Effective Management of Popliteal Artery Entrapment Syndrome

Key Features of Popliteal Artery Entrapment Syndrome

PAES is primarily characterized by the external compression of the popliteal artery, typically due to an aberrant course of the gastrocnemius muscle or other anatomical variations. This condition is colloquially referred to as “jogging disease” because it predominantly affects young, athletic individuals who engage in activities that involve repetitive knee flexion. The incidence of PAES is estimated at 0.17%, with a marked male predominance [1, 2].

Table 1 illustrates the anatomical variations associated with PAES and their clinical implications:

Risk Factors and Demographics of PAES Patients

The demographics of PAES patients reveal a pattern that often includes young, active males, typically aged between 20 to 40 years. Most patients do not present with traditional cardiovascular risk factors like hypertension or diabetes, marking a distinct population that is otherwise healthy [2, 3].

Several risk factors have been identified:

1. Gender: Males are approximately four times more likely to develop PAES compared to females.
2. Athletic Activity: Activities involving repetitive knee flexion, such as running, cycling, or skating, play a significant role in the onset of symptoms.
3. Anatomical Variations: Individuals with anatomical variations in the popliteal artery or surrounding musculature are at higher risk [4, 5].

Symptoms and Clinical Presentation of PAES

Patients with PAES may exhibit a range of symptoms, often beginning with exertional calf pain (claudication) that is relieved by rest. Other symptoms may include:

• Calf pain during physical activities, particularly when engaging in knee flexion.
• Numbness or tingling sensations in the leg.
• Coldness or pallor in the affected limb.
• Weak or absent pulses in the popliteal artery during exertion but normal at rest [2, 3].

The median age for diagnosis is around 32 years, and symptoms can be bilateral in approximately 30% of cases. As symptoms progress, patients may experience significant ischemia, which can result in necrosis if left untreated [1, 5].

Diagnostic Techniques for Identifying PAES

Diagnosing PAES requires a high index of suspicion, particularly in young athletes presenting with exertional calf pain. The following diagnostic techniques are commonly employed:

1. Doppler Ultrasound: This non-invasive test is often the first step in diagnosing PAES. It can demonstrate reduced blood flow during provocative maneuvers, such as active plantar flexion [6].

2. CT Angiography: This imaging technique provides a detailed view of the arterial anatomy and can help identify any anatomical variations that may predispose a patient to PAES [6].

3. Magnetic Resonance Angiography (MRA): Similar to CT angiography, MRA can visualize arterial flow and detect any compression or abnormalities in the popliteal artery.

4. Provocative Tests: Physical examination maneuvers that engage the gastrocnemius muscle through plantar flexion and dorsiflexion can reveal diminished or absent distal pulses, a hallmark of PAES [1, 3].

Table 2 summarizes the diagnostic modalities and their relevance:

Treatment Options and Surgical Interventions for PAES

The management of PAES largely depends on the severity of symptoms and the presence of ischemia. In asymptomatic individuals, conservative management may be sufficient. However, surgical intervention is often indicated for symptomatic patients to prevent progression to more severe complications.

Surgical Options Include:

1. Decompression Surgery: This procedure involves releasing any compressing structures around the popliteal artery, such as fibrous bands or abnormal muscle tissue.

2. Arterial Bypass: In cases where significant arterial damage or occlusion has occurred, a bypass may be necessary to restore adequate blood flow to the affected limb [6, 7].

3. Endovascular Techniques: Emerging minimally invasive techniques may be utilized for some patients, involving balloon angioplasty or stenting, though these are less common for PAES [6].

Post-operative care typically involves monitoring for complications, including bleeding or infection, and ensuring the restoration of normal blood flow to the affected limb.

FAQ Section

What is Popliteal Artery Entrapment Syndrome (PAES)?

PAES is a rare condition characterized by the compression of the popliteal artery at the back of the knee, often leading to symptoms of calf pain and potential limb ischemi

Who is most at risk for developing PAES?

Young, active males aged 20 to 40 years are at the highest risk, particularly those engaged in sports or activities involving repetitive knee flexion.

How is PAES diagnosed?

Diagnosis typically involves Doppler ultrasound, CT angiography, MRI, and physical examination maneuvers to assess blood flow changes during activity.

What are the treatment options for PAES?

Treatment may involve conservative management for asymptomatic patients, while surgical options include decompression surgery and arterial bypass for symptomatic patients.

Can PAES lead to serious complications?

Yes, if untreated, PAES can result in acute limb ischemia, which may lead to severe complications, including tissue necrosis and the need for amputation.

References

1. A case report of Balamuthia mandrillaris encephalitis. doi:10.1186/s40478-025-01963-8
2. Popliteal artery entrapment syndrome in a 20-year-old man. doi:10.11913481
3. The role of plasma metagenomic sequencing in identification of Balamuthia mandrillaris encephalitis. doi:10.1186/s40478-025-01963-8
4. Genetic mutations and prognostic indicators in differentiated thyroid cancer: a molecular perspective. doi:10.55730/1300-0144.5944
5. Association of certain biochemical parameters related to bone cycle with genotype in MPS IIIB patients. doi:10.55730/1300-0144.5973
6. A comparison study of sensory processing in older adults with and without dementia. doi:10.55730/1300-0144.5948
7. Diagnostic Utility of Kappa Free Light Chain Index in Adults With Inaugural Optic Neuritis. doi:10.11913550
8. Unwanted Clinical Complications Following the Consumption of Death Coffee: A Case Series. doi:10.11913531