Popliteal artery entrapment syndrome

Abstract

Ms X, a 22-year-old lady, was referred to the vascular unit in view of a long-standing history of bilateral exertional calf pain. Her pain-free walking distance was roughly 100 metres. Stopping to rest alleviated the pain within 5 minutes, allowing her to walk another 100 metres pain-free. The patient reported an insidious onset of these symptoms in 2016, with a gradual increase in time of onset from exertion over the next 2 years, to the current state she presented with, having remained stable since. On examination, the pedal pulses were palpable and on duplex ultrasound scanning (DUS), she had normal triphasic waveforms bilaterally in the distal arteries. There was no significant change in the waveforms on plantarflexion. However, a dynamic MRI-angiography (MRA) of the legs confirmed the diagnosis of a rare condition called popliteal artery entrapment syndrome (PAES). DUS was repeated with the addition of forced plantarflexion of the foot and on the right leg, triphasic waveforms changed to monophasic continuous with this manoeuvre. In view of this, Ms X underwent surgical exploration of the right popliteal fossa to release the popliteal artery from its entrapment.