at the Forty-fifth Midwestern Vascular Surgical Society annual meeting, Chicago, Illinois, September 9-11, 2021. Presented at the Wisconsin Surgical Society annual meeting, Kohler, Wisconsin, November 6-9, 2021.

Optimizing the diagnostic approach of functional popliteal artery entrapment syndrome: Presented at the Forty-fifth Midwestern Vascular Surgical Society annual meeting, Chicago, Illinois, September 9-11, 2021. Presented at the Wisconsin Surgical Society annual meeting, Kohler, Wisconsin, November 6-9, 2021.

The treatment of bilateral popliteal artery entrapment syndrome with nonuniform symptoms: A case report and literature review.

Popliteal artery entrapment syndrome (PAES) is a rare vascular disease, and cases of bilateral PAES associated with distinct symptoms in each of the affected legs are very rare. In an effort to improve current understanding regarding the presentation and treatment of this condition, a case of bilateral PAES is herein described with a corresponding review of the associated literature. The overall process of diagnosing and treating one patient affected by bilateral PAES was retrospectively assessed to provide comprehensive insight regarding this disease. This patient was diagnosed via contrast-enhanced computed tomography (CT), and right-sided symptomatic PAES was successfully treated via autogenous saphenous venous graft arterial bypass surgery. In contrast, the asymptomatic left-sided PAES in this patient was subject to close follow-up monitoring. Over a 2-year postoperative follow-up period, this patient did not experience any symptoms or complications. As such, autogenous saphenous venous graft arterial bypass surgery represents a safe and efficacious means of treating PAES, whereas surgery may not be required for cases of asymptomatic PAES even in patients with a bilateral presentation.

Dynamic Imaging Is The Ideal Modality For The Diagnosis Of Popliteal Artery Entrapment Syndrome

Dynamic Imaging Is The Ideal Modality For The Diagnosis Of Popliteal Artery Entrapment Syndrome

Toxine Botulique de type A et médecine du sport: ­revue de littérature et applications pratiques

In sports medicine, Botulinum Toxin type A (BoNT-A) can sometimes be used as an alternative for some of the most common pathologies of the musculoskeletal system. The objective of this narrative review is to identify the main current indications for BoNT-A in common sports pathologies, the technical conditions for its use, the doses used, and the main beneficial or adverse effects expected, in order to allow a practical approach for the clinician. The injections are performed by a Physical and Rehabilitation Medicine or Sports Medicine specialist, and requires an operator trained in EMG and/or ultrasound muscle detection. The main indications are epicondylalgia, plantar fasciitis, chronic exertional compartment syndrome (CECS), the functional popliteal artery entrapment syndrome (FPAES) and patellofemoral syndrome. The main effect sought being muscle-relaxant, undesirable transient paresis may occur, requiring some precautions regarding the dose used and a search for the optimal period in the sports calendar in order to minimize this risk. Despite the multiplication of recent studies on the subject, the current level of evidence remains low and limits the use of BoNT-A to cases of failure or contraindication to first- or second-line treatments, and is performed without any guarantee of financial coverage.

Concurrent Diagnosis of Functional Popliteal Artery Entrapment Syndrome and Chronic Exertional Compartment Syndrome in Athletes.

Concurrent Diagnosis of Functional Popliteal Artery Entrapment Syndrome and Chronic Exertional Compartment Syndrome in Athletes.

Bilateral Popliteal Artery Entrapment Syndrome in a 4-Year-Old Child with Cerebral Palsy

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The reliability of duplex ultrasound in diagnosing popliteal artery entrapment syndrome: An observational pilot study

Background and objectivePopliteal artery entrapment syndrome (PAES) is a vascular compression affecting young people. PAES can cause claudication and lead to distal blood flow reduction. Ultrasound could provide a direct and indirect diagnosis approach using different provocative maneuvers. However, the reliability and accuracy of Duplex ultrasound alone to diagnose PAES are uncertain. This study hypothesizes that Duplex ultrasound could lead to false-positive results. Therefore, the study aims to assess the popliteal artery diameter and velocity profile in asymptomatic young people at different provocative maneuvers. MethodsA prospective study of twenty-three limbs of asymptomatic young individuals aged between 21 and 24 was conducted. All individuals were offered a Duplex ultrasound scan of the popliteal and distal runoff arteries at the vascular ultrasound laboratory. Peak systolic velocity (PSV), spectral waveform, the diameter of the popliteal artery, and distal runoff flow velocities were measured at three positions (neutral, active plantarflexion, and erect on top of toes above and below the knee level. These diagnostic parameters were recorded and analyzed. ResultsThe data was collected over two months; the examined individuals were men with an average age of 23 years and a body mass index of 23.16 kg/m. Popliteal artery diameter above the knee at the neutral position was 5.57 mm, active plantarflexion 5.48 mm, and erect on the top of toes 5.69 mm, (p = 0.624). PSV means above-knee at neutral, active plantarflexion, and erect on the top of toes positions were 50.80, 56.17, and 61.61, respectively, with a p-value of 0.225. There was a significant difference in the diameter and velocity of the popliteal artery below the knee at active plantarflexion and erect on top of toes positions; the mean diameter at neutral was 4.61, at active plantarflexion 4.57, and at erect on top of toes 3.47 (p = 0.018). Furthermore, there was a significant difference in the PSV between measurements, mean at neutral, active plantarflexion, and erect on top of toes, (56.67, 69.43, 93.04) respectively, with a p-value of 0.006. ConclusionDuplex ultrasound diagnosis is a valuable imaging technique and can provide important information about the diameter and velocity profile of the popliteal artery at different provocative maneuvers. However, our findings suggest that Duplex ultrasound alone would lead to false-positive results and cannot be elusive in determining the asymptomatic from symptomatic patients with PAES.

Optimizing the diagnostic approach of functional popliteal artery entrapment syndrome

ObjectiveFunctional popliteal artery entrapment syndrome (fPAES) is an underdiagnosed and undertreated etiology of atypical claudication. Symptoms of fPAES include deep posterior muscle cramping and pain with exercise and, unlike anatomic PAES, there are seldom vascular complications. Common noninvasive diagnostic modalities include ankle-brachial index, arterial duplex Doppler ultrasound (DUS) examination, and cross-sectional imaging such as magnetic resonance angiography (MRA). Entrapment can be difficult to reproduce during diagnostic testing, requiring provocative maneuvers. Because we believed different provocative maneuvers provide different diagnostic efficacy, we sought to optimize our diagnostic approach to fPAES. MethodsWe performed a retrospective review of patients before and after optimizing our noninvasive imaging protocol comparing patients with fPAES versus other atypical claudicants with chronic compartment syndrome. ResultsArterial DUS examination and exercise ankle-brachial index were important components of our protocol with a significant decrease in systolic posterior tibial blood pressure of –14 mm Hg after exercise, whereas nonentrapment release patients had an overall increase of 8 mm Hg (P = .006). Arterial DUS examination of the distal PA with forced plantarflexion demonstrated a trend toward an increase in the measured velocity ratio, especially in the middle and distal PA. MRA with stressed plantar flexion findings were positive in 6 of 11 patients with fPAES, with false negatives likely owing to patients’ inability to maintain a provocative position for the duration of the MRA. ConclusionsDiagnosing fPAES is challenging owing to a lack of standardized diagnostic testing and provocative maneuvers. Different maneuvers demonstrated varying diagnostic yields for fPAES. Exercise ABIs were the most reliable vascular laboratory test to detect changes attributable to fPAES and to distinguish it from chronic compartment syndrome. Segmental PA DUS examination seems to be promising as a means of detecting PA impingement. Stress positional MRA effectively demonstrates anatomic PAES, but has a false-negative rate for fPAES.

Popliteal Entrapment Syndrome: Diagnostic, Surgical Management, and Short-Term Results of a Ten-Year Experience

Popliteal artery entrapment syndrome (PAES) is a rare cause of lower limb claudication in young sportsperson without cardiovascular risk factor. We reported our diagnostic approach, surgical management, and short-term outcomes of this syndrome, over a 10-year period. Sportsperson with intermittent claudication systematically received color duplex ultrasonography with dynamic maneuvers in the sport medicine department. In case of PAES suspicion, diagnosis was confirmed by dynamic computed tomography or dynamic magnetic resonance angiography. Each patient was then evaluated by a vascular surgeon and surgery was performed. We retrospectively screened patients who underwent PAES surgery between 2010 and 2020 in the Department of Surgery in Angers University Hospital. Between January 2010 and December 2020, 38 patients with 67 symptomatic legs underwent surgery for PAES. Twenty three (60.5%) were men. The mean age at the time of surgery was 24.7 +/- 9years. Clinical presentation was bilateral in 30 patients (81.1%). Duplex ultrasound demonstrated severe stenosis or occlusion in 45 legs (77%). When performed, CT-scan demonstrated popliteal artery compression in all cases (100%). As per Whelan and Rich classification, 36 patients (94.7%) had type 6 PAES. There was no mortality or severe complication after surgery. Morbidity included 4 postoperative hematoma (6%) and 8 prolonged healing (13%). The mean time of follow-up was 2.3months +/- 1.2months. After surgery, D-scan showed no signs of remaining popliteal artery compression in 92.5% of the case. Twelve patients (33.3%) were able to resume sport, 18 (50%) partially, and 6 (16.6%) did not resume sport yet. We report a cohort of 38 patients who underwent surgery for PAES. Among them, 36 (94.7%) were functional PAES. Morbidity included 13% of prolonged healing. Two months follow-up demonstrated good results at dynamic D-scan without signs of remaining popliteal artery compression in 92.5% of the cases. These short-term results showed that one-third of patients were able to resume sport activity at an initial level.

Popliteal Artery Entrapment Syndrome: About A Series of Four Cases

Popliteal Artery Entrapment Syndrome: About A Series of Four Cases