Popliteal artery entrapment syndrome radiology reference. Popliteal artery definition of popliteal artery by. Popliteal artery entrapment syndrome paes is defined as an abnormal relationship between the popliteal vessels and the neighbouring musculotendinous structures, which results in deviation and compression of the popliteal artery. Ct angiography and mri in patients with popliteal artery. It is characterized by various anomalous anatomic relationships between the muscle and arteries in the popliteal fossa, resulting in extrinsic arterial compression. Popliteal artery entrapment syndrome refers to symptomatic compression or occlusion of the popliteal artery due to a developmentally abnormal positioning of the popliteal artery in relation to its surrounding structures such as with the medial head of gastrocnemius or less commonly with popliteus or fibrous bands. Ta continuation of femoral artery in the popliteal space, bifurcating at the lower border of the popliteus muscle as it passes deep to the arcus tendineus of the soleus muscle into the anterior and posterior tibial arteries. We report a rare case of a patient with bilateral popliteal artery entrapment who presented with the same symptom 11 years after his first experience of popliteal artery entrapment syndrome. The diagnosis is made by noninvasive testing using mri, mra or ct scan with contrast. Popliteal entrapment syndrome journal of vascular surgery. Popliteal artery entrapment syndrome university of. The term popliteal entrapment syndrome was initially coined by love and whelan 1 x 1 love, jw and whelan, tj. Popliteal artery entrapment syndrome paes is an uncommon cause of lower limb claudication, 1 most commonly affecting young athletes.
Popliteal artery entrapment syndrome paes is an uncommon congenital anomaly affecting young adults who present with symptoms of calf claudication. Evaluation of popliteal arteries with ct angiography in. Surgical treatment for popliteal artery entrapment syndrome. This syndrome is a developmental abnormality that results from an abnormal relationship between the popliteal artery and the surrounding musculotendinous structures that cause repeated arterial. To evaluate the longterm outcomes of surgical treatment for popliteal artery entrapment syndrome paes. Modern diagnostic methods such as duplex scans and magnetic resonance imaging are necessary for abnormalities to be detected. Imaging of popliteal vascular entrapment may be performed with ultrasound, magnetic resonance imaging mri. These conditions, which may be common throughout the arterial system or exclusive to the popliteal artery, include atherosclerosis, popliteal artery aneurysm, arterial embolus, trauma, popliteal artery entrapment syndrome, and cystic adventitial disease. The diagnosis in each case was made preoperatively. Popliteal artery entrapment syndrome paes is a rare condition where the popliteal artery is compressed in the popliteal fossa during plantar flexion. If youve had the condition for a long time, you may need artery bypass surgery. Popliteal artery entrapment syndrome paes is a condition caused when the popliteal artery becomes compressed by the medial head of the gastrocnemius proximally and fascial band of the soleus distally during activity, leading to painful claudication type symptoms and oftentimes paresthesias. Compression of the artery restricts blood flow to the lower leg and can. N2 imaging description popliteal artery entrapment is a developmental abnormality that results in compression of the popliteal artery due to abnormal relationships between the vessel and adjacent soft tissues within the popliteal fossa.
Popliteal artery aneurysm highyield usmle step 1 pathology duration. Popliteal artery entrapment syndrome cured youtube. Once diagnosed, paes should be treated early to prevent disease progression and permanent arterial damage. Popliteal artery entrapment syndrome paes occurs when muscles that surround the popliteal artery in the area of the popliteal fossa, occlude the artery and sometimes the vein as well, and decrease blood flow to the lower leg.
If there is a suspicion of this disease, diagnostic evaluation needs to be conducted. Popliteal artery entrapment syndrome anatomy, imaging. It wasnt until the 1960s that the term popliteal artery entrapment syndrome, or paes, was first used, 24. Apr 15, 2020 the popliteal artery entrapment syndrome can be classified based on what caused the popliteal artery to become compressed. A two colour doppler ultrasound images with a linear 12 mhz probe in the transverse position at the level of the knee crease with the patient prone. The popliteal artery may be compressed behind the knee, due to congenital deformity of the muscles or tendon insertions of the popliteal fossa.
History often includes exertional lower leg pain, cramping, andor paresthesias rather quickly relieved by rest, though examination may be benign. Popliteal artery entrapment means popliteal artery compression caused by an abnormal anatomical relationship between the vessel and nearby musculotendinous structures or surrounding. To report on a case of popliteal artery entrapment that was treated surgically. Two cases of misdiagnosed popliteal artery entrapment syndrome. It is caused by an anomalous relationship of the gastrocnemius muscle and artery in the popliteal fossa resulting in extrinsic arterial comression. What is popliteal entrapment syndromecausessymptoms. The image on the left demonstrates normal popliteal arterial and venous colour flow in the rest position. Continued entrapment leads to progressive fibrosis of the popliteal artery. Popliteal artery entrapment syndrome paes refers to symptomatic compression or occlusion of the popliteal artery due to a developmentally abnormal positioning of the popliteal artery in relation to its surrounding structures such as with the medial head of gastrocnemius mhg or less commonly with popliteus or fibrous bands. Clinical examination and laboratory data were not helpful for diagnosis. Two of these 30 patients were referred from other institutions where posterior knee explorations had been performed without finding an identifiable cause for popliteal entrapment. Popliteal artery entrapment syndrome paes is a rare vascular disease that affects the legs of some young athletes. Boniak intravascular ultrasound as a novel tool for the diagnosis and targeted treatment of functional popliteal artery entrapment. Popliteal artery entrapment syndrome paes is an uncommon cause of lower limb claudication,1 most commonly affecting young athletes.
Investigating functional paes is also fraught with potential. The popliteal artery is a relatively short vascular segment, but it is affected by a unique pathological condition which is popliteal artery entrapment syndrome. It shares many features with other causes of exertional leg pain, and more than one condition can be present at once, confusing the clinical picture. The occlusion is unilateral however the anatomic anomaly is. The diagnosis is made by noninvasive testing using mri. We present an 18 yearold female avid soccer player, who complained of severe pain in both calves for over a year. Paes is currently diagnosed with a combination of clinical presentation, clinical findings and imaging studies including. Jul 14, 2014 based on these clinical and radiological findings, the source of claudication was thought to be popliteal artery stenosis and with the aid of mri imagining, abnormal tendinous insertion which originates from gastrocnemius medial head was found fig. Symptoms are similar to intermittent claudication but the patient cohort is markedly different, with young athletes being primarily affected. There are also other diagnoses that can mimic popliteal artery entrapment, like chronic compartment syndrome of the lower extremity, knee joint pain, or other problems with the muscles in this area. Though a relatively rare syndrome, it is likely underdiagnosed.
Popliteal artery entrapment syndrome is recognized as a cause of lower leg claudication in patients younger than 50 years of age. The anomalous anatomic relationship for compression of the. Introduction functional popliteal artery entrapment syndrome paes is an important and possibly underrecognized cause of exertional leg pain. Popliteal vascular entrapment syndrome is caused by aberrations or hypertrophy of the gastrocnemius muscles, which compress the neurovascular structures of the popliteal fossa, leading to symptoms of vascular and degeneration as well as aneurysm formation. Findings are consistent with thrombotic occlusion of the left popliteal artery due to popliteal artery entrapment syndrome. The popliteal artery is a relatively short vascular segment but is affected by a unique set of pathologic conditions. Popliteal artery entrapment syndrome radiology case. The patient was a 46yearold hypertensive male diver who had been experiencing pain in his right leg for around six months. Until she came to the university of maryland medical center and was diagnosed with popliteal artery entrapment syndrome. Popliteal artery entrapment syndrome paes is a rare anatomical abnormality that causes intermittent claudication in young active men without cardiovascular risk factors.
Due to an abnormal course of the popliteal artery and the calf muscle group, the artery can be compressed and reduce blood flow. During the same year interval, 30 patients have undergone surgical treatment for functional popliteal entrapment syndrome 10 males, 20 females. Clinical evaluation of mr imaging features of popliteal artery entrapment and cystic adventitial disease. Popliteal artery definition of popliteal artery by the. With magnetic resonance imaging mri and computed tomography ct scans of the knee joint, a more detailed anatomy of the anatomical popliteal artery entrapment syndrome caused by.
A new diagnostic approach to popliteal artery entrapment syndrome. This is the seventh reported case of popliteal artery entrapment due to an anomalous course of the popliteal artery in relation to the medial head of the gastrocnemius muscle. Popliteal artery entrapment is a rare syndrome, but it may affect physically active young adults and worsen their quality of life. Surgery is said to be the only treatment of popliteal entrapment syndrome, which requires the surgeon to release the entrapped artery thus providing relief. If treated early, a simple surgical release of the. Review article functional popliteal artery entrapment. Functional popliteal artery entrapment syndrome paes is an important and possibly underrecognized cause of exertional leg pain. Popliteal artery entrapment syndrome color atlas and. May 24, 2017 popliteal entrapment syndrome is a rare vascular disease that leads to chronic leg ischemia. Popliteal artery entrapment syndrome refers to intermittent claudication, usually in the young, produced by an anomalous course of the popliteal artery medial to the medial head of the gastrocnemius muscle.
Surgery to release the calf muscle and artery usually doesnt affect leg function. Diagnosis of popliteal venous entrapment syndrome by. The features indicative of paes are outlined, as it can share features with other causes of elp. Popliteal artery entrapment syndrome should be considered in patients younger than 50 years of age with isolated popliteal artery stenosis or occlusion. To reach the um vascular disease team, call 4103285840. Popliteal artery entrapment johns hopkins university. This syndrome is related to an abnormal embryological development with an aberrant anatomical relationship between the popliteal artery and its surrounding structures. Jan 17, 2017 popliteal artery entrapment syndrome cured duration. Investigating functional paes is also fraught with potential problems and if it is. Popliteal entrapments anatomical basis was first described by anderson stuart in 18791.
A new diagnostic approach to popliteal artery entrapment. The popliteal artery is the dominant source of blood supply to the leg below the knee. We examined patients characteristics and surgical procedures, and. The first case of popliteal artery entrapment was reported in 1879 by anderson stuart 1, a medical student in medical school of edinburgh, although it was not until 1959 that hamming performed the first popliteal artery surgical decompression in holland 2. Bypass surgery is usually done only on those who have severe narrowing of the artery stenosis due to longterm popliteal artery entrapment syndrome. Popliteal entrapment syndrome is a rare vascular disease that leads to chronic leg ischemia. Surgical treatment for popliteal artery entrapment. Popliteal artery entrapment syndrome paes is a condition caused when the popliteal artery becomes compressed by the medial head of the gastrocnemius proximally and fascial band of the soleus distally during activity, leading to painful. Types 1 and 4 are due to abnormalities in the course of the popliteal artery, while types 2 and 3 are due to an abnormal insertion of the medial head of the gastrocnemius muscle. Popliteal artery entrapment syndrome is an uncommon entity typically affecting young athletic males who present with symptoms of calf claudication.
Type 2 shows an abnormal course of the popliteal artery, with entrapment. Popliteal artery entrapment syndrome diagnosis and. Mri has advantage of showing both arterial changes and underlying abnormality found in patients with popliteal artery entrapment syndrome. Bilateral popliteal artery entrapment syndrome with. This syndrome should be suspected in young male patients who have unilateral intermittent claudication without evidence of generalized arteriosclerosis.
Popliteal artery entrapment syndrome cured duration. Paes is currently diagnosed with a combination of clinical presentation, clinical findings and imaging studies including computed tomography ctct. Know the classification, causes, symptoms, diagnosis, and treatment of popliteal entrapment syndrome. The popliteal artery entrapment syndrome can be classified based on what caused the popliteal artery to become compressed. Physical examination revealed normal pulses except in the left leg, where none could be palpated distal to the femoral pulse. The authors present a new diagnostic procedure to quickly and noninvasively diagnose the popliteal artery entrapment syndrome. Popliteal artery entrapment syndrome evaluation with.
With magnetic resonance imaging mri and computed tomography ct scans of the knee joint, a more detailed anatomy of the anatomical popliteal artery entrapment syndrome caused by an aberrant. Popliteal artery occlusive disease is a common occurrence, especially in elderly patients, smokers, and those with diabetes mellitus and other cardiovascular diseases. Functional popliteal artery entrapment syndrome paes is an important and possibly underrecognized cause of exertional leg pain elp. As it is poorly understood, it is at risk of misdiagnosis and mismanagement. Ab popliteal artery entrapment syndrome is an uncommon entity with a spectrum of findings. A predisposing anatomical anomaly is seen with the popliteal artery located medial to the medial head of gastrocnemius mhg and separate to the popliteal vein. These conditions, which may be common throughout the arterial system or exclusive to the popliteal artery, include atherosclerosis, popliteal artery aneurysm, arterial embolus, trauma, popliteal artery entrapment syndrome, and cystic. Two cases of misdiagnosed popliteal artery entrapment. Popliteal entrapment syndrome definition of popliteal. Popliteal artery entrapment or chronic exertional compartment.
A 29yearold male was seen at the hospital because of intermittent left calf claudication by a walking for 5 minutes. Rarely, this syndrome can also be caused by an anomalous fibrous band or by the popliteus muscle. Popliteal artery entrapment syndrome paes may be implicated as a cause of lower leg pain in active individuals. Love and whelan coined the term popliteal artery entrapment syndrome in 1965 3. The popliteal artery entrapment syndrome is a rather uncommon pathology, which results in claudication and chronic leg ischemia. In 1965, the term paes was coined by love and whelan2. Ct angiography and mri in patients with popliteal artery entrapment syndrome zhong hai 1, shao guangrui 1, zhao yuan 2, xu zhuodong 3, liu cheng 3, liao jingmin 4 and shen yun 4 audio available share. Each year, more than 100,000 peripheral arterial reconstructive operations and 50,000 lowerlimb amputations for lowerextremity ischemia are performed in the united states. Tailored mri and mr angiography can show the abnormal muscular or fibrous attachment and the arterial findings necessary for diagnosis and surgical planning.
Popliteal artery entrapment syndrome paes is a nonatherosclerotic cause of claudication and acute ischemia of the legs in young individuals. Anatomical popliteal artery entrapment syndrometitle. The abnormal relationship of the popliteal artery to the gastrocnemius muscle was first described by a medical student, t. Popliteal artery entrapment syndrome paes is a rare but potentially limbthreatening disease seen predominantly in young athletes. The muscle and tendons near the knee are positioned so that they compress the popliteal artery the main artery that runs through and behind the knee. Yong jae kwon, et al anatomical popliteal artery entrapment syndrome medial head of gastrocnemius muscle a b c fig. Popliteal artery entrapment syndrome jama jama network. Five examples of the popliteal entrapment syndrome have been reported in 4 patients aged between 17 and 41. A large personal experience on the surgical treatment of such a disease 29 cases in 22 patients allowed us to focus on the optimal diagnostic procedure useful to detect this problem at an early stage. Popliteal artery entrapment syndrome university of maryland. This syndrome is a developmental abnormality that results from an abnormal relationship between the popliteal artery and the surrounding musculotendinous structures that cause repeated arterial compression with exercise.
The consequence of reduced flow from calf contraction is immediate and leads to cramping and calf pain during exercise. Diagnosis of popliteal venous entrapment syndrome by magnetic. Popliteal artery entrapment syndrome paes miami vascular. Sep 19, 2009 popliteal vascular entrapment syndrome is caused by aberrations or hypertrophy of the gastrocnemius muscles, which compress the neurovascular structures of the popliteal fossa, leading to symptoms of vascular and degeneration as well as aneurysm formation. In this position, the artery is traumatized and repeatedly compressed between bone and contracting muscle. Fujiw accurate morphological diagnosis utilizing mri. Feb 29, 2016 until she came to the university of maryland medical center and was diagnosed with popliteal artery entrapment syndrome. Type 1 shows location of the medial head of gastrocnemius muscle, which is attached more laterally than is normal, with resulting popliteal artery entrapment. Popliteal artery entrapment syndrome is an uncommon congenital disorder of the artery.
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