Functional Popliteal Artery Entrapment Syndrome: Poorly Understood and Frequently Missed? A Review of Clinical Features, Appropriate Investigations, and Treatment Options

Abstract

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. The features indicative of PAES are outlined, as it can share features with other causes of ELP. Investigating functional PAES is also fraught with potential problems and if it is performed incorrectly, it can result in false negative and false positive findings. A review of the current vascular investigations is provided, highlighting some of the limitations standard tests have in determining functional PAES. Once a clinical suspicion for PAES is satisfied, it is necessary to further distinguish the subcategories of anatomical and functional entrapment and the group of asymptomatic occluders. When definitive entrapment is confirmed, it is important to identify the level of entrapment so that precise intervention can be performed. Treatment strategies for functional PAES are discussed, including the possibility of a new, less invasive intervention of guided Botulinum toxin injection at the level of entrapment as an alternative to vascular surgery.

<p>Popliteal Artery Entrapment Syndrome in a Young Baseball Pitcher: A Case Report</p>

“…This result may be related to the situation that athletes are unable to engage in training due to limb discomfort caused by PAES not being resolved. 25…”

Two otherwise healthy young brothers present with intermittent claudication, just a coincidence?

“…A table contrasting the clinical features of PAES as compared  to the musculoskeletal conditions described above can be found in figure 5 16…”

A new diagnostic approach to popliteal artery entrapment syndrome

“…PAES is currently diagnosed with a combination of clinical presentation, clinical findings and imaging studies including computed tomography (CT)/CT angiography, magnetic resonance imaging (MRI)/MR angiography (MRA) and Doppler ultrasonography (USS). 4 , 5 The diagnostic capability of traditional static imaging techniques performed is limited in this dynamic condition. Angiographic imaging with the calves contracted is often technically challenging, as many patients are unable to maintain full contraction of the calves or require multiple contractions of the calves to occlude their popliteal arteries.…”

“…The new technique will diagnose both anatomical and functional entrapment types 6 , 7 as well as define the anatomy sufficiently for treatment. 4 , 5 …”