Popliteal Artery Entrapment Syndrome: A Diagnostic Enigma. Case Report and Current Concepts Review

2021 ◽  
pp. 1-5
Author(s):  
Timothy L. Miller ◽  
Rose Backs
Keyword(s):  
Orthopedic Surgery ◽  
Popliteal Artery ◽  
Sports Medicine ◽  
Physical Therapists ◽  
Athletic Trainers ◽  
Leg Pain ◽  
Entrapment Syndrome ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment ◽  
Cross Country

Presented here is the case of a 16-year-old male cross-country runner with chronic leg pain who was diagnosed with popliteal artery entrapment syndrome. An extensive workup was performed on the athlete that eventually included a postexercise arteriogram to reach the diagnosis. Ultimately the athlete’s symptoms required him to undergo bilateral leg surgeries to decompress the popliteal arteries. Extensive collaboration between athletic trainers, physical therapists, orthopedic surgery, sports medicine, and vascular surgery was required to treat the athlete’s condition and return him to distance running.

scholarly journals FUNCTIONAL POPLITEAL ARTERY ENTRAPMENT SYNDROME: INVESTIGATION WITH DYNAMIC AND DOPPLER ULTRASOUND

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0007
Author(s):  
Patricia B. Delzell ◽  
Fatemeh Abdollahi Mofakham ◽  
Jennifer Bullen ◽  
Jason Genin
Keyword(s):  
Popliteal Artery ◽  
Plantar Flexion ◽  
Leg Pain ◽  
Ultrasound Studies ◽  
True Incidence ◽  
Entrapment Syndrome ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment ◽  
Dynamic Ultrasound ◽  
Significant Change

A. Background Functional popliteal artery entrapment syndrome (fPAES), a cause of exertional leg pain, has a clinical presentation and clinical findings that are often indistinguishable from those of other leg pain causes (1). This condition may also coexist and overlap in symptomatology with other leg pain causes, further complicating the diagnosis (2). Although fPAES is usually considered a rare cause of leg pain (3), the true incidence of this condition is unknown, and fPAES is likely underdiagnosed and underreported (4). A missed diagnosis may result in disease progression and the use of unnecessary invasive procedures (3), and untreated fPAES may lead to popliteal artery damage, embolization, and limb ischemia (5). Although a diagnostic method using a combination of dynamic ultrasound and MR imaging/MR angiography has been described for fPAES (5), to our knowledge, no investigational studies have been performed to assess the dynamic ultrasound findings in this entity. This study sought to evaluate the usefulness of dynamic plantar flexion and dorsiflexion of the calf and the effect on the popliteal artery Doppler waveform in patients with clinically suspected fPAES and no structural abnormality. B. Methods We performed a retrospective review of ultrasound studies in patients who presented with clinically suspected PAES over a 3-year period. The ultrasound studies consisted of an anatomic survey of the popliteal. Dynamic nonresistant dorsiflexion and plantar flexion evaluations of the popliteal artery plus spectral Doppler evaluations of the popliteal artery obtained in neutral, plantar flexion, and dorsiflexion positions were performed before and after patients exercised. Patients with anatomic abnormalities were excluded. The following parameters were assessed: The proportion of symptomatic knees versus asymptomatic knees in which plantar flexion and/or dorsiflexion of the foot resulted in popliteal artery compression. The peak systolic velocity (PSV) of the popliteal artery in all positions for knees with and knees without dynamic popliteal artery compression. The absolute value change in PSV of the popliteal artery from neutral to plantar flexion and from neutral to dorsiflexion in the pre- and postexercise state for knees with and knees without dynamic popliteal artery compression. ROC analysis for clustered data was used to assess the ability of PSV to distinguish between knees with and knees without arterial compression. C. Results A total of 88 knees (77 symptomatic, 11 asymptomatic) in 45 patients were included in the study. Dynamic arterial compression was observed in 38% (29/77) of symptomatic knees. No compression seen in asymptomatic knees. Both pre-exercise and postexercise knees with arterial compression had significantly higher absolute changes in PSV from neutral to plantar flexion versus knees without arterial compression (Table). There was a smaller significant change in PSV from neutral to dorsiflexion in the pre-exercise state. There was no significant change in PSV in the postexercise state from neutral to dorsiflexion or with respect to PSV values at any position between knees with and knees without arterial compression. D. Conclusions/Significance In patients with clinically suspected PAES without anatomic abnormality, dynamic ultrasound demonstrated compression of the popliteal artery in 38% of knees. No dynamic arterial compression was seen in asymptomatic knees. There was a significant elevation in PSV from neutral to plantar flexion in pre- and postexercise states and from pre-exercise neutral to dorsiflexion positions in knees with arterial compression versus knees without arterial compression. Tables [Table: see text] References Joy SM, Raudales R. Popliteal artery entrapment syndrome. Curr Sports Med Rep. 2015;14(5):364-367. Hislop M, Kennedy D, Cramp B, Dhupelia S. Functional popliteal artery entrapment syndrome: poorly understood and frequently missed? A review of clinical features, appropriate investigations, and treatment options. J Sports Med (Hindawi Publ Corp). 2014;2014:105953. Gaunder C, McKinney B, Rivera J. Popliteal artery entrapment or chronic exertional compartment syndrome? Case Rep Med. 2017;2017:6981047 Hislop M, Brideaux A, Dhupelia S. Functional popliteal artery entrapment syndrome: use of ultrasound guided Botox injection as a non-surgical treatment option. Skeletal Radiol. 2017;46(9):1241-1248. Williams C, Kennedy D, Bastian-Jordan M, Hislop M, Cramp B, Dhupelia S. A new diagnostic approach to popliteal artery entrapment syndrome. J Med Radiat Sci. 2015;62(3):226-229.

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

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Matthew Hislop ◽  
Dominic Kennedy ◽  
Brendan Cramp ◽  
Sanjay Dhupelia
Keyword(s):  
Popliteal Artery ◽  
Botulinum Toxin Injection ◽  
Treatment Options ◽  
False Negative ◽  
Treatment Strategies ◽  
Leg Pain ◽  
Entrapment Syndrome ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment ◽  
Invasive Intervention

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.

A Practical Approach for the Differential Diagnosis of Chronic Leg Pain in the Athlete

2005 ◽  
Vol 33 (8) ◽  
pp. 1241-1249 ◽  
Author(s):  
Peter H. Edwards ◽  
Michelle L. Wright ◽  
Jodi F. Hartman
Keyword(s):  
Magnetic Resonance ◽  
Popliteal Artery ◽  
Lower Leg ◽  
Athletic Injury ◽  
Leg Pain ◽  
Entrapment Syndrome ◽  
Diagnostic Studies ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment ◽  
Lower Leg Pain

Chronic lower leg pain results from various conditions, most commonly, medial tibial stress syndrome, stress fracture, chronic exertional compartment syndrome, nerve entrapment, and popliteal artery entrapment syndrome. Symptoms associated with these conditions often overlap, making a definitive diagnosis difficult. As a result, an algorithmic approach was created to aid in the evaluation of patients with complaints of lower leg pain and to assist in defining a diagnosis by providing recommended diagnostic studies for each condition. A comprehensive physical examination is imperative to confirm a diagnosis and should begin with an inquiry regarding the location and onset of the patient's pain and tenderness. Confirmation of the diagnosis requires performing the appropriate diagnostic studies, including radiographs, bone scans, magnetic resonance imaging, magnetic resonance angiography, compartmental pressure measurements, and arteriograms. Although most conditions causing lower leg pain are treated successfully with nonsurgical management, some syndromes, such as popliteal artery entrapment syndrome, may require surgical intervention. Regardless of the form of treatment, return to activity must be gradual and individualized for each patient to prevent future athletic injury.

Dual source CT angiography in popliteal artery entrapment syndrome

2012 ◽  
Vol 57 (2) ◽  
pp. 156-160
Author(s):  
Xiaoli Sun ◽  
Cheng Liu ◽  
Rengui Wang ◽  
Dailun Hou ◽  
JiuHong Chen
Keyword(s):  
Ct Angiography ◽  
Popliteal Artery ◽  
Dual Source Ct ◽  
Entrapment Syndrome ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment ◽  
Dual Source

Botulinum Toxin as a Treatment for Functional Popliteal Artery Entrapment Syndrome

2015 ◽  
Vol 47 (6) ◽  
pp. 1124-1127 ◽  
Author(s):  
MARIE-EVE ISNER-HOROBETI ◽  
GUILLAUME MUFF ◽  
JULIEN MASAT ◽  
JEAN-LUC DAUSSIN ◽  
STEPHANE P. DUFOUR ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Popliteal Artery ◽  
Entrapment Syndrome ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment

Intraoperative Duplex Ultrasound Criteria for Performing Interposition Bypass in the Treatment of Popliteal Artery Entrapment Syndrome

2015 ◽  
Vol 29 (1) ◽  
pp. 124.e7-124.e12 ◽  
Author(s):  
Joseph M. White ◽  
Scott R. Golarz ◽  
Paul W. White ◽  
Robert M. Craig ◽  
David R. Whittaker
Keyword(s):  
Popliteal Artery ◽  
Duplex Ultrasound ◽  
Entrapment Syndrome ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment

Popliteal artery entrapment syndrome: A case report

1978 ◽  
Vol 65 (9) ◽  
pp. 613-615 ◽  
Author(s):  
K. Inada ◽  
M. Hirose ◽  
Y. Iwashima ◽  
K. Matsumoto
Keyword(s):  
Case Report ◽  
Popliteal Artery ◽  
Entrapment Syndrome ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment
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