What is popliteal artery entrapment syndrome?
Popliteal artery entrapment syndrome (PAES) is a rare vascular disease that affects the legs of some young athletes. The muscle and tendons near the knee are positioned so that they compress the popliteal artery – the main artery that runs through and behind the knee. Compression of the artery restricts blood flow to the lower leg and can damage the artery.
Patients with PAES may be born with the condition due to a developmental defect in the calf muscle on the back of the lower leg (gastrocnemius or popliteus muscle) and the popliteal artery. The condition can also develop over time, as exercise and training lead to an enlarged calf muscle that compresses the popliteal artery.
Who is at risk for PAES?
PAES occurs most often in male athletes under age 30, particularly those who are runners or play soccer, football or rugby. However, the condition can also affect young female athletes.. As the muscles next to the popliteal artery get larger, there is a greater chance of compression. This may be referred to an "over-use" injury.
Less than 3% of people are born with the defect that can lead to PAES, and most people with the condition never develop symptoms.
What can I expect after PAES surgery?
Hospital stay is typically one to two days. Physical therapy may be done as an outpatient to help facilitate recovery by using stretching and flexibility exercises. Once you fully recover, you can expect to go back to training and your normal routine.
What type of follow-up care will I need?
Follow up ultrasound of the repaired artery and blood pressure checks in the feet will be done in the office at one to two months in the office and at one year. If the artery has returned to normal you won’t need any further follow-up visits unless your symptoms return or a bypass of the artery was required.
Symptoms and Causes
What are the symptoms of PAES?
Patients with PAES have history of aching pain, numbness, and tiredness or cramping in the calf when they exercise. The symptoms typically go away in three to five minutes of resting. In many cases, the pain always occurs at the same point during exercise and affects the same leg. In some cases they may note leg swelling. The leg pain is known as intermittent claudication (walking pain).
The symptoms of popliteal artery entrapment (PAES) are similar to adventitial cystic disease. If young patient has pain when walking, the doctor will check for both of these conditions.
Diagnosis and Tests
How is PAES diagnosed?
A vascular specialist is the type of doctor who can best diagnose PAES. You will have a physical exam that includes checking the pulse in your foot and popliteal artery. If you have the condition, the doctor may be able to feel the pulses while you’re resting, but they may be harder to detect when you exercise or flex or extend your foot. Diagnostic tests are done to measure blood flow through the knee, leg and foot.
These can include:
- Ankle brachial pressures with exercise – Measures the blood pressures in the arms and legs before and after exercise
- Duplex Ultrasound – Uses sound waves to image the artery and measure blood flow
- Computed tomographic angiography (CTA) – Type of CT scan that uses dye to look for areas around the knee with poor blood flow or narrowed arteries
- Magnetic Resonance Angiography (MRA) – Test using magnetic field and pulses of radio wave energy to provide pictures of muscles tendons and blood vessels inside the body
Management and Treatment
What treatments are available for patients with PAES?
Surgery can be done to correct the problem with the muscle or tendons and release the popliteal artery. This eliminates the compression of the artery and allows normal blood flow to the leg.
In more advanced cases when the popliteal artery is blocked, rather than pinched, the surgeon will correct the problem with the muscles or tendons and also perform a bypass around the blocked section of the artery to restore blood flow.
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