Popliteal Artery Entrapment Syndrome: Types, Symptoms, Treatment

Overview

Popliteal artery entrapment syndrome (PAES) is a rare vascular condition that may result in the compression or occlusion of the popliteal artery. It occurs when the muscle and tendons near the knee are positioned so that they compress the popliteal artery, which is the main artery that runs through and behind the knee. Compression of the artery restricts blood flow to the lower leg and can damage the artery.

PAES often affects the legs of young athletes. About 60% of patients with the disorder are sportsmen under 30 years old. It is estimated that men are 15 times more likely to develop PAES than women.

Types

From the perspective of anatomy, PAES can be classified into five types:

Type 1

This type occurs because of an abnormal relationship of the popliteal artery with the medial head of gastrocnemius (MHG).

Type 2

In this condition, there is no deviation of the popliteal artery. But the MHG inserts more towards the side than usual and the artery goes beneath the muscle.

Type 3

There is an abnormal muscle bundle from the MHG that surrounds and constricts the popliteal artery.

Type 4

Here, the popliteal artery lies deep in the popliteal fossa and is entrapped by the popliteus muscle.

Type 5

In this type, both the popliteal artery and the vein are entrapped.

Causes

The proper cause of PAES is unclear. Excessive exercising and pressure on the calf may result in the problem. Hypertrophy of the musculotendinous structures may also lead to the condition. Risk factors for PAES include:

Age and profession

If you are an athlete between the ages of 25-40, particularly runners or soccer players under 30 years old, you are at higher risk of getting PAES.

Genetics

Less than 3% of people are born with a defect that can lead to PAES, but most people with the condition never develop symptoms.

Gender

Men are at greater risk to be affected than women.

Symptoms

Generally, signs and symptoms of PAES are quite similar to those of adventitial cystic disease. They include:

Pain and numbness in the legs
Frequent occurrence of cramps or tiredness in the calf when exercising
Swelling of the legs

Though the symptoms may go away in three or five minutes with resting, you should pay attention if you have risk factors for PAES.

Diagnosis

Differential diagnosis is quite important for PAES because many other conditions can cause similar signs and symptoms, such as adventitial cystic disease, cystic adventitial disease of the popliteal artery, thrombosed popliteal artery aneurysm, muscle strain or medial tibial stress syndrome.

For diagnosing PAES, your doctor will first ask about your medical history and symptoms. Then, he or she will carry out a physical exam. During the exam, the doctor will check if there are diminished pulses with active foot plantar flexion or passive foot dorsiflexion and coolness of posterior calf.

Imaging tests are very effective to diagnose PAES. They include:

Radiographs, which is the most normal one
Doppler ultrasound to detect changes in pulse when active plantar flexion or passive dorsiflexion is performed
Arteriogram to confirm the diagnosis, which is close to 100% sensitivity
MRI and CT scan to help detect abnormalities in the legs

Treatment

If you experience only mild symptoms and the cause of your PAES is rigorous exercise, you may need nothing but activity modification and observation. For more severe cases and complex causes, surgical treatment is required. Different operative options include:

Bypass surgery, or saphenous vein graft to restore blood flow to the leg
Dividing the anomalous musculotendinous tissue to release the popliteal artery when it is still intact
Vascular reconstruction together with the division of the anomalous musculotendinous structure when the popliteal artery is occluded, stenotic, or aneurysmal

Keyword: popliteal artery entrapment syndrome (PAES).

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* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.