Popliteal artery entrapment syndrome - Diagnosis and management, with report of three cases

Popliteal artery entrapment syndrome is an important albeit infrequent caus e of serious disability among young adults and athletes with anomalous anat omic relationships between the popliteal artery and surrounding musculotend inous structures. We report our experience with 3 patients, in whom we used duplex ultrasonography, computed tomography, digital subtraction angiograp hy, and conventional arteriography to diagnose popliteal artery entrapment and to grade the severity of dynamic circulatory insufficiency and arterial damage. We used a posterior surgical approach to give the best view of the anatomic structures compressing the popliteal artery. In 2 patients, in whom compre ssion had not yet damaged the arterial wall, operative decompression of the artery by resection of the aberrant muscle was sufficient in the 3rd patie nt operative reconstruction of an occluded segment with autologous vein gra ft was necessary, in addition to decompression of the vessel and resection of aberrant muscle. The result in each case was complete recovery, with abs ence of symptoms and with patency verified by Doppler examination. We concl ude that clinicians who encounter young patients with progressive lower-lim b arterial insufficiency should be aware of the possibility of popliteal ar tery entrapment. Early diagnosis through a combined approach (careful physi cal examination and history-taking, duplex ultrasonography, computerized to mography, and angiography) is necessary for exact diagnosis. The treatment of choice is the surgical creation of normal anatomy within the popliteal f ossa.