Best Practice Case Studies-Popliteal Artery Entrapment Syndrome

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Popliteal Artery Entrapment Syndrome (PAES) is an often misdiagnosed condition that manifests as exertional pain in the lower extremities. It involves abnormal compression of the popliteal artery due to anatomical musculoskeletal anomalies. PAES can severely impact vascular health, potentially causing damage or occlusion of the popliteal artery over time, which may lead to significant complications, including limb-threatening ischemia. First anatomically described in 1879, the syndrome has been clinically recognized and characterized into several variants over time.<br /><br />Diagnostic evaluation involves a thorough physical examination and imaging studies, including advanced imaging techniques like CT, CT angiography, MRI, and MRA, to identify anatomical aberrancies. Initial non-invasive diagnostic tools include the ankle-brachial index and dynamic duplex ultrasound, which measure blood flow and look for exercise-induced arterial compression, although these can yield false positives, particularly in athletes.<br /><br />PAES has been categorized into six main anatomical types plus a functional form. Most anatomical cases occur in older males, while functional variants are observed in young, active females. Treatment typically involves surgical correction, which has been shown to yield excellent long-term results. For functional PAES, which doesn’t usually cause vascular injury, treatment focuses on symptom management. Surgical intervention varies among PAES types, with the nature of the anatomical entrapment guiding the specific procedure.<br /><br />Emerging treatments focus on non-operative options for functional PAES, including the use of botulinum toxin A. This approach aims to chemically reduce muscle bulk and alleviate arterial compression without surgery. Awareness and understanding of PAES among clinicians can enhance diagnosis and treatment effectiveness, preventing the potential adverse outcomes associated with delayed diagnosis or inappropriate management.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 56

Topic Vascular

Keywords

Popliteal Artery Entrapment Syndrome

PAES

exertional pain

anatomical anomalies

vascular health

ischemia

diagnostic evaluation

imaging techniques

surgical correction

botulinum toxin A

2nd Edition

2nd Edition, CASE 56

Vascular