Computed Tomographic Angiography and Digital Subtraction Angiography Findings in Popliteal Artery Entrapment Syndrome

Abstract

Computed tomographic angiography can demonstrate both the vascular changes and the anatomic variations in the popliteal fossa and may be valuable in the diagnosis of PAES.

Popliteal entrapment syndrome

“…The duration of symptoms before diagnosis was reported in 10 of 30 PAES studies and was a median of 12 months (range, 4 hours-120 months). 24,29,30,33,35,37,39,44,48,50 No relationship between duration of symptoms and presence of irreversible arterial damage (occlusion, poststenotic dilatation, or aneurysm formation) was found in the three studies that reported sufficient patient-level detail to carry out this analysis (P ϭ .55, P ϭ .17, and P ϭ .64, two-sided Mann-Whitney U test). 24,30,48 Surgical treatments.…”

“…[52][53][54][55] By using surgical confirmation of pathology as the reference standard and provocation catheter arteriography as the index test, 13 of 21 studies provided sufficient information to yield a mean estimate of sensitivity for provocation arteriography of 97% (median, 100%; range, 85%-100%). [22][23][24]27,30,33,36,37,39,40,[42][43][44] Similar estimates for other diagnostic modalities are given in Table II. One prospective study and five of seven retrospective case series on PAES recommended the use of cross-sectional magnetic resonance (MR) imaging (MRI)/MR angiography (MRA) or computed tomography (CT)/CT angiography in diagnosis because it allowed visualization of the common vas- cular (arterial stenosis, occlusion, aneurysmal change, and deviated course) and extravascular (abnormal muscle attachments and muscular hypertrophy) anatomic abnormalities implicated in arterial entrapment.…”

“…Eleven studies described a median proportion of 11% of limbs (range, 5%-67%) presenting with acute ischemia. 24,26,27,30,33,36,37,41,42,45,49 A median proportion of 38.25% of patients (range, 0%-100%) diagnosed with bilateral PAES was described in 26 studies. In 12 of 30 studies, a median proprtion of 17.5% of limbs (range, 6%-31%) diagnosed with PAES were asymptomatic, whereas this proportion was unclear in seven studies.…”

“…Of the 12 studies on PAES containing asymptomatic limbs, surgery was performed for all asymptomatic limbs in eight studies. 27,29,30,40,42,44,45,49 In one series, no surgery was performed in the single described asymptomatic limb. 24 In three studies, it was not possible to determine the proportion of asymptomatic limbs that underwent surgery.…”

Delayed Presentations of Popliteal Artery Entrapment Syndrome in a Middle-Aged Military Population

“…Multiplanar reconstruction, maximum intensity projection, and volume rendering are valuable tools for the surgeon's preoperative planning. 15 At Walter Reed, the CT scanner is a GE Healthcare Lightspeed device (General Electric, Milwaukee, WI). Using a Stellant dual-head injector (Medrad, Warrendale, PA), we inject 90-140 mL of intravenous contrast into the antecubital fossa, followed by 50 mL of normal saline.…”