Popliteal Artery Entrapment Syndrome

Popliteal artery entrapment syndrome (PAES) is a rare vascular condition that occurs when the popliteal artery, which supplies blood to the knee, leg, and foot, is compressed or entrapped by surrounding muscles, tendons, or other structures in the popliteal fossa.

Causes and Risk Factors

The exact cause of PAES is not fully understood, but it is thought to be related to anatomic variations, such as:

• An abnormal course of the popliteal artery
• Hypertrophy or anomalous insertion of the gastrocnemius or plantaris muscles
• Prolonged or repetitive activities that cause muscle hypertrophy or inflammation in the popliteal fossa

Symptoms

Patients with PAES may experience a range of symptoms, including:

• Intermittent claudication (pain in the calf or leg when walking or exercising)
• Numbness or tingling in the foot or toes
• Coldness or discoloration of the affected limb
• Weakened or absent pedal pulses

Diagnosis

Diagnosing PAES can be challenging, as symptoms may be similar to those of other conditions. Diagnostic tests that may be used include:

• Duplex ultrasound
• Computed tomography angiography (CTA)
• Magnetic resonance angiography (MRA)
• Arteriography

Treatment

Treatment for PAES typically involves a combination of surgical and non-surgical approaches, including:

• Surgical release of the entrapped popliteal artery
• Muscle resection or transfer to relieve compression
• Angioplasty or stenting to improve blood flow
• Physical therapy and exercise programs to improve circulation and reduce symptoms

Complications

If left untreated, PAES can lead to serious complications, including:

• Chronic limb ischemia
• Gangrene or tissue loss
• Amyotrophic lateral sclerosis (in rare cases)

Prognosis

The prognosis for patients with PAES is generally good, especially if treated promptly and effectively. However, some patients may experience persistent symptoms or require ongoing management to prevent complications.