Popliteal entrapment syndrome

Popliteal compression syndromes are a rare cause of vascular pathology and should be considered in the differential diagnosis of young athletic men with claudication symptoms. The underlying cause is compression by hypertrophied muscles (functional entrapment) or aberrant courses of the vessels or surrounding muscle or tendon structures. The median time from onset of symptoms to diagnosis is 12 months. Permanent damage to the arterial wall with stenosis or occlusions up to poststenotic aneurysm formation with thromboembolic occlusions can be the consequence. Diagnostically, popliteal artery entrapment syndrome (PAES) is challenging and often unrecognized. While clinical symptoms with intermittent claudication, calf/foot pain or dysesthesia are usually non-specific, functional tests with loss of pulse during dorsiflexion/plantar flexion or a weakened ABI after exercise can be indicative. Functional tests, such as duplex sonography and magnetic resonance angiography (MRA) are useful and digital subtraction angiography is useful in the case of inconclusive findings. Surgical treatment is necessary in symptomatic PAES. The prognosis is favorable with a timely diagnosis but vascular reconstruction is required if damage to the vessel wall has already occurred.