Figure 1
Popliteal artery entrapment syndrome
Clinical History
The patient, a non-smoker, presented with complaints of calf pain and intermittent claudication.
Imaging Findings
The patient, a non-smoker, presented with complaints of calf pain and intermittent claudication.
A DSA examination was performed by the right femoral approach. DSA images revealed medial deviation in the proximal popliteal artery and post-stenotic aneurysmatic dilatation in the mid-popliteal artery. Partial thrombus formation was seen in this aneurysmatic segment and in the tibioperoneal trunk by angiography. In addition, anterior tibial artery occlusion due to distal embolisation was seen. Popliteal artery entrapment syndrome was considered and MRI was performed.
The patient was treated surgically. The entrapped popliteal artery was released by myectomy, and arterial reconstruction was performed by using an autogenous saphenous vein bypass.
Discussion
Popliteal artery entrapment (PAE) syndrome is an uncommon disease, seen in young men and women, causing intermittent claudication in the lower extremities. Bilateral entrapment syndrome has been described in the literature.
PAE syndrome is the result of anomalous relationships between the popliteal artery and the neighbouring muscular and/or tendinous structures. Abnormal lateral attachment of the medial head of the gastrocnemius muscle or accessory muscle slips can cause external popliteal artery compression. PAE syndrome is classified into five subtypes.
The clinical diagnosis of PAE syndrome is difficult and this diagnosis must be borne in mind in young patients reporting intermittent claudication. In most patients the diagnosis is only reached after several years of symptoms. Post-stenotic aneurysm formation and embolisation are usually present at the time of diagnosis. Distal embolisation to the tibial arteries or the foot arch is common.
Angiography shows the typical findings: medial displacement of the proximal popliteal artery, stenosis or occlusion in its midportion, poststenotic dilatation, and distal embolisation. Although angiography shows the luminal findings, MRI better demonstrates the extravascular structures.
PAE syndrome should be treated surgically. Distal embolisation may compromise the results of surgical treatment.
Differential Diagnosis List
Popliteal artery entrapment syndrome
Final Diagnosis
Popliteal artery entrapment syndrome
References
[1]
Atilla S, Akpek ET, Yucel C, Tali ET, Isik S.
MR imaging and MR angiography in popliteal artery entrapment syndrome.
Eur Radiol 1998;8(6):1025-9. (PMID: 9683714)
[2] di Marzo L, Cavallaro A, Sciacca V, Mingoli A, Tamburelli A. Surgical treatment of popliteal artery entrapment syndrome: a ten-year experience. Eur J Vasc Surg 1991;5:59-64. (PMID: 2009987)
Case information
| URL: | https://eurorad.org/case/1931 |
| DOI: | 10.1594/EURORAD/CASE.1931 |
| ISSN: | 1563-4086 |
Figure 2
Popliteal artery entrapment syndrome
AP angiogram demonstrates medial deviation in the proximal right popliteal artery and post-stenotic aneurysmatic dilatation in the mid popliteal artery.
DSA image shows partial thrombus formation in the aneurysmatic segment and in the tibioperoneal trunk. Also anterior tibial artery occlusion due to distal embolisation is seen.
Post-operative DSA image demonstrates arterial reconstructions that were made using an autogenous saphenous vein bypass.
Popliteal artery entrapment syndrome
Popliteal artery entrapment syndrome
AP angiogram demonstrates medial deviation in the proximal right popliteal artery and post-stenotic aneurysmatic dilatation in the mid popliteal artery.
DSA image shows partial thrombus formation in the aneurysmatic segment and in the tibioperoneal trunk. Also anterior tibial artery occlusion due to distal embolisation is seen.
Post-operative DSA image demonstrates arterial reconstructions that were made using an autogenous saphenous vein bypass.