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

Abstract

Objectives: This paper reviews the knowledge regarding the embryogenesis and anatomy of the popliteal fossa with the aim of determining which variations predispose towards exertional leg pain and Functional Popliteal Artery Entrapment Syndrome (PAES) in particular.Methods: Current literature review and synopsis of published knowledge is presented. Ethics approval was granted for this study by the Greenslopes Research and Ethics Committee.Results: Functional PAES is thought to be more common than previously recognized. Four subgroups of clinical presentation were found, depending on anatomical variation in the popliteal fossa: Anatomical PAES; Functional PAES; Asymptomatic Occluders and Asymptomatic Non-occluders. Features predisposing towards Functional PAES include a more lateralized medial head of gastrocnemius and a lower percentage of maximal force of plantarflexion required to cause occlusion of the artery. Conclusions:Functional PAES may be responsible for a large number of previously unrecognized cases of exertional leg pain, and an understanding of how it develops is important. In understanding the anatomical variations present in the popliteal fossa, one can classify which sub-group the patient belongs to, and how much this predisposes towards the development of exertional leg pain. The necessity for treatment, as well as where interventions should be targeted, can be determined by coupling these investigation findings with clinical features of claudicant leg pain.

Popliteal Artery Entrapment Syndrome: A Case Report and Review of the Literature

“…Congenital, or anatomical, PAES is caused by abnormal embryological development of the popliteal artery or of the myofascial structures in the popliteal fossa with muscular hypertrophy causing further arterial compression [ 2 – 4 ]. Acquired PAES has been reported in high-performance athletes, such as cyclists [ 5 , 6 ]. The majority of cases of PAES have been reported in men [ 5 , 10 , 11 ].…”

“…Acquired PAES has been reported in high-performance athletes, such as cyclists [ 5 , 6 ]. The majority of cases of PAES have been reported in men [ 5 , 10 , 11 ].…”

Avoiding the Trap of Misdiagnosis: Valuable Teaching Points Derived from a Case of Longstanding Popliteal Artery Entrapment Syndrome

“…Delay in diagnosis or misdiagnosis occurs commonly as patients lack vascular risk factors that would otherwise predispose them to symptoms associated with atherosclerosis and claudication [ 4 ]. Furthermore, PAES may often be subclinical in nature, and the prevalence of the condition may be deflated due to underreporting [ 5 , 6 ]. As PAES predominantly affects young men [ 7 – 9 ], reaching a diagnosis in a female patient may prove to be more challenging, as demonstrated by this case, which remained undiagnosed for more than 12 years.…”

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 …”