Materiały źródłowe

• #1 Popliteal artery entrapment syndrome: an approach to diagnosis and management | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/52/16/1073

  Popliteal artery entrapment syndrome (PAES) is an anomaly resulting in symptomatic extrinsic compression of the popliteal artery by the surrounding musculotendinous structures; most frequently the medial head of the gastrocnemius muscle. This may be congenital or acquired through muscular hypertrophy. PAES can be further classified by anatomical type (I–VI, table 1). It may exist alone or in combination with popliteal vein and/or tibial nerve compression as part of popliteal entrapment syndrome. […] PAES is a frequent cause of intermittent claudication in an otherwise healthy, often athletic cohort, with potentially severe adverse sequelae and can represent a diagnostic challenge. […] A lower-limb arterial duplex scan detected bilateral popliteal artery occlusion on forced plantar flexion. […] A CT angiogram was performed which detected no abnormality. […] However, on forced plantar flexion, complete occlusion of both popliteal arteries was evident. […] The patient was diagnosed with bilateral PAES and underwent staged popliteal artery releases.

• #2 POPLITEAL ARTERY ENTRAPMENT SYNDROME | Sports Medicine Today

  https://www.sportsmedtoday.com/popliteal-artery-entrapment-syndrome-va-252.htm

  Popliteal Artery Entrapment Syndrome (PAES) is an uncommon vascular condition that affects the legs, most often in younger male athletes. […] A sports medicine physician will carefully review the symptoms, and examine the leg for swelling, coolness and decreased sensation. […] Based on the evaluation findings, the physician may recommend testing to evaluate the blood flow below the knee. […] Being aware of this syndrome is crucial for the early diagnosis and prevention of disease progression.

• #3 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  For symptomatic PAES patients, surgical resection has been the management of choice. […] Surgery with popliteal artery release allows for the definitive reestablishment of normal anatomy and often portends excellent results. […] The prognosis of the PAES entirely relies on its detection time. […] If PAES is detected and managed early in the course of the disease, the prognosis of the PAES is generally reasonable. […] However, if the PAES is detected late when extensive arterial damage has already happened, then the patient is at risk of having permanent claudication or even limb loss. […] PAES is a limb-threatening vascular disorder demanding of early clinical diagnosis and early intervention.

• #4 Popliteal artery entrapment syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/diagnosis-treatment/drc-20465225

  To diagnose popliteal artery entrapment syndrome (PAES), the health team checks you and asks questions about your symptoms and health history. But because most people with PAES are young and usually in good health, diagnosing the condition can sometimes be challenging. There are typically no unusual findings from a physical exam. […] Tests are done to rule out other causes of leg pain, including muscle strains, stress fractures and peripheral artery disease, which results from clogged arteries. […] Ankle-brachial index (ABI) measurement is usually the first test done to diagnose PAES. Blood pressure measurements are taken in the arms and legs during and after walking on a treadmill. The ABI is determined by dividing ankle pressure by arm pressure. The blood pressure in the legs should be higher than that in the arms. But if you have PAES, your ankle pressure drops during exercise.

• #5

  https://www.ijcrimedicine.com/archive/2018-articles/2018100046Z09JM-mathew/100046Z09JM-full-text.php

  The differential diagnosis of lower extremity pain with exertion is quite broad which explains a median delay in diagnosis of patients with PAES of 12 months. […] Diagnostic imaging includes ultrasound and angiography. However, If diagnostic imaging is negative, but clinical suspicion remains, dynamic testing may aid in the diagnosis. […] The condition should be suspected in patients presenting with unexplained leg pain after or during exercise in which other more common diagnoses have been ruled out. […] When suspecting this condition, there are multiple diagnostic modalities available. In the clinic, specific provocative maneuvers can be employed. […] Imaging techniques include duplex ultrasound, conventional angiography, magnetic resonance angiography, and computed tomography angiography.

• #6 Popliteal Artery Entrapment Syndrome (PAES): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17375-popliteal-artery-entrapment-syndrome-paes

  Popliteal artery entrapment syndrome (PAES) is a rare condition that causes leg pain in some young athletes. […] A vascular specialist is the type of healthcare provider who can best diagnose PAES. Theyll do a physical exam that includes checking the pulse in your foot and your popliteal artery. […] To check for PAES, your healthcare provider will get resting leg blood pressures and look for a drop with exercise. […] Diagnostic tests measure blood flow through your knee, leg and foot. […] Surgery is the preferred treatment for popliteal artery entrapment syndrome because it gives excellent results for most people. […] The popliteal artery entrapment syndrome recovery time after surgery is four to six months. […] Surgical treatment is successful in more than 90% of people and its unlikely that theyll have symptoms again. […] If you have popliteal artery entrapment syndrome, talk with your provider about whether surgery is right for you. Its been a successful treatment in many cases.

• #7 Popliteal artery entrapment syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/diagnosis-treatment/drc-20465225

  To diagnose popliteal artery entrapment syndrome (PAES), the health team checks you and asks questions about your symptoms and health history. But because most people with PAES are young and usually in good health, diagnosing the condition can sometimes be challenging. There are typically no unusual findings from a physical exam. […] Tests are done to rule out other causes of leg pain, including muscle strains, stress fractures and peripheral artery disease, which results from clogged arteries. […] Ankle-brachial index (ABI) measurement is usually the first test done to diagnose PAES. Blood pressure measurements are taken in the arms and legs during and after walking on a treadmill. The ABI is determined by dividing ankle pressure by arm pressure. The blood pressure in the legs should be higher than that in the arms. But if you have PAES, your ankle pressure drops during exercise.

• #8 Popliteal artery entrapment syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/symptoms-causes/syc-20465211

  Popliteal artery entrapment syndrome (PAES) is an uncommon condition that affects the main artery behind the knee. […] Make an appointment for a health checkup if you have any type of leg pain. This is especially important if you have calf or foot cramping during activity that gets better with rest. […] Popliteal artery entrapment syndrome (PAES) is caused by an irregular calf muscle, usually the gastrocnemius muscle. […] The changes in the calf muscle cause it to press on the main artery behind the knee. This reduces blood flow to the lower leg. The lack of blood flow causes pain and cramping in the back of the lower leg during times of activity. […] Long-term pressure on the popliteal artery can cause the artery to narrow. This is called artery stenosis. It can cause pain and cramping with just slight activity, such as walking. […] Older athletes with symptoms of popliteal artery entrapment syndrome should be checked for a ballooning or bulging of the artery. This is called a popliteal aneurysm. It is common in older men.

• #9 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  Popliteal artery entrapment syndrome (PAES) is an uncommon cause of lower extremity exertional claudication due to external compression of vascular structures in the popliteal fossa. […] Typical presentation of unilateral or bilateral, intermittent claudication in the feet and calves specifically after exercise and relieved by rest in a young person should prompt further evaluation. Early diagnosis and intervention is essential for preventing thromboembolic complication and in worst cases limb loss. […] Initial tests with Ankle Brachial indices or Doppler ultrasound with provocative maneuvers will prompt more definitive cross sectional imaging studies. CTA or MRA also with provocative maneuvers has a high sensitivity and specificity and will clinch the diagnosis. […] PAES is a challenging diagnosis due to non-specific symptomatology and is often misdiagnosed as exertional compartment syndrome.

• #10 Popliteal artery entrapment syndrome: an approach to diagnosis and management | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/52/16/1073

  Popliteal artery entrapment syndrome (PAES) is an anomaly resulting in symptomatic extrinsic compression of the popliteal artery by the surrounding musculotendinous structures; most frequently the medial head of the gastrocnemius muscle. This may be congenital or acquired through muscular hypertrophy. PAES can be further classified by anatomical type (I–VI, table 1). It may exist alone or in combination with popliteal vein and/or tibial nerve compression as part of popliteal entrapment syndrome. […] PAES is a frequent cause of intermittent claudication in an otherwise healthy, often athletic cohort, with potentially severe adverse sequelae and can represent a diagnostic challenge. […] A lower-limb arterial duplex scan detected bilateral popliteal artery occlusion on forced plantar flexion. […] A CT angiogram was performed which detected no abnormality. […] However, on forced plantar flexion, complete occlusion of both popliteal arteries was evident. […] The patient was diagnosed with bilateral PAES and underwent staged popliteal artery releases.

• #11 Popliteal Artery Entrapment Syndrome | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/popliteal-artery-entrapment-syndrome

  Popliteal artery entrapment syndrome (PAES) is a rare vascular condition that affects the legs. […] The condition is often difficult to diagnose because it can mimic other conditions such as knee joint pain or other muscle-related problems. […] Our experts diagnose PAES based on a patients medical history, a physical exam and non-invasive diagnostic testing. These tests may include: Ankle brachial index measurement with exercise to measure the blood pressure in the arms and legs before and after exercise. Duplex ultrasound, which uses sound waves to image the artery and measure blood flow. Computed tomographic angiography (CTA), which uses dye to identify areas around the knee with poor blood flow or narrowed arteries. Magnetic resonance angiography (MRA) to provide images of muscles, tendons and blood vessels. Angiogram with intravascular ultrasound (IVUS), which captures real-time images of blood flow while the leg and foot are maneuvered into various positions.

• #12 Popliteal artery entrapment syndrome: a rare diagnosis for calf pain | HKMJ

  https://www.hkmj.org/abstracts/v27n1/58.htm

  An 18-year-old man presented with a long history of occasional right calf pain and fullness. […] Magnetic resonance arteriogram showed almost complete occlusion of the right popliteal artery and distal superficial femoral artery at the level of the right popliteal fossa. […] Popliteal artery entrapment syndrome (PAES) is a rare and frequently underdiagnosed disease entity. […] The classic presentation of PAES is of symptoms related to vascular compression, which is intermittent lower limb claudication. […] In addition to a careful history, proper physical examination aids in diagnosis. […] Further diagnostic testing is usually needed to make a confident diagnosis of PAES. […] Doppler ultrasonography is one of the first-line imaging modalities. […] Conventional angiography has been long used for the diagnosis of PAES.

• #13 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  A thorough differential should include exertional compartment syndrome, neurogenic claudication, and atherosclerotic peripheral arterial disease (PAD). […] On physical exam, lower limb arterial pulses are likely to be normal unless severe popliteal artery stenosis or occlusion is present. An ankle-brachial index (ABI) can be useful to screen for PAES. […] Therefore, imaging is indicated to make a definitive diagnosis. […] Positive DUS findings or high clinical suspicion should prompt further imaging, necessary to delineate the anatomical subtype of PAES and inform surgical planning. […] Both modalities rely on provocative maneuvers by the patient to demonstrate occlusion and imaging can be performed prior to and during these maneuvers. […] If cross-sectional imaging findings are equivocal or a large thrombus is identified in the popliteal vessels, catheter-directed angiography should be pursued.

• #14 Popliteal artery entrapment syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/popliteal-artery-entrapment-syndrome

  To diagnose popliteal artery entrapment syndrome (PAES), the health team checks you and asks questions about your symptoms and health history. But because most people with PAES are young and usually in good health, diagnosing the condition can sometimes be challenging. There are typically no unusual findings from a physical exam. […] Tests are done to rule out other causes of leg pain, including muscle strains, stress fractures and peripheral artery disease, which results from clogged arteries. […] Tests may include the following: […] Ankle-brachial index (ABI) measurement is usually the first test done to diagnose PAES. Blood pressure measurements are taken in the arms and legs during and after walking on a treadmill. The ABI is determined by dividing ankle pressure by arm pressure. The blood pressure in the legs should be higher than that in the arms. But if you have PAES, your ankle pressure drops during exercise.

• #15 Popliteal artery entrapment syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/diagnosis-treatment/drc-20465225

  To diagnose popliteal artery entrapment syndrome (PAES), the health team checks you and asks questions about your symptoms and health history. But because most people with PAES are young and usually in good health, diagnosing the condition can sometimes be challenging. There are typically no unusual findings from a physical exam. […] Tests are done to rule out other causes of leg pain, including muscle strains, stress fractures and peripheral artery disease, which results from clogged arteries. […] Ankle-brachial index (ABI) measurement is usually the first test done to diagnose PAES. Blood pressure measurements are taken in the arms and legs during and after walking on a treadmill. The ABI is determined by dividing ankle pressure by arm pressure. The blood pressure in the legs should be higher than that in the arms. But if you have PAES, your ankle pressure drops during exercise.

• #16 Popliteal Artery Entrapment Syndrome – Sports Medicine Review

  https://www.sportsmedreview.com/blog/popliteal-artery-entrapment-syndrome/

  The ankle-brachial index (ABI), which is a comparison of the blood pressure at the ankle with the upper arm, is performed at rest and then following exercise to the point of reproducing the patient’s symptoms. […] If there is a drop in the ankle-brachial index with exercise, it is then appropriate to proceed with a dynamic duplex ultrasound of the popliteal artery with provocative maneuvers. […] A technique for evaluating popliteal artery entrapment syndrome has been described as ultrasound of the popliteal artery with the patient in active plantar flexion and then with the knee flexed to 15°. […] Advanced imaging including computed tomography (CT) and CT angiography or magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) is important in evaluating for anatomic aberrancies that must be corrected. […] Diagnostic testing should be done in a logical manner and awareness of this condition can lead to a more prompt diagnosis and treatment.

• #17 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  Besides, the duplex arterial ultrasonography (DAU) using provocative maneuvers (leg/foot positioned first in a neutral position and then in resisted plantar flexion) provides a quick, inexpensive, and non-invasive initial screening test. […] Findings of arterial compromise or prominent collaterals in the fossa suggest the diagnosis of PAES. […] The management of the PAES is tailored based on the presence and absence of the symptoms. […] For asymptomatic patients with incidental findings of popliteal artery entrapment, management is typically expectant, as the majority of these patients never experience symptoms or disease progression. […] On the contrary, if muscle insertion abnormalities are the cause of the PAEs even in an asymptomatic patient, surgical correction is the preferred method of treatment.

• #18 VASCULAR ULTRASOUND FOR POPLITEAL ARTERY ENTRAPMENT – Mayfair Diagnostics

  https://www.radiology.ca/article/vascular-ultrasound-popliteal-artery-entrapment/

  Popliteal artery entrapment syndrome (PAES) is an uncommon vascular condition that occurs when the calf muscles compress the main artery behind the knee (the popliteal artery). […] PAES can be challenging to diagnose because its relatively uncommon and it affects otherwise healthy young adults. The symptoms can also mimic other conditions, such as knee joint pain or other muscle-related problems. In many cases, a diagnosis is made via medical imaging using vascular ultrasound. […] For PAES, a vascular ultrasound exam can assess the popliteal artery with the calf in a neutral or relaxed position and in a flexed position, such as standing on tip toes, toes bent back, or toes pointed forward. Images can then be generated that help determine whether there is any compression or blockage of the popliteal artery that could indicate popliteal artery entrapment syndrome.

• #19 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  A thorough differential should include exertional compartment syndrome, neurogenic claudication, and atherosclerotic peripheral arterial disease (PAD). […] On physical exam, lower limb arterial pulses are likely to be normal unless severe popliteal artery stenosis or occlusion is present. An ankle-brachial index (ABI) can be useful to screen for PAES. […] Therefore, imaging is indicated to make a definitive diagnosis. […] Positive DUS findings or high clinical suspicion should prompt further imaging, necessary to delineate the anatomical subtype of PAES and inform surgical planning. […] Both modalities rely on provocative maneuvers by the patient to demonstrate occlusion and imaging can be performed prior to and during these maneuvers. […] If cross-sectional imaging findings are equivocal or a large thrombus is identified in the popliteal vessels, catheter-directed angiography should be pursued.

• #20 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  The rare clinical manifestation of Popliteal Artery Entrapment Syndrome (PAES) was defined approximately 40 years ago. […] This activity describes the evaluation, and treatment of PAES, and reviews the role of the interprofessional team in managing patients with this condition. […] The advances in radiological imaging likewise allowed far better delineation and also enhanced sensitivity in detecting PAES. […] A combination of the magnetic resonance imaging (MRI) with arteriography has been reported to be one of the most accurate diagnostic approaches for the PAES. […] Diagnosis of the PAES poses a considerable clinical challenge as it calls for the proper interpretation of clinical as well as radiological aspects of this rare clinical entity. […] In a recent study on exploring the best diagnostic modality for the PAES, Willimas et al. reported that a combination of the MRI and the duplex ultrasonography (DU) is far superior in diagnosing PAES.

• #21 Popliteal artery entrapment syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/popliteal-artery-entrapment-syndrome

  Duplex ultrasound of the calf uses high-frequency sound waves to show how fast blood moves through the leg arteries. This test may be done before or after exercise. You may be asked to flex your foot up and down, which puts your calf muscle to work. […] Magnetic resonance angiography (MRA) shows if the calf muscle is trapping the artery. It also can tell how much of the popliteal artery is narrowed. You may be asked to flex your foot or press it against a board during this test. Doing so helps show how blood is flowing to your lower leg. […] CT angiography also shows which leg muscle is causing the artery entrapment. As with MRA, you may be asked to move your foot during this test. […] Catheter-based angiography shows how blood is flowing to and from the lower leg in real time. It’s done if the diagnosis is still unclear after other, less-invasive imaging tests.

• #22 Popliteal artery entrapment syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/diagnosis-treatment/drc-20465225

  Duplex ultrasound of the calf uses high-frequency sound waves to show how fast blood moves through the leg arteries. This test may be done before or after exercise. You may be asked to flex your foot up and down, which puts your calf muscle to work. […] Magnetic resonance angiography (MRA) shows if the calf muscle is trapping the artery. It also can tell how much of the popliteal artery is narrowed. You may be asked to flex your foot or press it against a board during this test. Doing so helps show how blood is flowing to your lower leg. […] CT angiography also shows which leg muscle is causing the artery entrapment. As with MRA, you may be asked to move your foot during this test. […] Catheter-based angiography shows how blood is flowing to and from the lower leg in real time. It’s done if the diagnosis is still unclear after other, less-invasive imaging tests.

• #23 A new diagnostic approach to popliteal artery entrapment syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4592677/

  This paper presents a new approach for the diagnosis and definition of PAES using a combination of ultrasound and MRI protocols. The new technique will diagnose both anatomical and functional entrapment types as well as define the anatomy sufficiently for treatment. […] The combination of USS and MRI/MRA modalities facilitates diagnosis of PAES, as well as defines the functional and anatomical components of the occlusion. This demonstrates the location of the occlusion and contributing muscles. These images guide management, either with surgery or, more recently, Botox injection. […] Ultrasound is inexpensive and readily available, and useful as a screening tool to confirm occlusion. […] MRI complements USS as it is also safe and readily available, and provides improved soft tissue definition. […] Further research is needed to determine whether occlusion of the popliteal artery above a particular threshold of plantar flexion force can more accurately diagnose function PAES.

• #24 Popliteal artery entrapment syndrome: a rare diagnosis for calf pain | HKMJ

  https://www.hkmj.org/abstracts/v27n1/58.htm

  It has recently been replaced by diagnostic modalities that are non-invasive such as computed tomography angiography and magnetic resonance imaging with magnetic resonance arteriogram. […] Magnetic resonance imaging and MR angiography are promising imaging modalities for the diagnosis of PAES due to their superior capability to demonstrate surrounding anatomy and soft tissue compared with computed tomography angiography, with no ionising radiation required. […] This case illustrates the importance of considering this rare diagnosis when encountering young patients with lower limb claudication or calf pain symptoms.

• #25 A new diagnostic approach to popliteal artery entrapment syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4592677/

  A new method of diagnosing and defining functional popliteal artery entrapment syndrome is described. By combining ultrasonography and magnetic resonance imaging techniques with dynamic plantarflexion of the ankle against resistance, functional entrapment can be demonstrated and the location of the arterial occlusion identified. This combination of imaging modalities will also define muscular anatomy for guiding intervention such as surgery or Botox injection. […] 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). The diagnostic capability of traditional static imaging techniques performed is limited in this dynamic condition.

• #26 A rare cause of intermittent claudication: recurrence of popliteal artery entrapment syndrome in a 16-years-old boy – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?lang=en&id=1808

  Color Doppler sonography is the primary imaging method used in the diagnosis of PAES, and it may also reveal popliteal artery stenosis, changes in color flow, or increased peak systolic velocity. Furthermore, this type of imaging also sometimes show the popliteal fossa anatomy and poststenotic aneurysms. Computed tomography angiography and magnetic resonance imaging (MRI) can show arterial stenosis, poststenotic dilatation, and the popliteal fossa anatomy. However, MRI is the best choice for evaluating the popliteal fossa anatomy and vascular compromise without the use of ionizing radiation or iodinated contrast material. […] The primary treatment method for PAES is surgery that involves extracting the muscle or tendons which causing the entrapment and also if necessary vessel lumen should be restored with endarterectomy or bypass grafting. The endovascular treatment of PAES not preferred choice without removing the underlying reason for the vessel entrapment however combined therapy-endovascular and surgical- had been performed. […] Therefore, the pediatrician has to look for the presentation of claudication, which is the primary symptom of PAES. After surgery, teenage patients should be followed up closely to check for recurrence of this syndrome.

• #27 Popliteal entrapment syndrome: case report and surgical technique review

  https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0003-31702024000400007&lng=en&nrm=iso&tlng=en

  Popliteal artery entrapment syndrome (PAES) is due to an abnormal relationship between the popliteal artery and the surrounding structures in the popliteal fossa. […] PAES is a rare and underdiagnosed condition. Early diagnosis and surgical treatment can influence the prognosis of the limb in young patients. […] Missing out on its diagnosis can compromise the prognosis of the affected limb. Surgical treatment is essential and involves the release of the popliteal artery, sometimes requiring its revascularization. […] Finding a lesion (stenosis or thrombosis) in the popliteal artery in young patients requires considering the diagnosis of PAES. Currently, MRA is considered the diagnostic imaging modality of choice to assess the relationship between the popliteal artery and the surrounding musculotendinous structures. […] PAES is a rare condition, but knowledge of it is essential for early diagnosis and treatment. Missing this entity can lead to irreversible consequences for the limb in a young patient.

• #28 Popliteal artery entrapment syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/diagnosis-treatment/drc-20465225

  Duplex ultrasound of the calf uses high-frequency sound waves to show how fast blood moves through the leg arteries. This test may be done before or after exercise. You may be asked to flex your foot up and down, which puts your calf muscle to work. […] Magnetic resonance angiography (MRA) shows if the calf muscle is trapping the artery. It also can tell how much of the popliteal artery is narrowed. You may be asked to flex your foot or press it against a board during this test. Doing so helps show how blood is flowing to your lower leg. […] CT angiography also shows which leg muscle is causing the artery entrapment. As with MRA, you may be asked to move your foot during this test. […] Catheter-based angiography shows how blood is flowing to and from the lower leg in real time. It’s done if the diagnosis is still unclear after other, less-invasive imaging tests.

• #29 Popliteal artery entrapment syndrome: an approach to diagnosis and management | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/52/16/1073

  Popliteal artery entrapment syndrome (PAES) is an anomaly resulting in symptomatic extrinsic compression of the popliteal artery by the surrounding musculotendinous structures; most frequently the medial head of the gastrocnemius muscle. This may be congenital or acquired through muscular hypertrophy. PAES can be further classified by anatomical type (I–VI, table 1). It may exist alone or in combination with popliteal vein and/or tibial nerve compression as part of popliteal entrapment syndrome. […] PAES is a frequent cause of intermittent claudication in an otherwise healthy, often athletic cohort, with potentially severe adverse sequelae and can represent a diagnostic challenge. […] A lower-limb arterial duplex scan detected bilateral popliteal artery occlusion on forced plantar flexion. […] A CT angiogram was performed which detected no abnormality. […] However, on forced plantar flexion, complete occlusion of both popliteal arteries was evident. […] The patient was diagnosed with bilateral PAES and underwent staged popliteal artery releases.

• #30

  https://link.springer.com/article/10.1007/s12262-024-04065-2

  Popliteal artery entrapment syndrome (PAES), a rare vascular developmental anomaly, occurs due to abnormal relationship between popliteal artery and the myofascial structures in the popliteal fossa. […] Diagnosis remains challenging as symptoms mimic other vascular conditions like peripheral arterial occlusive disease (PAOD), thromboangiitis obliterans (TAO), adventitial cystic disease (ACD), fibro-muscular dysplasia (FMD), small- and medium-vessel vasculitis etc. […] CT angiogram and MRI are the investigations of choice and surgery is considered as the mainstay of treatment. […] PAES with popliteal artery occlusion was suspected clinically, confirmed on imaging and treated successfully by popliteal artery (P1-P3) reverse saphenous vein graft (RSVG) with favorable outcome.

• #31

  https://www.orthobullets.com/knee-and-sports/3107/popliteal-artery-entrapment-syndrome

  Popliteal artery entrapment syndrome is a condition characterized by constriction of the popliteal artery by adjacent muscles, tendons or fibrous tissue. […] Diagnosis can be suspected clinically with diminished pulses with active foot plantar flexion or passive foot dorsiflexion and confirmed with a lower extremity arteriogram. […] Arteriogram used to confirm diagnosis. […] close to 100% sensitivity. […] will show stenosis, obliteration and post-stenotic dilation.

• #32 A rare cause of intermittent claudication: recurrence of popliteal artery entrapment syndrome in a 16-years-old boy – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?lang=en&id=1808

  Popliteal artery entrapment syndrome (PAES) is a rare clinical entity which is predominantly seen in young athletic men. The primary symptom of PAES is intermittent claudication. Surgery is the primary treatment of choice. After surgery in adolescence period particularly, these patients should be monitored closely because of risk of recurrence. The main complaint with popliteal artery stenosis is intermittent claudication. Popliteal artery entrapment syndrome (PAES) is an uncommon clinical entity that presents with claudication, and popliteal arterial diseases are rare causes of intermittent claudication. […] Because of his history and existing symptoms, computed tomography (CT) angiography was performed, and circumferential narrowing was seen at the popliteal arteries; however, there was no thrombosis. The stenosis ratio was approximately 80% for the right and 60% for the left popliteal artery, and the bilateral popliteal artery was being compressed by the medial gastrocnemius tendons.

• #33 Popliteal artery entrapment syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/popliteal-artery-entrapment-syndrome?lang=us

  Lower limb angiography usually demonstrates medial deviation/compression of the popliteal artery when the ankle is plantarflexed. Occlusion of the vessels with thrombus can be seen in the acute presentation. Usually, collateral vessels are present. Even slight irregularity of the vessel can indicate a degree of entrapment.

• #34 Long-Term Results of Surgical Treatment for Popliteal Artery Entrapment Syndrome

  https://www.mdpi.com/2075-4418/14/12/1302

  Long-term results of surgical treatment for popliteal artery entrapment syndrome (PAES) seem to be very satisfying. […] The aim of this study was to describe our institutional experience in terms of diagnosis, surgical management, and long-term results of PAES during a 15-year follow-up period. […] Nowadays, a specific diagnostic protocol for suspected PAES has not reached a worldwide consensus. […] Non-invasive imaging modalities associated with a meticulous clinical examination, such as dorsiflexion and plantarflexion, causing popliteal artery compression and distal pulse disappearance, usually lead to an accurate diagnosis. […] In our series, the sensitivity to the detection of PAES was 96.2% for DSA with dynamic maneuvers, 54.5% (12 limbs) for MRA, and 51.7% (29 limbs) for CTA. […] The key to the success of the PAES syndrome treatment remains to be the exact and prompt diagnosis to avoid delays and irreversible arterial damage.

• #35 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  The rare clinical manifestation of Popliteal Artery Entrapment Syndrome (PAES) was defined approximately 40 years ago. […] This activity describes the evaluation, and treatment of PAES, and reviews the role of the interprofessional team in managing patients with this condition. […] The advances in radiological imaging likewise allowed far better delineation and also enhanced sensitivity in detecting PAES. […] A combination of the magnetic resonance imaging (MRI) with arteriography has been reported to be one of the most accurate diagnostic approaches for the PAES. […] Diagnosis of the PAES poses a considerable clinical challenge as it calls for the proper interpretation of clinical as well as radiological aspects of this rare clinical entity. […] In a recent study on exploring the best diagnostic modality for the PAES, Willimas et al. reported that a combination of the MRI and the duplex ultrasonography (DU) is far superior in diagnosing PAES.

• #36 Popliteal artery entrapment syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Popliteal_artery_entrapment_syndrome

  The popliteal artery entrapment syndrome (PAES) is an uncommon pathology that occurs when the popliteal artery is compressed by the surrounding popliteal fossa myofascial structures. […] PAES can be diagnosed with a combination of medical history, physical examination, and advanced imaging modalities such as duplex ultrasound, computer tomography, or magnetic resonance angiography. […] Multiple imaging modalities are used to confirm the diagnosis of PAES. […] According to a recent study by Willimas et al, a combination of DU and MRA is far superior in diagnosing PAES. […] If DU is negative but there is still strong suspicion for PAES, MRA or CTA with provocative maneuvers are needed as follow-up imaging. […] If MRA or CTA is non-conclusive, DSA may be used as a further option with a high sensitivity (97%) for PAES diagnosis.

• #37 A new diagnostic approach to popliteal artery entrapment syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4592677/

  This paper presents a new approach for the diagnosis and definition of PAES using a combination of ultrasound and MRI protocols. The new technique will diagnose both anatomical and functional entrapment types as well as define the anatomy sufficiently for treatment. […] The combination of USS and MRI/MRA modalities facilitates diagnosis of PAES, as well as defines the functional and anatomical components of the occlusion. This demonstrates the location of the occlusion and contributing muscles. These images guide management, either with surgery or, more recently, Botox injection. […] Ultrasound is inexpensive and readily available, and useful as a screening tool to confirm occlusion. […] MRI complements USS as it is also safe and readily available, and provides improved soft tissue definition. […] Further research is needed to determine whether occlusion of the popliteal artery above a particular threshold of plantar flexion force can more accurately diagnose function PAES.

• #38 A new diagnostic approach to popliteal artery entrapment syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4592677/

  A new method of diagnosing and defining functional popliteal artery entrapment syndrome is described. By combining ultrasonography and magnetic resonance imaging techniques with dynamic plantarflexion of the ankle against resistance, functional entrapment can be demonstrated and the location of the arterial occlusion identified. This combination of imaging modalities will also define muscular anatomy for guiding intervention such as surgery or Botox injection. […] 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). The diagnostic capability of traditional static imaging techniques performed is limited in this dynamic condition.

• #39 A new diagnostic approach to popliteal artery entrapment syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4592677/

  This paper presents a new approach for the diagnosis and definition of PAES using a combination of ultrasound and MRI protocols. The new technique will diagnose both anatomical and functional entrapment types as well as define the anatomy sufficiently for treatment. […] The combination of USS and MRI/MRA modalities facilitates diagnosis of PAES, as well as defines the functional and anatomical components of the occlusion. This demonstrates the location of the occlusion and contributing muscles. These images guide management, either with surgery or, more recently, Botox injection. […] Ultrasound is inexpensive and readily available, and useful as a screening tool to confirm occlusion. […] MRI complements USS as it is also safe and readily available, and provides improved soft tissue definition. […] Further research is needed to determine whether occlusion of the popliteal artery above a particular threshold of plantar flexion force can more accurately diagnose function PAES.

• #40 A new diagnostic approach to popliteal artery entrapment syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4592677/

  This paper presents a new approach for the diagnosis and definition of PAES using a combination of ultrasound and MRI protocols. The new technique will diagnose both anatomical and functional entrapment types as well as define the anatomy sufficiently for treatment. […] The combination of USS and MRI/MRA modalities facilitates diagnosis of PAES, as well as defines the functional and anatomical components of the occlusion. This demonstrates the location of the occlusion and contributing muscles. These images guide management, either with surgery or, more recently, Botox injection. […] Ultrasound is inexpensive and readily available, and useful as a screening tool to confirm occlusion. […] MRI complements USS as it is also safe and readily available, and provides improved soft tissue definition. […] Further research is needed to determine whether occlusion of the popliteal artery above a particular threshold of plantar flexion force can more accurately diagnose function PAES.

• #41 A new diagnostic approach to popliteal artery entrapment syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4592677/

  This paper presents a new approach for the diagnosis and definition of PAES using a combination of ultrasound and MRI protocols. The new technique will diagnose both anatomical and functional entrapment types as well as define the anatomy sufficiently for treatment. […] The combination of USS and MRI/MRA modalities facilitates diagnosis of PAES, as well as defines the functional and anatomical components of the occlusion. This demonstrates the location of the occlusion and contributing muscles. These images guide management, either with surgery or, more recently, Botox injection. […] Ultrasound is inexpensive and readily available, and useful as a screening tool to confirm occlusion. […] MRI complements USS as it is also safe and readily available, and provides improved soft tissue definition. […] Further research is needed to determine whether occlusion of the popliteal artery above a particular threshold of plantar flexion force can more accurately diagnose function PAES.

• #42 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  A thorough differential should include exertional compartment syndrome, neurogenic claudication, and atherosclerotic peripheral arterial disease (PAD). […] On physical exam, lower limb arterial pulses are likely to be normal unless severe popliteal artery stenosis or occlusion is present. An ankle-brachial index (ABI) can be useful to screen for PAES. […] Therefore, imaging is indicated to make a definitive diagnosis. […] Positive DUS findings or high clinical suspicion should prompt further imaging, necessary to delineate the anatomical subtype of PAES and inform surgical planning. […] Both modalities rely on provocative maneuvers by the patient to demonstrate occlusion and imaging can be performed prior to and during these maneuvers. […] If cross-sectional imaging findings are equivocal or a large thrombus is identified in the popliteal vessels, catheter-directed angiography should be pursued.

• #43 Popliteal artery entrapment syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/diagnosis-treatment/drc-20465225

  Duplex ultrasound of the calf uses high-frequency sound waves to show how fast blood moves through the leg arteries. This test may be done before or after exercise. You may be asked to flex your foot up and down, which puts your calf muscle to work. […] Magnetic resonance angiography (MRA) shows if the calf muscle is trapping the artery. It also can tell how much of the popliteal artery is narrowed. You may be asked to flex your foot or press it against a board during this test. Doing so helps show how blood is flowing to your lower leg. […] CT angiography also shows which leg muscle is causing the artery entrapment. As with MRA, you may be asked to move your foot during this test. […] Catheter-based angiography shows how blood is flowing to and from the lower leg in real time. It’s done if the diagnosis is still unclear after other, less-invasive imaging tests.

• #44 Popliteal Artery Entrapment Syndrome | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/popliteal-artery-entrapment-syndrome

  Popliteal artery entrapment syndrome (PAES) is a rare vascular condition that affects the legs. […] The condition is often difficult to diagnose because it can mimic other conditions such as knee joint pain or other muscle-related problems. […] Our experts diagnose PAES based on a patients medical history, a physical exam and non-invasive diagnostic testing. These tests may include: Ankle brachial index measurement with exercise to measure the blood pressure in the arms and legs before and after exercise. Duplex ultrasound, which uses sound waves to image the artery and measure blood flow. Computed tomographic angiography (CTA), which uses dye to identify areas around the knee with poor blood flow or narrowed arteries. Magnetic resonance angiography (MRA) to provide images of muscles, tendons and blood vessels. Angiogram with intravascular ultrasound (IVUS), which captures real-time images of blood flow while the leg and foot are maneuvered into various positions.

• #45 Popliteal artery entrapment syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/popliteal-artery-entrapment-syndrome?lang=us

  Lower limb angiography usually demonstrates medial deviation/compression of the popliteal artery when the ankle is plantarflexed. Occlusion of the vessels with thrombus can be seen in the acute presentation. Usually, collateral vessels are present. Even slight irregularity of the vessel can indicate a degree of entrapment.

• #46 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  Besides, the duplex arterial ultrasonography (DAU) using provocative maneuvers (leg/foot positioned first in a neutral position and then in resisted plantar flexion) provides a quick, inexpensive, and non-invasive initial screening test. […] Findings of arterial compromise or prominent collaterals in the fossa suggest the diagnosis of PAES. […] The management of the PAES is tailored based on the presence and absence of the symptoms. […] For asymptomatic patients with incidental findings of popliteal artery entrapment, management is typically expectant, as the majority of these patients never experience symptoms or disease progression. […] On the contrary, if muscle insertion abnormalities are the cause of the PAEs even in an asymptomatic patient, surgical correction is the preferred method of treatment.

• #47 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  Surgical management of PAES is twofold: decompression of the offending musculotendinous structures and repair of vascular injury. […] For Types I and II PAES, myotomy of the medial head of the gastrocnemius is performed, followed by re-routing of the popliteal artery. […] Outcomes for myotomy are excellent, with 1- and 5-year patency rates of 100%, respectively. […] While the treatment for anatomic PAES is surgical decompression, management of the functional subtype may vary. […] Early surgical treatment before vascular injury and remodeling occur provides for superior outcomes. Specific localization of pain, ABIs, and popliteal DUS can provide rapid indications of pathology. CTA or MRA with provocative maneuvers then classify PAES subtypes and guide surgical planning.

• #48 Popliteal artery entrapment syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Popliteal_artery_entrapment_syndrome

  The popliteal artery entrapment syndrome (PAES) is an uncommon pathology that occurs when the popliteal artery is compressed by the surrounding popliteal fossa myofascial structures. […] PAES can be diagnosed with a combination of medical history, physical examination, and advanced imaging modalities such as duplex ultrasound, computer tomography, or magnetic resonance angiography. […] Multiple imaging modalities are used to confirm the diagnosis of PAES. […] According to a recent study by Willimas et al, a combination of DU and MRA is far superior in diagnosing PAES. […] If DU is negative but there is still strong suspicion for PAES, MRA or CTA with provocative maneuvers are needed as follow-up imaging. […] If MRA or CTA is non-conclusive, DSA may be used as a further option with a high sensitivity (97%) for PAES diagnosis.

• #49

  https://link.springer.com/article/10.1007/s12262-024-04065-2

  Popliteal artery entrapment syndrome (PAES), a rare vascular developmental anomaly, occurs due to abnormal relationship between popliteal artery and the myofascial structures in the popliteal fossa. […] Diagnosis remains challenging as symptoms mimic other vascular conditions like peripheral arterial occlusive disease (PAOD), thromboangiitis obliterans (TAO), adventitial cystic disease (ACD), fibro-muscular dysplasia (FMD), small- and medium-vessel vasculitis etc. […] CT angiogram and MRI are the investigations of choice and surgery is considered as the mainstay of treatment. […] PAES with popliteal artery occlusion was suspected clinically, confirmed on imaging and treated successfully by popliteal artery (P1-P3) reverse saphenous vein graft (RSVG) with favorable outcome.

• #50 Concurrent Chronic Exertional Compartment Syndrome and Popliteal Artery Entrapment Syndrome

  https://www.mdpi.com/2075-4418/14/16/1825

  Exertional leg pain occurs with notable frequency among athletes and poses diagnostic challenges to clinicians due to overlapping symptomatology. […] The initial assessment yielded a diagnosis of chronic exertional compartment syndrome (CECS), predicated on the results of compartment testing. However, her clinical presentation was suspicious for concurrent type VI popliteal artery entrapment syndrome (PAES), prompting further radiographic testing of magnetic resonance angiography (MRA). MRA revealed severe arterial spasm with plantarflexion bilaterally, corroborating the additional diagnosis of PEAS. […] This case underscores the importance for clinicians to be aware that the successful diagnosis of one condition does not exclude the possibility of a secondary, unrelated pathology. […] Diagnostic approaches to these diseases include physical exam maneuvers and various imaging modalities. In this specific case, dynamic imaging modalities were the most elucidating in the assessment of external vascular compression, vessel wall disease, and musculoskeletal overuse syndromes.

• #51 Nonatheromatous popliteal artery diseases causing claudication or limb-threatening ischemia – UpToDate

  https://www.uptodate.com/contents/nonatheromatous-popliteal-artery-diseases-causing-claudication-or-limb-threatening-ischemia

  Nonatheromatous popliteal artery diseases that can cause symptoms of claudication or, rarely, limb-threatening ischemia predominantly include popliteal artery entrapment syndrome and adventitial cystic disease. Affected patients are typically younger compared with those affected by peripheral artery disease and lack typical risk factors associated with atherosclerosis. […] The clinical features, diagnosis, and treatment of nonatheromatous popliteal artery disease are reviewed. […] The clinical features, diagnosis, and management of atherosclerotic lower extremity disease are reviewed elsewhere.

• #52

  https://link.springer.com/article/10.1007/s12262-024-04065-2

  Popliteal artery entrapment syndrome (PAES), a rare vascular developmental anomaly, occurs due to abnormal relationship between popliteal artery and the myofascial structures in the popliteal fossa. […] Diagnosis remains challenging as symptoms mimic other vascular conditions like peripheral arterial occlusive disease (PAOD), thromboangiitis obliterans (TAO), adventitial cystic disease (ACD), fibro-muscular dysplasia (FMD), small- and medium-vessel vasculitis etc. […] CT angiogram and MRI are the investigations of choice and surgery is considered as the mainstay of treatment. […] PAES with popliteal artery occlusion was suspected clinically, confirmed on imaging and treated successfully by popliteal artery (P1-P3) reverse saphenous vein graft (RSVG) with favorable outcome.

• #53 Uncommon Diseases of The Popliteal Artery: A Pictorial Review | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-016-0513-6

  Uncommon diseases of the popliteal artery include cystic adventitial disease, popliteal artery entrapment syndrome (PAES) and popliteal artery aneurysm (PAA). Because all of these conditions may present with pain or intermittent claudication, imaging is crucial for differentiating them and directing management. Delayed diagnosis can lead to major complications, including acute limb ischemia. Our aim is to provide an illustrative overview of these conditions in order to make radiologists aware of them and avoid misdiagnosis for timely appropriate management. […] Imaging plays a central role in the diagnosis of cystic adventitial disease. While all modalities are helpful, ultrasound, magnetic resonance (MR) imaging, and MR angiography are the most helpful, because of their ability to identify cystic lesions within the wall of the popliteal artery.

• #54 Popliteal artery entrapment syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/symptoms-causes/syc-20465211

  Popliteal artery entrapment syndrome (PAES) is an uncommon condition that affects the main artery behind the knee. […] Make an appointment for a health checkup if you have any type of leg pain. This is especially important if you have calf or foot cramping during activity that gets better with rest. […] Popliteal artery entrapment syndrome (PAES) is caused by an irregular calf muscle, usually the gastrocnemius muscle. […] The changes in the calf muscle cause it to press on the main artery behind the knee. This reduces blood flow to the lower leg. The lack of blood flow causes pain and cramping in the back of the lower leg during times of activity. […] Long-term pressure on the popliteal artery can cause the artery to narrow. This is called artery stenosis. It can cause pain and cramping with just slight activity, such as walking. […] Older athletes with symptoms of popliteal artery entrapment syndrome should be checked for a ballooning or bulging of the artery. This is called a popliteal aneurysm. It is common in older men.

• #55

  https://link.springer.com/article/10.1007/s12262-024-04065-2

  Popliteal artery entrapment syndrome (PAES), a rare vascular developmental anomaly, occurs due to abnormal relationship between popliteal artery and the myofascial structures in the popliteal fossa. […] Diagnosis remains challenging as symptoms mimic other vascular conditions like peripheral arterial occlusive disease (PAOD), thromboangiitis obliterans (TAO), adventitial cystic disease (ACD), fibro-muscular dysplasia (FMD), small- and medium-vessel vasculitis etc. […] CT angiogram and MRI are the investigations of choice and surgery is considered as the mainstay of treatment. […] PAES with popliteal artery occlusion was suspected clinically, confirmed on imaging and treated successfully by popliteal artery (P1-P3) reverse saphenous vein graft (RSVG) with favorable outcome.

• #56 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  Popliteal artery entrapment syndrome (PAES) is an uncommon cause of lower extremity exertional claudication due to external compression of vascular structures in the popliteal fossa. […] Typical presentation of unilateral or bilateral, intermittent claudication in the feet and calves specifically after exercise and relieved by rest in a young person should prompt further evaluation. Early diagnosis and intervention is essential for preventing thromboembolic complication and in worst cases limb loss. […] Initial tests with Ankle Brachial indices or Doppler ultrasound with provocative maneuvers will prompt more definitive cross sectional imaging studies. CTA or MRA also with provocative maneuvers has a high sensitivity and specificity and will clinch the diagnosis. […] PAES is a challenging diagnosis due to non-specific symptomatology and is often misdiagnosed as exertional compartment syndrome.

• #57 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  For symptomatic PAES patients, surgical resection has been the management of choice. […] Surgery with popliteal artery release allows for the definitive reestablishment of normal anatomy and often portends excellent results. […] The prognosis of the PAES entirely relies on its detection time. […] If PAES is detected and managed early in the course of the disease, the prognosis of the PAES is generally reasonable. […] However, if the PAES is detected late when extensive arterial damage has already happened, then the patient is at risk of having permanent claudication or even limb loss. […] PAES is a limb-threatening vascular disorder demanding of early clinical diagnosis and early intervention.

• #58 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  For symptomatic PAES patients, surgical resection has been the management of choice. […] Surgery with popliteal artery release allows for the definitive reestablishment of normal anatomy and often portends excellent results. […] The prognosis of the PAES entirely relies on its detection time. […] If PAES is detected and managed early in the course of the disease, the prognosis of the PAES is generally reasonable. […] However, if the PAES is detected late when extensive arterial damage has already happened, then the patient is at risk of having permanent claudication or even limb loss. […] PAES is a limb-threatening vascular disorder demanding of early clinical diagnosis and early intervention.

• #59 Popliteal artery entrapment syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/symptoms-causes/syc-20465211

  Popliteal artery entrapment syndrome (PAES) is an uncommon condition that affects the main artery behind the knee. […] Make an appointment for a health checkup if you have any type of leg pain. This is especially important if you have calf or foot cramping during activity that gets better with rest. […] Popliteal artery entrapment syndrome (PAES) is caused by an irregular calf muscle, usually the gastrocnemius muscle. […] The changes in the calf muscle cause it to press on the main artery behind the knee. This reduces blood flow to the lower leg. The lack of blood flow causes pain and cramping in the back of the lower leg during times of activity. […] Long-term pressure on the popliteal artery can cause the artery to narrow. This is called artery stenosis. It can cause pain and cramping with just slight activity, such as walking. […] Older athletes with symptoms of popliteal artery entrapment syndrome should be checked for a ballooning or bulging of the artery. This is called a popliteal aneurysm. It is common in older men.

• #60 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  For symptomatic PAES patients, surgical resection has been the management of choice. […] Surgery with popliteal artery release allows for the definitive reestablishment of normal anatomy and often portends excellent results. […] The prognosis of the PAES entirely relies on its detection time. […] If PAES is detected and managed early in the course of the disease, the prognosis of the PAES is generally reasonable. […] However, if the PAES is detected late when extensive arterial damage has already happened, then the patient is at risk of having permanent claudication or even limb loss. […] PAES is a limb-threatening vascular disorder demanding of early clinical diagnosis and early intervention.

• #61 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  For symptomatic PAES patients, surgical resection has been the management of choice. […] Surgery with popliteal artery release allows for the definitive reestablishment of normal anatomy and often portends excellent results. […] The prognosis of the PAES entirely relies on its detection time. […] If PAES is detected and managed early in the course of the disease, the prognosis of the PAES is generally reasonable. […] However, if the PAES is detected late when extensive arterial damage has already happened, then the patient is at risk of having permanent claudication or even limb loss. […] PAES is a limb-threatening vascular disorder demanding of early clinical diagnosis and early intervention.

• #62 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  Surgical management of PAES is twofold: decompression of the offending musculotendinous structures and repair of vascular injury. […] For Types I and II PAES, myotomy of the medial head of the gastrocnemius is performed, followed by re-routing of the popliteal artery. […] Outcomes for myotomy are excellent, with 1- and 5-year patency rates of 100%, respectively. […] While the treatment for anatomic PAES is surgical decompression, management of the functional subtype may vary. […] Early surgical treatment before vascular injury and remodeling occur provides for superior outcomes. Specific localization of pain, ABIs, and popliteal DUS can provide rapid indications of pathology. CTA or MRA with provocative maneuvers then classify PAES subtypes and guide surgical planning.

• #63

  https://www.ijcrimedicine.com/archive/2018-articles/2018100046Z09JM-mathew/100046Z09JM-full-text.php

  Following treatment, patients should continue long-term outpatient follow-up. The prognosis of surgically-corrected PAES is often favorable if the diagnosis is made early. Following surgery, more than 90% of patients have a significant improvement in their symptoms and return to normal physical activity within three months. […] With this case presentation, we aimed to emphasize the consideration of popliteal entrapment syndrome in the differential diagnosis in patients presenting with vascular claudication and chronic pain of the lower extremity.

• #64 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  Surgical management of PAES is twofold: decompression of the offending musculotendinous structures and repair of vascular injury. […] For Types I and II PAES, myotomy of the medial head of the gastrocnemius is performed, followed by re-routing of the popliteal artery. […] Outcomes for myotomy are excellent, with 1- and 5-year patency rates of 100%, respectively. […] While the treatment for anatomic PAES is surgical decompression, management of the functional subtype may vary. […] Early surgical treatment before vascular injury and remodeling occur provides for superior outcomes. Specific localization of pain, ABIs, and popliteal DUS can provide rapid indications of pathology. CTA or MRA with provocative maneuvers then classify PAES subtypes and guide surgical planning.

• #65 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  For symptomatic PAES patients, surgical resection has been the management of choice. […] Surgery with popliteal artery release allows for the definitive reestablishment of normal anatomy and often portends excellent results. […] The prognosis of the PAES entirely relies on its detection time. […] If PAES is detected and managed early in the course of the disease, the prognosis of the PAES is generally reasonable. […] However, if the PAES is detected late when extensive arterial damage has already happened, then the patient is at risk of having permanent claudication or even limb loss. […] PAES is a limb-threatening vascular disorder demanding of early clinical diagnosis and early intervention.

• #66 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  Surgical management of PAES is twofold: decompression of the offending musculotendinous structures and repair of vascular injury. […] For Types I and II PAES, myotomy of the medial head of the gastrocnemius is performed, followed by re-routing of the popliteal artery. […] Outcomes for myotomy are excellent, with 1- and 5-year patency rates of 100%, respectively. […] While the treatment for anatomic PAES is surgical decompression, management of the functional subtype may vary. […] Early surgical treatment before vascular injury and remodeling occur provides for superior outcomes. Specific localization of pain, ABIs, and popliteal DUS can provide rapid indications of pathology. CTA or MRA with provocative maneuvers then classify PAES subtypes and guide surgical planning.

• #67

  https://journals.lww.com/ijvs/fulltext/2021/08030/popliteal_artery_entrapment_syndrome__our.12.aspx

  The treatment of PAES is based on the type of entrapment and degree of arterial pathology. It can range from simple myotomy of the medial head of the gastrocnemius to vascular repair or grafting if arterial damage is present, to endarterectomy in the presence of a thrombus. […] PAES is uncommon, and early recognition based on history, physical examination, and imaging results is paramount to initiate treatment and avoid the severe late presentation of acute limb ischemia.

• #68 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  Surgical management of PAES is twofold: decompression of the offending musculotendinous structures and repair of vascular injury. […] For Types I and II PAES, myotomy of the medial head of the gastrocnemius is performed, followed by re-routing of the popliteal artery. […] Outcomes for myotomy are excellent, with 1- and 5-year patency rates of 100%, respectively. […] While the treatment for anatomic PAES is surgical decompression, management of the functional subtype may vary. […] Early surgical treatment before vascular injury and remodeling occur provides for superior outcomes. Specific localization of pain, ABIs, and popliteal DUS can provide rapid indications of pathology. CTA or MRA with provocative maneuvers then classify PAES subtypes and guide surgical planning.

• #69 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  Besides, the duplex arterial ultrasonography (DAU) using provocative maneuvers (leg/foot positioned first in a neutral position and then in resisted plantar flexion) provides a quick, inexpensive, and non-invasive initial screening test. […] Findings of arterial compromise or prominent collaterals in the fossa suggest the diagnosis of PAES. […] The management of the PAES is tailored based on the presence and absence of the symptoms. […] For asymptomatic patients with incidental findings of popliteal artery entrapment, management is typically expectant, as the majority of these patients never experience symptoms or disease progression. […] On the contrary, if muscle insertion abnormalities are the cause of the PAEs even in an asymptomatic patient, surgical correction is the preferred method of treatment.

• #70 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  Besides, the duplex arterial ultrasonography (DAU) using provocative maneuvers (leg/foot positioned first in a neutral position and then in resisted plantar flexion) provides a quick, inexpensive, and non-invasive initial screening test. […] Findings of arterial compromise or prominent collaterals in the fossa suggest the diagnosis of PAES. […] The management of the PAES is tailored based on the presence and absence of the symptoms. […] For asymptomatic patients with incidental findings of popliteal artery entrapment, management is typically expectant, as the majority of these patients never experience symptoms or disease progression. […] On the contrary, if muscle insertion abnormalities are the cause of the PAEs even in an asymptomatic patient, surgical correction is the preferred method of treatment.

• #71 Popliteal Artery Entrapment Syndrome (PAES): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17375-popliteal-artery-entrapment-syndrome-paes

  Popliteal artery entrapment syndrome (PAES) is a rare condition that causes leg pain in some young athletes. […] A vascular specialist is the type of healthcare provider who can best diagnose PAES. Theyll do a physical exam that includes checking the pulse in your foot and your popliteal artery. […] To check for PAES, your healthcare provider will get resting leg blood pressures and look for a drop with exercise. […] Diagnostic tests measure blood flow through your knee, leg and foot. […] Surgery is the preferred treatment for popliteal artery entrapment syndrome because it gives excellent results for most people. […] The popliteal artery entrapment syndrome recovery time after surgery is four to six months. […] Surgical treatment is successful in more than 90% of people and its unlikely that theyll have symptoms again. […] If you have popliteal artery entrapment syndrome, talk with your provider about whether surgery is right for you. Its been a successful treatment in many cases.

• #72 A rare cause of intermittent claudication: recurrence of popliteal artery entrapment syndrome in a 16-years-old boy – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?lang=en&id=1808

  Color Doppler sonography is the primary imaging method used in the diagnosis of PAES, and it may also reveal popliteal artery stenosis, changes in color flow, or increased peak systolic velocity. Furthermore, this type of imaging also sometimes show the popliteal fossa anatomy and poststenotic aneurysms. Computed tomography angiography and magnetic resonance imaging (MRI) can show arterial stenosis, poststenotic dilatation, and the popliteal fossa anatomy. However, MRI is the best choice for evaluating the popliteal fossa anatomy and vascular compromise without the use of ionizing radiation or iodinated contrast material. […] The primary treatment method for PAES is surgery that involves extracting the muscle or tendons which causing the entrapment and also if necessary vessel lumen should be restored with endarterectomy or bypass grafting. The endovascular treatment of PAES not preferred choice without removing the underlying reason for the vessel entrapment however combined therapy-endovascular and surgical- had been performed. […] Therefore, the pediatrician has to look for the presentation of claudication, which is the primary symptom of PAES. After surgery, teenage patients should be followed up closely to check for recurrence of this syndrome.

• #73 What is Popliteal Artery Entrapment Syndrome? – Brisbane Physiotherapy & Podiatry

  https://www.brisbanephysiotherapy.com/news/popliteal-artery-entrapment-syndrome-physiotherapy

  Diagnosing PAES involves a combination of clinical evaluation, imaging studies, and specialized tests. Magnetic resonance imaging (MRI), computed tomography (CT) angiography, or duplex ultrasound may be used to visualize the popliteal artery and assess for signs of compression or obstruction. Clinically assessing the lower limb pulses in a variety of different knee positions or performing an ankle-brachial index (ABI) test may be performed to evaluate circulation and blood flow. […] Understanding the causes, symptoms, and treatment options for PAES is essential for accurate diagnosis and effective management. If you’re experiencing symptoms suggestive of PAES, it’s important to consult with a healthcare professional for evaluation and appropriate treatment.

• #74 Popliteal artery entrapment syndrome – Bradshaw – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/46396/html

  Popliteal artery entrapment syndrome (PAES) is an uncommon cause of lower extremity exertional claudication due to external compression of vascular structures in the popliteal fossa. […] Typical presentation of unilateral or bilateral, intermittent claudication in the feet and calves specifically after exercise and relieved by rest in a young person should prompt further evaluation. Early diagnosis and intervention is essential for preventing thromboembolic complication and in worst cases limb loss. […] Initial tests with Ankle Brachial indices or Doppler ultrasound with provocative maneuvers will prompt more definitive cross sectional imaging studies. CTA or MRA also with provocative maneuvers has a high sensitivity and specificity and will clinch the diagnosis. […] PAES is a challenging diagnosis due to non-specific symptomatology and is often misdiagnosed as exertional compartment syndrome.

• #75 What is Popliteal Artery Entrapment Syndrome? – Brisbane Physiotherapy & Podiatry

  https://www.brisbanephysiotherapy.com/news/popliteal-artery-entrapment-syndrome-physiotherapy

  Diagnosing PAES involves a combination of clinical evaluation, imaging studies, and specialized tests. Magnetic resonance imaging (MRI), computed tomography (CT) angiography, or duplex ultrasound may be used to visualize the popliteal artery and assess for signs of compression or obstruction. Clinically assessing the lower limb pulses in a variety of different knee positions or performing an ankle-brachial index (ABI) test may be performed to evaluate circulation and blood flow. […] Understanding the causes, symptoms, and treatment options for PAES is essential for accurate diagnosis and effective management. If you’re experiencing symptoms suggestive of PAES, it’s important to consult with a healthcare professional for evaluation and appropriate treatment.

• #76 Popliteal artery entrapment syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/diagnosis-treatment/drc-20465225

  To diagnose popliteal artery entrapment syndrome (PAES), the health team checks you and asks questions about your symptoms and health history. But because most people with PAES are young and usually in good health, diagnosing the condition can sometimes be challenging. There are typically no unusual findings from a physical exam. […] Tests are done to rule out other causes of leg pain, including muscle strains, stress fractures and peripheral artery disease, which results from clogged arteries. […] Ankle-brachial index (ABI) measurement is usually the first test done to diagnose PAES. Blood pressure measurements are taken in the arms and legs during and after walking on a treadmill. The ABI is determined by dividing ankle pressure by arm pressure. The blood pressure in the legs should be higher than that in the arms. But if you have PAES, your ankle pressure drops during exercise.

• #77 VASCULAR ULTRASOUND FOR POPLITEAL ARTERY ENTRAPMENT – Mayfair Diagnostics

  https://www.radiology.ca/article/vascular-ultrasound-popliteal-artery-entrapment/

  Popliteal artery entrapment syndrome (PAES) is an uncommon vascular condition that occurs when the calf muscles compress the main artery behind the knee (the popliteal artery). […] PAES can be challenging to diagnose because its relatively uncommon and it affects otherwise healthy young adults. The symptoms can also mimic other conditions, such as knee joint pain or other muscle-related problems. In many cases, a diagnosis is made via medical imaging using vascular ultrasound. […] For PAES, a vascular ultrasound exam can assess the popliteal artery with the calf in a neutral or relaxed position and in a flexed position, such as standing on tip toes, toes bent back, or toes pointed forward. Images can then be generated that help determine whether there is any compression or blockage of the popliteal artery that could indicate popliteal artery entrapment syndrome.

• #78 Type 2 popliteal artery entrapment syndrome: a case report – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?lang=en&id=1681

  In this article, we report a 39-year-old male case who was admitted with claudication and diagnosed with popliteal artery entrapment syndrome. The diagnosis of popliteal artery entrapment syndrome was established by means of magnetic resonance imaging. […] The patient was scheduled for aorto-iliac and femoro-popliteal angiography. […] A right popliteal magnetic resonance imaging (MRI) was performed to demonstrate the entrapment, and this showed the medial head of the gastrocnemius muscle passing between the popliteal artery and the vein, and it had attached itself to the medial condyle of the femur. Therefore, the diagnosis of PAES was confirmed. […] Because it is a rare cause of lower extremity claudication, diagnosis of PAES has a high rate of suspicion. The definitive diagnostic tool for this syndrome is an MRI.

• #79 Popliteal artery entrapment syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/diagnosis-treatment/drc-20465225

  Duplex ultrasound of the calf uses high-frequency sound waves to show how fast blood moves through the leg arteries. This test may be done before or after exercise. You may be asked to flex your foot up and down, which puts your calf muscle to work. […] Magnetic resonance angiography (MRA) shows if the calf muscle is trapping the artery. It also can tell how much of the popliteal artery is narrowed. You may be asked to flex your foot or press it against a board during this test. Doing so helps show how blood is flowing to your lower leg. […] CT angiography also shows which leg muscle is causing the artery entrapment. As with MRA, you may be asked to move your foot during this test. […] Catheter-based angiography shows how blood is flowing to and from the lower leg in real time. It’s done if the diagnosis is still unclear after other, less-invasive imaging tests.

• #80 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  The rare clinical manifestation of Popliteal Artery Entrapment Syndrome (PAES) was defined approximately 40 years ago. […] This activity describes the evaluation, and treatment of PAES, and reviews the role of the interprofessional team in managing patients with this condition. […] The advances in radiological imaging likewise allowed far better delineation and also enhanced sensitivity in detecting PAES. […] A combination of the magnetic resonance imaging (MRI) with arteriography has been reported to be one of the most accurate diagnostic approaches for the PAES. […] Diagnosis of the PAES poses a considerable clinical challenge as it calls for the proper interpretation of clinical as well as radiological aspects of this rare clinical entity. […] In a recent study on exploring the best diagnostic modality for the PAES, Willimas et al. reported that a combination of the MRI and the duplex ultrasonography (DU) is far superior in diagnosing PAES.

• #81 Popliteal Artery Entrapment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441965/

  For symptomatic PAES patients, surgical resection has been the management of choice. […] Surgery with popliteal artery release allows for the definitive reestablishment of normal anatomy and often portends excellent results. […] The prognosis of the PAES entirely relies on its detection time. […] If PAES is detected and managed early in the course of the disease, the prognosis of the PAES is generally reasonable. […] However, if the PAES is detected late when extensive arterial damage has already happened, then the patient is at risk of having permanent claudication or even limb loss. […] PAES is a limb-threatening vascular disorder demanding of early clinical diagnosis and early intervention.

• #82 POPLITEAL ARTERY ENTRAPMENT SYNDROME | Sports Medicine Today

  https://www.sportsmedtoday.com/popliteal-artery-entrapment-syndrome-va-252.htm

  Popliteal Artery Entrapment Syndrome (PAES) is an uncommon vascular condition that affects the legs, most often in younger male athletes. […] A sports medicine physician will carefully review the symptoms, and examine the leg for swelling, coolness and decreased sensation. […] Based on the evaluation findings, the physician may recommend testing to evaluate the blood flow below the knee. […] Being aware of this syndrome is crucial for the early diagnosis and prevention of disease progression.

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