Materiały źródłowe

• #1 Popliteal Artery Entrapment Syndrome: A Diagnostic Enigma. Case Report and Current Concepts Review in: International Journal of Athletic Therapy and Training Volume 27 Issue 1 (2021)

  https://journals.humankinetics.com/view/journals/ijatt/27/1/article-p12.xml

  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. […] Ultimately the athletes 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 athletes condition and return him to distance running.

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

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

  Treatment for PAES aims to relieve arterial compression, restore normal blood flow, and alleviate symptoms. Depending on the severity of the condition, treatment options may include: […] Initially, conservative management strategies such as activity modification, rest, and nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to alleviate symptoms and reduce inflammation. […] Prescribed stretching and strengthening exercises can help improve muscle flexibility, reduce tension in the popliteal fossa, and optimize lower limb biomechanics. […] In cases where conservative measures fail to provide relief, surgical intervention may be necessary to release the entrapped artery and relieve pressure on the popliteal artery. Surgical options may include arterial decompression, arterial repositioning, or muscle release procedures.

• #1

  https://drtobycohen.com.au/popliteal-entrapment-syndrome/

  If you are diagnosed with PAES there are a number of treatment options available to you. Doctor Cohen will discuss each of these with you, and together you can decide on the best course of action. […] Your treatment depends on the underlying cause of the entrapment. Conservative management is the mainstay of treatment. This usually involves a combination of Botox therapy and functional rehabilitation. The Botox will be injected into the calf muscle to try and reduce their size, and therefore overcrowding of the popliteal fossa. This treatment is coupled with strengthening of the hamstring muscles and rehabilitation of the calf muscles. The Botox will usually last around six months. If conservative therapy fails surgery will be considered. […] The surgery normally involves an incision above the knee or inside the thigh. This allows access to the origin of the muscles which are responsible for the overcrowding. This will help release the abnormal calf muscle and give the popliteal artery more room. This procedure will take around one hour and you can go home the following day. […] As with all surgery, you will be required to undergo an important rehabilitation process. This process will be discussed with you when you meeting with Doctor Cohen regarding treatment options.

• #1 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. Surgery has a high success rate and recovery takes four to six weeks. […] Your healthcare provider can do surgery to remove a small portion of your gastrocnemius and popliteus muscle. This eliminates the compression of your artery and allows normal blood flow to your leg. […] Surgery is the preferred treatment for popliteal artery entrapment syndrome because it gives excellent results for most people. More than 90% of people who have the surgery have great improvement in their symptoms afterward. […] The only non-surgical treatment for the functional type of PAES uses injections of Botulinum toxin A. […] However, this effect only lasts for three to six months. If the muscle doesn’t get smaller, the symptoms will happen again. This has been successful in less than 60% of people a year after treatment.

• #1 Popliteal Artery Entrapment Syndrome – Sports Medicine Review

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

  Treatment of the functional subtype of popliteal artery entrapment syndrome has proven to be more difficult, and no standardized approach has been accepted. The main issue with surgical intervention is the balance of symptom relief with potential functional consequences. Depending on the location of the stenosis seen with provocative maneuvers in patients with functional popliteal artery entrapment syndrome, either a posterior or medial approach can be taken. For the more proximal lesions, a posterior approach is favored, and, for lower lesions, the medial approach should be used […] A relatively novel and promising approach has been described using botulinum toxin A as a means of chemically debulking the gastrocnemius and relieving the compressive effect on the artery. A large case series with 27 subjects reported close to a 60% favorable response rate at a 1-year follow-up with no reported complication or reduction in function. Although there is currently no set of concrete indications for its use, botulinum toxin A may present a valid nonoperative option to those diagnosed with functional popliteal artery entrapment syndrome in which the hypertrophied musculature is the cause of entrapment. Furthermore, those who wish to avoid or delay a surgical procedure or who are not surgical candidates may benefit from this treatment.

• #1 Popliteal Artery Entrapment Syndrome (PAES) – Motus Physical Therapy

  https://motusspt.com/popliteal-artery-entrapment-syndrome-paes/

  The treatment of PAES is aimed at relieving the symptoms and restoring normal blood flow to the affected limb. Treatment options include: […] Surgery is the most common treatment for PAES. The goal of surgery is to release the trapped artery and restore blood flow. Surgery may be performed through a small incision (endoscopic surgery) or a larger incision (open surgery). […] Endovascular stenting: This procedure involves the placement of a small metal mesh tube (stent) in the blocked artery. The stent opens up the artery and restores blood flow. […] Balloon angioplasty: This procedure involves inflating a small balloon at the site of the blockage. The balloon opens up the artery and restores blood flow. […] Drug therapy may be used to treat the symptoms of PAES. Drugs that may be used include pain relievers, anti-inflammatory drugs, and blood thinners.

• #1 Popliteal Artery Disease Treatment & Management: Approach Considerations, Medical Therapy, Preoperative and Intraoperative Considerations

  https://emedicine.medscape.com/article/461910-treatment

  The advent of cilostazol and its subsequent approval by the US Food and Drug Administration (FDA) represented a significant advance in pharmacologic treatment of patients with intermittent claudication. […] Atherosclerotic popliteal thrombosis in which the limb is not imminently threatened is best treated medically. […] Treatment with lysis, such as with urokinase and alteplase (TPA), can be efficacious. However, emboli are likely to recur if definitive therapy is not undertaken for the underlying problem. […] Aside from surgical intervention, rest is the only other treatment shown to decrease symptoms. […] No effective medical treatments are available for cystic adventitial disease. […] Surgical therapy for popliteal artery occlusion involves bypass of the occlusion, which can be achieved with grafts, including great saphenous vein (GSV) or prosthetic (eg, polytetrafluoroethylene [PTFE]) grafts.

• #1 Mayo Clinic Health Library – Popliteal artery entrapment syndrome | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20459610

  If popliteal artery entrapment syndrome (PAES) symptoms significantly affect everyday or athletic activities, surgery may be suggested. Surgery is the only way to fix the calf muscle and free the trapped artery. […] Surgery is done at a hospital or medical center while you are under general anesthesia. During surgery, the surgeon makes a cut on the inner calf just below or in the back of the knee. This releases the calf muscle to give the artery more room. The calf muscle no longer presses on the artery. […] Popliteal artery entrapment syndrome surgery takes about an hour. Typically, you’ll need to stay in the hospital for one day. […] If you’ve had the condition for a long time and have severe narrowing of the artery, you may need another surgery called an artery bypass. […] Surgery to release the calf muscle and artery usually doesn’t affect how the leg works. When the condition is diagnosed and treated early, a full recovery is expected, and symptoms should disappear.

• #1 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. In anatomic PAES, surgical correction of the aberrant anatomy is always necessary, as the natural history of the syndrome involves vascular injury and occlusion over time. For Types I and II PAES, myotomy of the medial head of the gastrocnemius is performed, followed by re-routing of the popliteal artery. Type III involves resection of the accessory slip. Type IV requires release of the popliteus, re-routing of the popliteal artery, with or without subsequent repair of the muscle. Treatment of Type V is similar, with the additional decompression of the popliteal vein. Outcomes for myotomy are excellent, with 1- and 5-year patency rates of 100%, respectively. […] If vascular pathology, such as intimal injury and fibrosis with stenosis and/or post-stenotic dilatation, is present repair or revascularization is necessary. Thromboendarterectomy and venous patch arterioplasty versus saphenous vein graft bypass should be considered, with the outcomes for the former reported to be slightly inferior. Placement of an endovascular stent is not recommended. Complications from arterial reconstruction are more frequent, with a median failure rate of 27.5%; however, these events are concentrated among cases with lesions extending beyond the popliteal artery. Overall, resolution of symptoms has been demonstrated in a median of 77% of patients.

• #1 SAVS – A Novel Approach To The Treatment Of Popliteal Artery Entrapment Syndrome In College Athletes

  https://meeting.savs.org/abstracts/2021/MP4.cgi

  A Novel Approach To The Treatment Of Popliteal Artery Entrapment Syndrome In College Athletes […] Most commonly, FPAES is surgically treated with muscle debulking utilizing a posterior S-shaped incision. […] Here we present our case series of college athletes undergoing FPAES repair utilizing a novel medial incision approach. […] We demonstrate favorable results and a low rate of complications for release of FPAES utilizing the medial approach. Our surgical approach avoids the wound complications of infection and neuropathy inherent to the posterior approach and may provide comparable hemodynamic outcomes for patients with FPAES.

• #1 Popliteal Artery Disease Treatment & Management: Approach Considerations, Medical Therapy, Preoperative and Intraoperative Considerations

  https://emedicine.medscape.com/article/461910-treatment

  Surgical treatment is advised in all types of popliteal entrapment syndrome. Recognition of progressive fibrosis with subsequent thrombosis in untreated entrapped artery supports early surgical intervention. […] There is evidence to suggest that when a popliteal artery has undergone fibrotic changes and occlusion, resection and vein (preferably GSV) graft interposition are required to ensure optimal long-term patency in these often young, physically active individuals. […] Cystic adventitial disease has been treated in numerous ways. Evacuation with removal of the cyst wall had a 94% initial success rate in 68 operations performed. […] Resection with a vein graft had a 95% initial success rate in 54 operations performed.

• #1 Surgical Treatment for Popliteal Artery Entrapment Syndrome, a Common Cause of a rare Clinical Entity: Report of One Case

  https://pubs.sciepub.com/ajmcr/3/11/8/index.html

  Thus, an indication for popliteal-popliteal bypass surgery, with interposition of the great saphenous vein, was quickly made. […] Once the diagnosis has been confirmed, surgical treatment should be considered, even if the patient is asymptomatic. […] Revascularization should be performed when the entrapped popliteal artery shows injury to the intima, such as fibroplasias, stenosis or aneurysmatic transformation.

• #1 Popliteal Artery Disease Treatment & Management: Approach Considerations, Medical Therapy, Preoperative and Intraoperative Considerations

  https://emedicine.medscape.com/article/461910-treatment

  GSV bypass can be used in a reversed or a nonreversed in-situ orientation. […] Percutaneous transluminal angioplasty (PTA) is a less invasive intervention in the treatment of popliteal artery occlusive disease. […] Although open repair has traditionally been recommended for TransAtlantic Inter-Society Consensus (TASC) II class D femoropopliteal lesions, there is evidence to suggest that in some cases, endovascular repair is a reasonable alternative for these lesions. […] Some studies have suggested that the use of drug-coated balloons (DCBs) is safe and effective for femoropopliteal disease, especially for preventing restenosis. […] The relative lack of long-term success rates with PTA and stenting led to the development of other endovascular procedures, such as atherectomy, laser angioplasty, cutting balloon angioplasty, cryoplasty, and brachytherapy.

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

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

  Management of PAES depends on the syndrome sub-type (anatomic or functional) and the acuity of presentation. Surgical decompression is crucial to relieve the aberrant anatomic causes of arterial compression. Earlier treatment likely consists only of musculotendinous release, rather than additional arterial bypass, which may be required once severe vascular damage has occurred, with inferior results. For the patient with emergent symptoms of acute limb ischemia, assessment should be made according to the Rutherford criteria. Viable or marginally threatened extremities (Rutherford I or IIa) may be considered for elective surgery with or without CDT. Immediately threatened (Rutherford IIb) limbs should undergo emergent revascularization. […] CDT may be considered for patients with acute PAES with new, severe symptoms for less than 2 weeks (prior to clot organization) and angiographic evidence of acute arterial occlusion. Both fibrinolytic and mechanical thrombectomy approaches have been successfully reported. However, these techniques do not address the underlying anatomic pathology, resulting in high rates of re-stenosis. Thrombolysis may be useful in cases of acute PAES with distal crural emboli to restore distal outflow.

• #1 Frontiers | Case Report: COVID-19 exacerbates acute lower limb ischemia in patients with popliteal artery entrapment syndrome

  https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1329863/full

  Popliteal artery entrapment syndrome (PAES) is a rare clinical ischemic disease of the lower limbs, mainly caused by various reasons such as popliteal artery compression and stenosis and secondary thrombosis caused by an injury of the vascular endothelium due to exercise and other factors. […] If not diagnosed and treated appropriately, it may lead to disability and even serious consequences, such as amputation. […] Anticoagulants and vasodilators are the conventional therapy. Furthermore, open surgery and endovascular intervention are the fundamental therapies to cure patients. The key to treating PAES lies in relieving popliteal artery compression and restoring the blood supply to the affected limb. Clinically, for patients with acute ischemia whose disease duration is less than 2 weeks, femoral artery incision thrombectomy or catheterization thrombolysis of the affected limb can be selected to restore the blood supply of the lower limb.

• #1 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. […] Management can range from non-intervention to open surgical decompression with a generally good prognosis. […] Symptomatic patients: open surgical decompression is the mainstay of treatment for PAES. The release of entrapment is achieved by performing division of the medial head of the gastrocnemius or musculotendinous band. […] Additionally, the use of Botulinum Toxin A has been used as an alternative noninvasive treatment for functional PAES. […] The outcome following the surgery is usually favorable. Successful resolution of PAES occurs in 77 percent of cases. […] Surgical complications include deep vein thrombosis, hematoma, wound infection, or seroma.

• #1 Circulation Clinic | Popliteal entrapment surgery

  https://www.circulationclinic.com/popliteal-entrapment-surgery

  Once the muscle anatomy has been reconstructed and there is restoration of flow through the popliteal artery or bypass the popliteal entrapment reconstruction is complete. […] The vast majority of patients undergoing popliteal artery entrapment release surgery do not suffer any significant complications. […] Clients who have had a formal reconstruction of their medial head of gastrocnemius will require physiotherapy upon removal of their plaster. This is aimed at gradually strengthening your newly positioned muscle and returning you to full fitness. […] All clients who have undergone a bypass as part of their surgery are entered into a graft surveillance programme to help prevent graft failure through early identification of graft or native artery narrowing.

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

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

  If compression is detected and the popliteal artery remains healthy, surgery most often results in restoring normal blood flow to the leg. During this surgery, an incision is made behind the knee to access the popliteal artery, and the muscle, tendon or band causing the compression is relieved. […] In more advanced cases, the compression may cause permanent change to the artery or complete blockage. For these patients, bypass surgery is performed using either a vein or synthetic graft to bypass the blocked section of the artery to create a new pathway for blood to reach the lower leg. The muscle, tendon or band responsible for the compression is also corrected. […] Recovery for either surgery is 4-6 weeks, depending on the individuals level of activity, with high-intensity athletes requiring the longest recovery period.

• #1 Surgical Treatment and Rehabilitation of Bilateral Popliteal Artery Entrapment Syndrome in a Young Boxer: A Case Report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10735325/

  Popliteal artery entrapment syndrome should be treated promptly when diagnosed, as the vascular lesion can progress. […] He was diagnosed with popliteal artery entrapment syndrome, and surgery treatment with reconstruction of the medial gastrocnemius muscle to maintain muscle strength was performed in collaboration with a cardiovascular surgeon. […] This case focuses on the early diagnosis of and proper orthopedic approach to popliteal artery entrapment syndrome, which is considered important to enable patients to return to high-level sports. […] Proper surgical treatment and postoperative rehabilitation are important for the return to high-level sports. […] Functional reconstruction is necessary for maintaining muscle strength in high-level athletes. […] Rehabilitation is essential to return to high-level sports.

• #1 Popliteal Artery Entrapment Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27432

  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. […] Furthermore, 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. […] Also, the open surgical procedures offer the best results to address the PAES and assess the artery for repair or bypass. […] Moreover, the management of functional PAES is still controversial although some have had success with gastrocnemius debulking. […] Post-operatively, surveillance is performed using arterial duplex imaging at 1, 3, 6, and 12 months, and annually after that.

• #1 Popliteal artery entrapment syndrome – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/care-at-mayo-clinic/mac-20465235

  Mayo Clinic doctors trained in evaluating and treating vascular diseases and performing vascular surgery and other health care staff work closely to evaluate and treat people with popliteal artery entrapment syndrome and other vascular conditions. […] Mayo Clinic doctors use the most current technology in popliteal artery entrapment treatment syndrome. […] This collaborative approach means your health care team can often evaluate you and create a treatment plan within 2 to 3 days. […] Doctors at Mayo Clinic’s Vascular Centers are focused on developing cutting-edge diagnostic tests and innovative treatments for people with vascular disease.

• #1 Popliteal Artery Entrapment Syndrome – Sports Medicine Review

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

  The treatment for popliteal artery entrapment syndrome will vary on the basis of anatomic or functional entrapment and the timing of diagnosis. Depending on the severity of the diagnosis, definitive care may require a joint operation with vascular surgery. In cases of anatomic popliteal artery entrapment syndrome, surgical correction of the anatomic aberrancy should be performed regardless of the severity of symptoms, as the natural history is vascular injury and occlusion over time […] Conversely, in patients with functional popliteal artery entrapment syndrome, vascular injury is virtually never seen, and surgical intervention is for symptom relief. In Type I situations, a surgical myotomy is performed with rerouting of the popliteal artery, with or without vascular repair as needed. For Type II situations, a surgical myotomy of the aberrant gastrocnemius insertion is performed. A Type III situation is the most straightforward treatment with resection of the accessory band. In a Type IV situation, a surgical release of the popliteus is performed with rerouting of the popliteal artery, with or without subsequent repair of the popliteus. Type V cases require similar treatments to those of Type I to III cases, depending on presentation but with associated relief of vein compression as well. Results for myotomy are excellent, with 100% patency results at 1 and 10 years postoperatively

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

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

  While the treatment for anatomic PAES is surgical decompression, management of the functional subtype may vary. Surgical approaches include lysis of fascial attachments, release of the plantaris tendon, and myotomy of the gastrocnemius, soleus, and/or plantaris. Recurrent or residual symptoms occurred in 9.2% of patients, with 7.1% undergoing a revision surgery. Botulinum toxin A injection has recently been reported as a non-invasive treatment for functional PAES. Similar to its use in chemically denervating the anterior scalene muscles to relieve neurovascular compression in thoracic outlet syndrome, botulinum toxin may relax the hypertrophied gastrocnemius to reduce PAES symptoms. One to three injections of 100 MU (mouse units) of botulinum toxin into the medial head of the gastrocnemius and/or plantaris resulted in partial symptomatic improvement in 82.9% of cases. While the duration of action of botulinum toxin is only 3 to 6 months, the lack of any serious complications makes this a reasonable therapeutic trial for patients with functional PAES.

• #1 Dry Needling of the Medial Gastrocnemius as Novel Treatment for Type-VI Functional Popliteal Artery Entrapment Syndrome|crimson publishers.com

  https://crimsonpublishers.com/rism/fulltext/RISM.000679.php

  Popliteal artery entrapment syndrome is rare, commonly overlooked, and characterized by the compression of the popliteal artery via the surrounding myofascial structures. […] This is the first case in current literature to report ultrasound-guided dry needling to the medial head of the gastrocnemius as novel treatment for functional popliteal artery entrapment syndrome. […] Treatment of PAES depends on the classification and its compression site. Historically, surgery has been the recommended treatment with good, reported outcomes. […] With regards to non-operative treatment, there have been limited reports of successful functional PAES treatment with intramuscular botulism toxin injections to the medial head of the gastrocnemius but more research is needed. […] After discussion of potential treatment options including consultation with vascular and orthopedic surgery, the patient declined surgical consultation due to the urgent nature of his upcoming deployment.

• #1 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 PAES seem to be very satisfying. […] Myotomy with or without arterial reconstruction using venous bypass can lead to good patency at 15 years of follow-up. […] Surgical management includes the release of any fibrous structures and sections of the muscular structures compressing the artery. […] In advanced cases with arterial damage, such as arterial stenosis or occlusion, revascularization surgery is needed. […] Autologous venous bypass grafting is a valid option. […] Those patients treated with MTS had a 15-year patency rate of 98%, whereas those treated with reconstruction had a 71% of patency rate at a 15-year follow-up (p < 0.001).

• #1 Surgical Treatment for Popliteal Artery Entrapment Syndrome, a Common Cause of a rare Clinical Entity: Report of One Case

  https://pubs.sciepub.com/ajmcr/3/11/8/index.html

  Popliteal artery entrapment syndrome (PAES) is a non-atherosclerotic cause of claudication and acute ischemia of the legs in young individuals. […] The surgical treatment implemented consisted of arterial decompression through sectioning the medial bundle of the gastrocnemius muscle, combined with a popliteal-to-popliteal graft from the great saphenous vein (inverted). […] Surgery is indicated in cases of PAES due to anomalies of muscle insertion, even if the patient is asymptomatic. […] This will probably avoid the risk of losing the limb in cases of irreversible vascular injury. […] Surgery eliminates the factor responsible for popliteal artery entrapment and also enables artery repair in cases of arterial thrombosis. […] In cases of PAES, treatment should be implemented early on, whether or not symptoms are present.

• #1 Popliteal Artery Disease Treatment & Management: Approach Considerations, Medical Therapy, Preoperative and Intraoperative Considerations

  https://emedicine.medscape.com/article/461910-treatment

  Regardless of the reason for popliteal artery occlusion, intervention is indicated in patients with severe claudication that alters lifestyle and does not respond to medical treatment and in patients with critical limb ischemia (CLI; or chronic limb-threatening ischemia [CTLI]). […] Patients with infection or gangrene in deeper tissues require amputation. Amputation is also indicated for those patients who are unable to ambulate because of reasons other than popliteal artery occlusive disease. […] Percutaneous endovascular procedures are increasingly being used to treat peripheral artery disease (PAD). Bare-metal, drug-eluting, biodegradable, and covered stents (stent-grafts) are intended to provide enhanced treatment with a reduced risk of the perioperative complications associated with open surgical treatment. Endovascular management is a reasonable alternative to open surgery in patients for whom standard surgery poses a considerable risk because of coexisting medical conditions.

• #1 What is Popliteal Artery Entrapment Syndrome (PAES)?

  https://vascular.tcvcg.com/blog/what-is-popliteal-artery-entrapment-syndrome-paes

  Popliteal Artery Entrapment Syndrome (PAES) is a vascular condition characterized by the compression or entrapment of the popliteal artery. […] The treatment for PAES depends on the severity of the condition and the impact on the patient’s daily life. Conservative treatments include rest, physical therapy, and modification of activities to reduce symptoms. In more severe cases or when conservative measures fail, surgical intervention may be recommended. […] Surgery for PAES involves releasing the entrapment and restoring normal blood flow to the lower leg. The specific procedure can vary based on the patient’s unique circumstances and the surgeon’s expertise. […] If you suspect that you or someone you know may have PAES, it’s essential to consult with a board-certified vascular specialist for a proper evaluation and personalized treatment plan. With the guidance of medical professionals, individuals with PAES can manage their condition and continue to lead active, healthy lives.

• #2 Popliteal Artery Entrapment Syndrome (PAES) – Physio Plus

  https://physioplus.com.au/popliteal-artery-entrapment-syndrome-paes/

  PAES typically affects a young 20-40yo athletic population and is up to 15x more common in males than females. […] Standard treatment of PAES involves relocating the medial gastroc head, optimizing the popliteal artery tract. However, botulinum A toxin (botox) injections used locally to the site of constriction in the medial gastroc head has gained traction in recent literature and is showing promising results. The procedure is far less invasive than traditional measures and has been shown to effectively reduce the muscles constriction of the vessel during exercise. Another benefit is that recovery time is significantly reduced, the player can return to sports almost immediately as function and pain allow. […] Physio management is involved in retraining the muscle to promote muscle atrophy in the medial gastroc head and guide successful return to sport. Long term management involves educating the patient to avoid excessive training of calves that would promote increased medial calf bulk which would encourage the condition to return.

• #2

  https://www.orthobullets.com/evidence/34106091

  Popliteal artery entrapment syndrome (PAES) is an uncommon condition that causes recurrent posterior leg pain and foot paresthesia in running athletes. […] Nonsurgical treatment with physical therapy and stretching of the gastrocnemius complex should be done as the first line of treatment. […] When conservative treatments are ineffective, referral to a vascular specialist for surgical intervention with a muscular band excision or transection, vascular bypass, or arterial reconstruction is necessary.

• #2 Popliteal Artery Entrapment Syndrome (PAES) — The Physio Lab

  http://www.thephysiolab.com/news/2025/3/7/popliteal-artery-entrapment-syndrome-paes

  The management of PAES typically involves both non-surgical and surgical approaches, depending on the severity of the condition. Early diagnosis and intervention are essential for preventing permanent damage to the popliteal artery. […] In less severe cases of PAES, conservative management may be sufficient. This could include: […] Physiotherapy: Stretching and strengthening exercises can help relieve pressure on the popliteal artery and improve muscle flexibility. Soft tissue releases, joint mobilisations and progressive strengthening of the calf muscles with calf raises and single leg balance exercises form the basis of physio treatment. […] In cases of moderate to severe PAES, surgery is often required to release the compression on the popliteal artery. The most common surgical approaches include:

• #2 Popliteal Artery Entrapment Syndrome – Sports Medicine Review

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

  Treatment of the functional subtype of popliteal artery entrapment syndrome has proven to be more difficult, and no standardized approach has been accepted. The main issue with surgical intervention is the balance of symptom relief with potential functional consequences. Depending on the location of the stenosis seen with provocative maneuvers in patients with functional popliteal artery entrapment syndrome, either a posterior or medial approach can be taken. For the more proximal lesions, a posterior approach is favored, and, for lower lesions, the medial approach should be used […] A relatively novel and promising approach has been described using botulinum toxin A as a means of chemically debulking the gastrocnemius and relieving the compressive effect on the artery. A large case series with 27 subjects reported close to a 60% favorable response rate at a 1-year follow-up with no reported complication or reduction in function. Although there is currently no set of concrete indications for its use, botulinum toxin A may present a valid nonoperative option to those diagnosed with functional popliteal artery entrapment syndrome in which the hypertrophied musculature is the cause of entrapment. Furthermore, those who wish to avoid or delay a surgical procedure or who are not surgical candidates may benefit from this treatment.

• #2 Popliteal Artery Disease Treatment & Management: Approach Considerations, Medical Therapy, Preoperative and Intraoperative Considerations

  https://emedicine.medscape.com/article/461910-treatment

  The advent of cilostazol and its subsequent approval by the US Food and Drug Administration (FDA) represented a significant advance in pharmacologic treatment of patients with intermittent claudication. […] Atherosclerotic popliteal thrombosis in which the limb is not imminently threatened is best treated medically. […] Treatment with lysis, such as with urokinase and alteplase (TPA), can be efficacious. However, emboli are likely to recur if definitive therapy is not undertaken for the underlying problem. […] Aside from surgical intervention, rest is the only other treatment shown to decrease symptoms. […] No effective medical treatments are available for cystic adventitial disease. […] Surgical therapy for popliteal artery occlusion involves bypass of the occlusion, which can be achieved with grafts, including great saphenous vein (GSV) or prosthetic (eg, polytetrafluoroethylene [PTFE]) grafts.

• #2 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. Surgery has a high success rate and recovery takes four to six weeks. […] Your healthcare provider can do surgery to remove a small portion of your gastrocnemius and popliteus muscle. This eliminates the compression of your artery and allows normal blood flow to your leg. […] Surgery is the preferred treatment for popliteal artery entrapment syndrome because it gives excellent results for most people. More than 90% of people who have the surgery have great improvement in their symptoms afterward. […] The only non-surgical treatment for the functional type of PAES uses injections of Botulinum toxin A. […] However, this effect only lasts for three to six months. If the muscle doesn’t get smaller, the symptoms will happen again. This has been successful in less than 60% of people a year after treatment.

• #2 Popliteal Artery Entrapment Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27432

  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. […] Furthermore, 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. […] Also, the open surgical procedures offer the best results to address the PAES and assess the artery for repair or bypass. […] Moreover, the management of functional PAES is still controversial although some have had success with gastrocnemius debulking. […] Post-operatively, surveillance is performed using arterial duplex imaging at 1, 3, 6, and 12 months, and annually after that.

• #2 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. In anatomic PAES, surgical correction of the aberrant anatomy is always necessary, as the natural history of the syndrome involves vascular injury and occlusion over time. For Types I and II PAES, myotomy of the medial head of the gastrocnemius is performed, followed by re-routing of the popliteal artery. Type III involves resection of the accessory slip. Type IV requires release of the popliteus, re-routing of the popliteal artery, with or without subsequent repair of the muscle. Treatment of Type V is similar, with the additional decompression of the popliteal vein. Outcomes for myotomy are excellent, with 1- and 5-year patency rates of 100%, respectively. […] If vascular pathology, such as intimal injury and fibrosis with stenosis and/or post-stenotic dilatation, is present repair or revascularization is necessary. Thromboendarterectomy and venous patch arterioplasty versus saphenous vein graft bypass should be considered, with the outcomes for the former reported to be slightly inferior. Placement of an endovascular stent is not recommended. Complications from arterial reconstruction are more frequent, with a median failure rate of 27.5%; however, these events are concentrated among cases with lesions extending beyond the popliteal artery. Overall, resolution of symptoms has been demonstrated in a median of 77% of patients.

• #2 Popliteal Artery Entrapment Syndrome – Sports Medicine Review

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

  The treatment for popliteal artery entrapment syndrome will vary on the basis of anatomic or functional entrapment and the timing of diagnosis. Depending on the severity of the diagnosis, definitive care may require a joint operation with vascular surgery. In cases of anatomic popliteal artery entrapment syndrome, surgical correction of the anatomic aberrancy should be performed regardless of the severity of symptoms, as the natural history is vascular injury and occlusion over time […] Conversely, in patients with functional popliteal artery entrapment syndrome, vascular injury is virtually never seen, and surgical intervention is for symptom relief. In Type I situations, a surgical myotomy is performed with rerouting of the popliteal artery, with or without vascular repair as needed. For Type II situations, a surgical myotomy of the aberrant gastrocnemius insertion is performed. A Type III situation is the most straightforward treatment with resection of the accessory band. In a Type IV situation, a surgical release of the popliteus is performed with rerouting of the popliteal artery, with or without subsequent repair of the popliteus. Type V cases require similar treatments to those of Type I to III cases, depending on presentation but with associated relief of vein compression as well. Results for myotomy are excellent, with 100% patency results at 1 and 10 years postoperatively

• #2 Popliteal artery entrapment syndrome – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/popliteal-artery-entrapment-syndrome/

  Surgery is the only way to correct the abnormal calf muscle and free the trapped artery. Your doctor will likely recommend surgery if your symptoms significantly affect your everyday or athletic activities. […] During surgery, the surgeon makes an incision on the inner calf just below the knee, or in the back of the knee, to release the abnormal calf muscle and give the artery more room. This will prevent the calf muscle from pressing on the artery in the future. Surgery is done while you are under general anesthesia. The procedure takes about an hour. Typically, you’ll need to stay in the hospital for one day. […] If you’ve had the condition for a long time, you may need artery bypass surgery. Bypass surgery is usually done only on those who have severe narrowing of the artery (stenosis) due to long-term popliteal artery entrapment syndrome. […] Surgery to release the calf muscle and artery usually doesn’t affect leg function. When the condition is diagnosed and treated early, a full recovery is expected, and your symptoms should disappear.

• #2 Popliteal Entrapment Syndrome | Dr Jason Toniolo

  https://www.drjasontoniolo.com.au/conditions-treated/arterial/popliteal-entrapment-syndrome/

  Popliteal entrapment syndrome occurs when the popliteal artery (behind the knee) is compressed by surrounding muscles or tendons, reducing blood flow to the lower leg. […] Surgery to release the trapped artery is often recommended to restore proper blood flow and prevent complications. […] There are six main types of popliteal artery entrapment, each with a different surgical solution. A thorough imaging investigational workup is required to diagnose the abnormality and plan intervention. […] The two surgical approaches include either: A medial approach (on the side of the calf that faces the other leg) or A posterior approach (around the knee crease). Each approach has its advantages and disadvantages, and is selected based on the anatomical problem identified on imaging.

• #2 Popliteal Artery Disease Treatment & Management: Approach Considerations, Medical Therapy, Preoperative and Intraoperative Considerations

  https://emedicine.medscape.com/article/461910-treatment

  Surgical treatment is advised in all types of popliteal entrapment syndrome. Recognition of progressive fibrosis with subsequent thrombosis in untreated entrapped artery supports early surgical intervention. […] There is evidence to suggest that when a popliteal artery has undergone fibrotic changes and occlusion, resection and vein (preferably GSV) graft interposition are required to ensure optimal long-term patency in these often young, physically active individuals. […] Cystic adventitial disease has been treated in numerous ways. Evacuation with removal of the cyst wall had a 94% initial success rate in 68 operations performed. […] Resection with a vein graft had a 95% initial success rate in 54 operations performed.

• #2 Circulation Clinic | Popliteal entrapment surgery

  https://www.circulationclinic.com/popliteal-entrapment-surgery

  Popliteal artery entrapment (PAE) release surgery involves open surgery to: a) re-establish normal musculature anatomy behind the knee, and b) repair any chronic damage to the popliteal artery that has resulted from abnormal muscle insertions. […] This operation will be offered to our clients in whom popliteal artery entrapment syndrome has been identified as the underlying cause for their presenting symptoms. […] Once the decision has been taken to proceed towards corrective surgery, further investigations may be required to assess your overall fitness to undergo open surgery, as well as to identify a suitable leg/arm vein for use in the reconstruction of the popliteal artery. […] The artery is then examined to assess for narrowing; if your surgeon suspects there is an intrinsic popliteal artery narrowing they will reconstruct the artery either with a short vein bypass or with a vein patch to widen the diseased segment.

• #2 Popliteal Artery Entrapment Syndrome (PAES) – Motus Physical Therapy

  https://motusspt.com/popliteal-artery-entrapment-syndrome-paes/

  The treatment of PAES is aimed at relieving the symptoms and restoring normal blood flow to the affected limb. Treatment options include: […] Surgery is the most common treatment for PAES. The goal of surgery is to release the trapped artery and restore blood flow. Surgery may be performed through a small incision (endoscopic surgery) or a larger incision (open surgery). […] Endovascular stenting: This procedure involves the placement of a small metal mesh tube (stent) in the blocked artery. The stent opens up the artery and restores blood flow. […] Balloon angioplasty: This procedure involves inflating a small balloon at the site of the blockage. The balloon opens up the artery and restores blood flow. […] Drug therapy may be used to treat the symptoms of PAES. Drugs that may be used include pain relievers, anti-inflammatory drugs, and blood thinners.

• #2

  https://link.springer.com/article/10.1007/s11936-004-0039-y

  Popliteal artery entrapment syndrome is a condition caused by direct compression of the popliteal artery as it passes within or exits the popliteal fossa. […] The treatment of popliteal artery entrapment syndrome is surgical. When the condition is detected at an early stage surgery may be limited to release of the artery alone. However, if the artery has been compressed for some time the resulting intimal damage necessitates bypass of the affected segment. […] Reports have also been published of attempts made at endovascular treatment. At present, this mode of management adds little to the definitive treatment of affected limbs and appears limited to use as a bridging procedure in cases presenting with limb ischemia. […] di Marzo L, Cavallaro A, Sciacca V, et al.: Surgical treatment of popliteal artery entrapment syndrome: a ten-year experience.

• #2 Frontiers | Case Report: COVID-19 exacerbates acute lower limb ischemia in patients with popliteal artery entrapment syndrome

  https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1329863/full

  For patients with a disease duration of more than 2 weeks, thrombectomy, venous patch arterioplasty, and autologous/artificial vessel bypass surgery can be adopted to restore the blood supply of the affected lower limb. Moreover, based on the current literature results, vascular bypass surgery is recommended as a priority for blood flow reconstruction. Thus, popliteal artery bypass surgery may be the best treatment for PAES. […] All patients with clear PAES should undergo surgical treatment.

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

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

  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 it’s unlikely that they’ll have symptoms again. Most athletes return to normal activity after surgery. […] If you have popliteal artery entrapment syndrome, talk with your provider about whether surgery is right for you. It’s been a successful treatment in many cases.

• #2 Popliteal Artery Entrapment Syndrome (PAES) Causes and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/popliteal-artery-entrapment-syndrome

  At UPMC, our vascular surgeons offer expert treatment for PAES. Based on the severity of your condition, we will work with you to determine if surgical care is right for you. […] Your UPMC vascular surgeon can treat PAES through open surgery to release the compression of the popliteal artery. […] Most people only spend 1-2 days in the hospital after surgery and don’t need physical therapy after they return home. The majority of patients make a full recovery within four weeks. […] PAES surgery successfully relieves symptoms in more than 90 percent of people. However, if you have damage to your popliteal artery, you may have pain in your legs when you exercise, even after surgery.

• #2 Surgical Treatment and Rehabilitation of Bilateral Popliteal Artery Entrapment Syndrome in a Young Boxer: A Case Report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10735325/

  The most important finding is that functional reconstruction of the medial gastrocnemius muscle and early rehabilitation enabled the patient to return to professional boxing without the preoperative symptoms. […] For a return to high-activity sports, functional surgical treatment and postoperative rehabilitation should be performed properly with a prompt diagnosis of PAES for maintaining gastrocnemius muscle strength and preventing joint contractures. […] This is the first detailed case report of PAES describing diagnostic, surgical, and rehabilitation methods from the perspective of orthopedics. […] In this case, rehabilitation was performed based on treatment after gastrocnemius rupture surgery, as described above.

• #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. […] Treatment for PAES is usually surgical and involves consultation with a surgeon (vascular surgeon) who specializes in blood vessels. Surgery is done to release the popliteal artery from the muscles compressing it. In cases where the artery has become blocked, the surgeon will bypass the affected area, as well as correct any muscular issues. […] If a surgical procedure is performed, return to play will depend on many factors including individual recovery. After surgery, most athletes can start non-impact aerobics at one week, followed by advancement of activity around four weeks. Repeat testing to assess blood supply will also be done. After completion of a formal rehabilitation program, athletes can resume full participation.

• #2 Popliteal Artery Entrapment Syndrome – MD Searchlight

  https://mdsearchlight.com/health/popliteal-artery-entrapment-syndrome/?utm_source=pubmedlink&utm_campaign=MDS&utm_content=27432

  Managing functional PAES, where the muscle contractions from normal leg movements cause the artery entrapment, remains a topic of debate. Some success has been found through a procedure that reduces the size of the calf muscle. […] After surgery, patients are followed-up using arterial duplex imaging, which uses ultrasound to see how blood is flowing through your arteries. This is typically carried out after 1, 3, 6, and 12 months, and then yearly from that point forward.

• #2 Circulation Clinic | Popliteal entrapment surgery

  https://www.circulationclinic.com/popliteal-entrapment-surgery

  Once the muscle anatomy has been reconstructed and there is restoration of flow through the popliteal artery or bypass the popliteal entrapment reconstruction is complete. […] The vast majority of patients undergoing popliteal artery entrapment release surgery do not suffer any significant complications. […] Clients who have had a formal reconstruction of their medial head of gastrocnemius will require physiotherapy upon removal of their plaster. This is aimed at gradually strengthening your newly positioned muscle and returning you to full fitness. […] All clients who have undergone a bypass as part of their surgery are entered into a graft surveillance programme to help prevent graft failure through early identification of graft or native artery narrowing.

• #2 Popliteal Artery Entrapment Syndrome (PAES) | Treatment & Symptoms | MedStar Health

  https://www.medstarhealth.org/services/popliteal-artery-entrapment-syndrome

  The team in our Vascular and Endovascular Program is a leader in innovative minimally invasive techniques to treat vascular conditions such as popliteal artery entrapment syndrome. […] Our heart and vascular teams work together and with other specialties to develop and implement individualized plans to treat a wide variety of conditions. This could include lifestyle modifications, medication or more advanced treatments. […] Vascular disease treatments address conditions that affect the blood vessels, which can cause blood flow to become decreased, interrupted or slowed.

• #2 Popliteal artery entrapment syndrome – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/popliteal-artery-entrapment/care-at-mayo-clinic/mac-20465235

  Mayo Clinic doctors trained in evaluating and treating vascular diseases and performing vascular surgery and other health care staff work closely to evaluate and treat people with popliteal artery entrapment syndrome and other vascular conditions. […] Mayo Clinic doctors use the most current technology in popliteal artery entrapment treatment syndrome. […] This collaborative approach means your health care team can often evaluate you and create a treatment plan within 2 to 3 days. […] Doctors at Mayo Clinic’s Vascular Centers are focused on developing cutting-edge diagnostic tests and innovative treatments for people with vascular disease.

• #2 Dry Needling of the Medial Gastrocnemius as Novel Treatment for Type-VI Functional Popliteal Artery Entrapment Syndrome|crimson publishers.com

  https://crimsonpublishers.com/rism/fulltext/RISM.000679.php

  Instead, treatment consisted of regular focused stretching of the medial and lateral gastrocnemius muscles supplemented with two sessions of ultrasound-guided dry needling of the medial head of the gastrocnemius muscle spread three weeks apart. […] This case highlights the utility of musculoskeletal and Doppler ultrasound in diagnosing PAES and introduces ultrasound-guided dry needling of the medial head of the gastrocnemius as a non-operative, minimally invasive treatment in functional PAES.

• #2 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

  Surgical intervention is indicated in symptomatic cases, including the release of the popliteal artery and, conditionally, its revascularization. […] If the popliteal artery is patent, endarterectomy with patch angioplasty can be considered, while in cases of arterial occlusion, a bypass should be considered. […] 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.

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

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

  Management of PAES depends on the syndrome sub-type (anatomic or functional) and the acuity of presentation. Surgical decompression is crucial to relieve the aberrant anatomic causes of arterial compression. Earlier treatment likely consists only of musculotendinous release, rather than additional arterial bypass, which may be required once severe vascular damage has occurred, with inferior results. For the patient with emergent symptoms of acute limb ischemia, assessment should be made according to the Rutherford criteria. Viable or marginally threatened extremities (Rutherford I or IIa) may be considered for elective surgery with or without CDT. Immediately threatened (Rutherford IIb) limbs should undergo emergent revascularization. […] CDT may be considered for patients with acute PAES with new, severe symptoms for less than 2 weeks (prior to clot organization) and angiographic evidence of acute arterial occlusion. Both fibrinolytic and mechanical thrombectomy approaches have been successfully reported. However, these techniques do not address the underlying anatomic pathology, resulting in high rates of re-stenosis. Thrombolysis may be useful in cases of acute PAES with distal crural emboli to restore distal outflow.

• #2 What is Popliteal Artery Entrapment Syndrome (PAES)?

  https://health.veininstitutenj.com/blog/what-is-popliteal-artery-entrapment-syndrome-paes

  The treatment for PAES depends on the severity of the condition and the impact on the patient’s daily life. Conservative treatments include rest, physical therapy, and modification of activities to reduce symptoms. In more severe cases or when conservative measures fail, surgical intervention may be recommended. […] Surgery for PAES involves releasing the entrapment and restoring normal blood flow to the lower leg. The specific procedure can vary based on the patient’s unique circumstances and the surgeon’s expertise. […] If you suspect that you or someone you know may have PAES, it’s essential to consult with a board-certified vascular specialist for a proper evaluation and personalized treatment plan. With the guidance of medical professionals, individuals with PAES can manage their condition and continue to lead active, healthy lives.

• #3 Frontiers | Case Report: COVID-19 exacerbates acute lower limb ischemia in patients with popliteal artery entrapment syndrome

  https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1329863/full

  Popliteal artery entrapment syndrome (PAES) is a rare clinical ischemic disease of the lower limbs, mainly caused by various reasons such as popliteal artery compression and stenosis and secondary thrombosis caused by an injury of the vascular endothelium due to exercise and other factors. […] If not diagnosed and treated appropriately, it may lead to disability and even serious consequences, such as amputation. […] Anticoagulants and vasodilators are the conventional therapy. Furthermore, open surgery and endovascular intervention are the fundamental therapies to cure patients. The key to treating PAES lies in relieving popliteal artery compression and restoring the blood supply to the affected limb. Clinically, for patients with acute ischemia whose disease duration is less than 2 weeks, femoral artery incision thrombectomy or catheterization thrombolysis of the affected limb can be selected to restore the blood supply of the lower limb.

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

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

  While the treatment for anatomic PAES is surgical decompression, management of the functional subtype may vary. Surgical approaches include lysis of fascial attachments, release of the plantaris tendon, and myotomy of the gastrocnemius, soleus, and/or plantaris. Recurrent or residual symptoms occurred in 9.2% of patients, with 7.1% undergoing a revision surgery. Botulinum toxin A injection has recently been reported as a non-invasive treatment for functional PAES. Similar to its use in chemically denervating the anterior scalene muscles to relieve neurovascular compression in thoracic outlet syndrome, botulinum toxin may relax the hypertrophied gastrocnemius to reduce PAES symptoms. One to three injections of 100 MU (mouse units) of botulinum toxin into the medial head of the gastrocnemius and/or plantaris resulted in partial symptomatic improvement in 82.9% of cases. While the duration of action of botulinum toxin is only 3 to 6 months, the lack of any serious complications makes this a reasonable therapeutic trial for patients with functional PAES.

• #3 Popliteal Artery Entrapment Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27432

  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. […] Furthermore, 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. […] Also, the open surgical procedures offer the best results to address the PAES and assess the artery for repair or bypass. […] Moreover, the management of functional PAES is still controversial although some have had success with gastrocnemius debulking. […] Post-operatively, surveillance is performed using arterial duplex imaging at 1, 3, 6, and 12 months, and annually after that.

• #3 Surgical Treatment for Popliteal Artery Entrapment Syndrome, a Common Cause of a rare Clinical Entity: Report of One Case

  https://pubs.sciepub.com/ajmcr/3/11/8/index.html

  Popliteal artery entrapment syndrome (PAES) is a non-atherosclerotic cause of claudication and acute ischemia of the legs in young individuals. […] The surgical treatment implemented consisted of arterial decompression through sectioning the medial bundle of the gastrocnemius muscle, combined with a popliteal-to-popliteal graft from the great saphenous vein (inverted). […] Surgery is indicated in cases of PAES due to anomalies of muscle insertion, even if the patient is asymptomatic. […] This will probably avoid the risk of losing the limb in cases of irreversible vascular injury. […] Surgery eliminates the factor responsible for popliteal artery entrapment and also enables artery repair in cases of arterial thrombosis. […] In cases of PAES, treatment should be implemented early on, whether or not symptoms are present.

• #3 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 PAES seem to be very satisfying. […] Myotomy with or without arterial reconstruction using venous bypass can lead to good patency at 15 years of follow-up. […] Surgical management includes the release of any fibrous structures and sections of the muscular structures compressing the artery. […] In advanced cases with arterial damage, such as arterial stenosis or occlusion, revascularization surgery is needed. […] Autologous venous bypass grafting is a valid option. […] Those patients treated with MTS had a 15-year patency rate of 98%, whereas those treated with reconstruction had a 71% of patency rate at a 15-year follow-up (p < 0.001).

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

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

  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 it’s unlikely that they’ll have symptoms again. Most athletes return to normal activity after surgery. […] If you have popliteal artery entrapment syndrome, talk with your provider about whether surgery is right for you. It’s been a successful treatment in many cases.

• #3 Popliteal artery entrapment syndrome needs an interdisciplinary approach – Turkish Journal of Thoracic and Cardiovascular Surgery

  https://tgkdc.dergisi.org/text.php?id=2324

  The long-term postoperative care after infrainguinal vein bypass surgery deserves a special interest, as the patient population is mostly young. All patients should be on antiplatelet therapy with low-dose aspirin. […] Therefore, an interdisciplinary approach may give these patients improved limb survival with long-standing comfort.

• #3 Sports Injury Bulletin – Anatomy – Popliteal artery entrapment: a mysterious syndrome

  https://www.sportsinjurybulletin.com/anatomy/popliteal-artery-entrapment-a-mysterious-syndrome

  In cases of anatomical PAES, surgery is almost always the most effective treatment. Because the types of entrapment vary, surgery can include fasciotomy, removal of the offending bands of muscle, muscle transfer, fossa decompression, or any combination of the above. Results are nearly always positive, with more than 90% of athletes who undergo this type of surgery fully returning to sport within three months. […] Functional PAES may be more difficult to treat effectively. Surgery in these situations appears somewhat less effective, with an average success rate around 80%. With the presence of normal anatomy, surgeons can only guess where the occlusion takes place and where to target intervention. Doctors at the Brisbane Sports and Exercise Medicine Specialists Clinic are pioneering a new treatment for functional PAES. They have obtained promising results by treating athletes with guided botulinum injections. They hypothesise that by paralysing the offending muscle surrounding the vessel, they remove the constriction on the artery. They further surmise that the localised muscle atrophy caused by the botulinum accounts for the prolonged effect of the medication beyond its expected therapeutic life. Further, they propose that the botulinum causes smooth muscle relaxation and therefore popliteal artery vasodilation. This new treatment gives athletes another option for treatment with fewer risks.

• #4 Popliteal Artery Entrapment Syndrome – Sports Medicine Review

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

  The treatment for popliteal artery entrapment syndrome will vary on the basis of anatomic or functional entrapment and the timing of diagnosis. Depending on the severity of the diagnosis, definitive care may require a joint operation with vascular surgery. In cases of anatomic popliteal artery entrapment syndrome, surgical correction of the anatomic aberrancy should be performed regardless of the severity of symptoms, as the natural history is vascular injury and occlusion over time […] Conversely, in patients with functional popliteal artery entrapment syndrome, vascular injury is virtually never seen, and surgical intervention is for symptom relief. In Type I situations, a surgical myotomy is performed with rerouting of the popliteal artery, with or without vascular repair as needed. For Type II situations, a surgical myotomy of the aberrant gastrocnemius insertion is performed. A Type III situation is the most straightforward treatment with resection of the accessory band. In a Type IV situation, a surgical release of the popliteus is performed with rerouting of the popliteal artery, with or without subsequent repair of the popliteus. Type V cases require similar treatments to those of Type I to III cases, depending on presentation but with associated relief of vein compression as well. Results for myotomy are excellent, with 100% patency results at 1 and 10 years postoperatively

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