Popliteal Entrapment Syndrome as a Cause of Chronic Lower Extremity Pain in a 16-Year Old

Abstract

Popliteal entrapment syndrome is an uncommon cause of intermittent claudication in young patients lacking atherosclerotic risk factors. ZS is a 16-year-old cisgender female with type 1 diabetes complicated by microalbuminuria, obesity (body mass index (BMI) = 45.86 kg/m²), and a history of perinatal stroke with residual right-sided hemiparesis, who presented with six months of worsening bilateral, exertional lower extremity pain. Common causes of chronic bilateral lower extremity pain include peripheral vascular disease and diabetic neuropathy. Less common etiologies include trauma, infection, or juvenile idiopathic arthritis. Given her risk factors, the patient's pain was initially managed as a diabetic neuropathy with pregabalin. Symptoms failed to improve, and she represented with positional coolness of the right lower extremity, diminished pulses of the bilateral lower extremities, and weakness in her toes. CT angiography demonstrated occlusion of the right distal superficial femoral and popliteal arteries and diffused tibial disease. Ultimately, the patient was discovered to have right-sided femoral-popliteal occlusion, and she required urgent femoraltibial bypass. Despite an initial improvement in symptoms postoperatively, she continued to have lower extremity pain and recurrent arterial thrombi, even with antiplatelet and anticoagulation therapy. Eventually, the patient required a right-sided below the knee amputation. This case highlights the high index of suspicion that clinicians must have in young patients with lower extremity pain, both with and without atherosclerotic risk factors, as early intervention facilitates better outcomes.

Surgical release of anterior tibial artery entrapment with associated popliteal artery entrapment

“…Given the risk of cumulative vascular damage from repetitive popliteal artery trauma, complete surgical release of an entrapped popliteal artery should be performed in all confirmed cases. 6 , 7 , 10 , 11 , 12 An intraoperative ultrasound examination was performed in this case to confirm complete surgical release of the popliteal and AT arteries, and it can even aid in the clinical resection of the gastrocnemius muscle in cases of type VI PAES. 13 Intraoperative ultrasound examination can be performed with the aid of a vascular laboratory technician and a sterile hockey-stick probe that is placed on the popliteal artery within the surgical wound.…”