A current interpretation of popliteal vascular entrapment

Abstract

Functional popliteal artery entrapment is differentiated from anatomical entrapment by the absence of abnormal popliteal fossa anatomy. Although functional compression is a common entity in the general population, the precise etiology and natural history remains unknown. Magnetic resonance imaging clearly defines muscular variations within the popliteal fossa. In light of some of these variations, this article reviews embryological anatomy, diagnosis, classification, and treatment of the popliteal entrapment syndrome.

Surgical Treatment for Popliteal Artery Entrapment Syndrome

“…The symptoms of PAES occur due to arterial wall degeneration, which depends on the degree of compression, the magnitude of the forces exerted on the popliteal artery and the duration of compression. 13) Left untreated, the compression mechanism frequently results in the deterioration of the popliteal artery, which may progress to eventual occlusion. 14) Sinha, et al 15) reported that PAES occludes the popliteal artery in 24% of patients and changes the popliteal artery to poststenotic dilatation or aneurysmal formation in 13.5% of patients.…”

Popliteal Vessels Entrapment by a Variant Accessory Belly of Medial Head of Gastrocnemius

“…Type III anomaly is characterized by an accessory slip of the medial head of the gastrocnemius forming a sling around the popliteal artery. The frequency of prevalence is as follows: type 1, 20%; type 2, 38%; and type 3, 26% [7]. In type IV anomaly, the normally positioned popliteal artery passes deep to the popliteus.…”

Functional Popliteal Artery Entrapment Syndrome: A Review of the Anatomy and Pathophysiology

“…This "competition for space" between the primitive neurovascular bundle and various migrating muscles potentially predisposes to functional PAES. Contraction of the bulky, powerful MHGM within a confined space bordered by strong fascia and solid bone can result in forceful compression of the adjacent neurovascular bundle [1]. In these cases the anatomy in the popliteal fossa is 'normal' but variations in the position of the MHGM likely predispose to functional PAES.…”

“…Popliteal artery entrapment syndrome (PAES) is an important and often over looked differential diagnosis in the assessment of exertional leg pain. PAES is defined as a group of conditions in which compression of the popliteal artery, popliteal vein, and tibial nerve (singly or in combination) in the popliteal fossa by surrounding musculoskeletal structures occurs to a degree sufficient to cause vascular and neurogenic symptoms [1].…”

“…The Popliteal Vascular Entrapment Forum in 1998 came up with a classification system for types of PAES and this is demonstrated in Figure 1 [1,3]. Complicating this further is the fact that there are a large number of patients who are seemingly asymptomatic but who can occlude their popliteal artery by placing the leg into sustained provocative positions (typically a combination of knee extension and plantarflexion) [4,5].…”