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Exertional leg pain is a common and disabling condition in athletes with challenging diagnosis and management. We report the case of a 29-year-old rugby player with a history and clinical examination consistent with chronic exertional compartment syndrome (CECS). Compartment pressure measurement was supportive of the diagnosis. However, magnetic resonance angiography (MRA) with provocative maneuvers showed functional popliteal artery entrapment syndrome (PAES). For the treatment of CECS, bilateral fasciotomy of the anterolateral compartments permitted return to full sport participation in 8 weeks. A follow-up MR angiogram at 12 months showed resolution of the popliteal entrapment leading us to hypothesize a possible relationship between CECS and functional PAES.

Popliteal entrapment syndrome is an uncommon cause of intermittent claudication in young patients lacking atherosclerotic risk factors. ZS is a 16-year-old cisgender female with type 1 diabetes complicated by microalbuminuria, obesity (body mass index (BMI) = 45.86 kg/m²), and a history of perinatal stroke with residual right-sided hemiparesis, who presented with six months of worsening bilateral, exertional lower extremity pain. Common causes of chronic bilateral lower extremity pain include peripheral vascular disease and diabetic neuropathy. Less common etiologies include trauma, infection, or juvenile idiopathic arthritis. Given her risk factors, the patient's pain was initially managed as a diabetic neuropathy with pregabalin. Symptoms failed to improve, and she re-presented with positional coolness of the right lower extremity, diminished pulses of the bilateral lower extremities, and weakness in her toes. CT angiography demonstrated occlusion of the right distal superficial femoral and popliteal arteries and diffused tibial disease. Ultimately, the patient was discovered to have right-sided femoral-popliteal occlusion, and she required urgent femoral-tibial bypass. Despite an initial improvement in symptoms postoperatively, she continued to have lower extremity pain and recurrent arterial thrombi, even with antiplatelet and anticoagulation therapy. Eventually, the patient required a right-sided below the knee amputation. This case highlights the high index of suspicion that clinicians must have in young patients with lower extremity pain, both with and without atherosclerotic risk factors, as early intervention facilitates better outcomes. Introduction.

Case Tibial plateau fractures can be associated with arterial injuries or dysvascular limbs, particularly in settings of trauma. Dysvascular limb in the setting of fracture is commonly due to dissection of the artery. Entrapment of the artery within the fracture is rare. We report a 48-year-old man who presented with left popliteal entrapment within a left tibial plateau fracture status-post external fixation and stent placement in the popliteal artery. Conclusion Findings from this case highlight entrapment of an artery as a mechanism of a dysvascular limb in the setting of high-energy lower-extremity fractures and specifically for tibial plateau fractures.

The main goal of the present document is to provide a set of practical recommendations for ultrasound imagers who are interested in artery diseases or for physicians who intend to undertake vascular procedures. This is the first part of the work. It is dedicated to general principles of ultrasonography, cervicoencephalic, subclavian, aortoiliac and lower extremity arteries, abdominal aorta, and popliteal aneurysms. It also discusses miscellaneous items such as medial arterial calcinosis, arterial embolism, arteritis, arterial stents and bypasses, false aneurysms, aortic dissection, popliteal entrapment syndrome, and iliac endofibrosis.

By age 60, 3–6% of men experience intermittent claudication due to obstructive disease of the aortoiliac and lower extremities. CT angiography (CTA) has become an integral part of assessing the treatment options in these patients. Its role is typically to determine a management strategy after peripheral arterial disease (PAD) is diagnosed. Other less expensive, noninvasive, and well-validated modalities are typically recommended as first-line studies in the diagnosis of PAD. CTA then becomes the platform for mapping vascular anatomy and delineating the location and severity of the stenosis. This information is of paramount importance in selecting patients who are candidates for endovascular or surgical revascularization. Additional information, including the presence of aneurysms, popliteal entrapment, and cystic adventitial disease, are also provided by CTA. In this group of patients, multidetector CT (MDCT) is noted to have high sensitivity (96%) and specificity (97%), and excellent interobserver agreement compared with digital subtraction angiography (DSA). Overestimation of stenosis has shown to be associated with significant calcification, but this problem can be overcome to a large extent by routinely adjusting the window and leveling setting in the presence of calcium.

Anatomic popliteal artery entrapment can be challenging to diagnose. Four cases are described in which initial diagnosis and treatment failed to identify and correct the anatomic defect responsible for patients’ symptoms. In 3 of these cases, initial assessment and diagnosis was exertional compartment syndrome, yet compartment release did not resolve the complaint. Following accurate diagnosis, surgical release of aberrant popliteal fossa anatomy provided all 4 patients with lasting symptom resolution, though 1 patient with bilateral operations has had relief of only 1 side. In the diagnostic algorithm for these patients, angiography with forced plantarflexion against resistance aids in eliciting the pathognomonic images of arterial occlusion in this disorder.

This article describes our approach and evidence-based evaluation of popliteal entrapment syndrome. Included is a technical description of our use of preoperative intravascular ultrasound for diagnosis and operative planning in combination with our utilization of intraoperative duplex ultrasound. This evidence-based, methodical approach enables not only the correct diagnosis of the type of popliteal entrapment, but more importantly, identifies irreparable injury to the popliteal artery that would necessitate operative arterial reconstruction prior to surgery.

Popliteal vascular entrapment is second only to atherosclerosis as the most common surgically correctible cause of leg claudication in young adults. Affected patients are often athletic individuals who present before the age of 50. This chapter highlights the abnormal developmental anatomy that is now accepted as the cause of popliteal entrapment and serves as the basis for the modern classification system. The importance of the unique histopathological changes observed in arterial entrapment syndromes are summarized, and the natural history of chronic arterial compression is reviewed. The diagnosis, investigation, and treatment proposed are based upon the currently published literature.

Although the majority of popliteal aneurysms are of atherosclerotic origin and are discovered in patients aged more than 50, the aetiology of a small minority may be attributed to arterial trauma, septic disruption, Behcet's disease, a medial fibromuscular dysplasia, or popliteal entrapment. The aim of this study was to propose a possible congenital origin for popliteal aneurysms without evidence of any other aetiology. A retrospective review of five younger patients (aged 20-45 years) with seven non-atherosclerotic popliteal aneurysms was performed. In patient nos 1 and 2, histological examination showed that the arterial wall had been replaced by an abundant collagenic tissue. After replacement by a saphenous bypass graft, these patients did well with a follow-up ranging from 1 to 15 years. Patient no. 3 was not operated on because of a symptomless occlusion of the tibial and peroneal arteries, and remains well 10 years later. Patients nos 4 and 5 were treated with a saphenous bypass graft. The last patient also had associated bilateral congenital anomalies of the division of the popliteal arteries. In the absence of any evidence of any classical aetiology, particularly fibromuscular dysplasia and popliteal entrapment, a congenital aetiology is proposed in aneurysms diagnosed in younger patients. The complex composition of the popliteal artery, being composed by an association of three original segments, may induce a fragility of the arterial wall that may be responsible for aneurysmal deterioration as well as abnormal branching or popliteal artery entrapment. These aneurysms are associated with the same risk of thrombosis as atherosclerotic aneurysms and therefore, they should be subjected to the same therapeutic considerations.

Carter and Eban [1] were the first to report bilateral abnormality of the popliteal artery and gastrocnemius muscles, in 1962. The term popliteal entrapment was then coined in 1965 by Love and Whelan [6], the same year that Hamming and Vink [3] published their clinical report of popliteal artery obstruction at an early age. Popliteal artery entrapment is characterized by extrin- sic compression of the popliteal artery, while in adven- titial cystic disease the artery is compressed by a cyst located in the adventitia of the artery.

Popliteal artery entrapment syndrome (PAES) is well-described in adults, but is an uncommon cause of lower-limb pain in children. We present an 11.5-year-old girl with thrombosed aneurysm of the right popliteal artery, subsequently diagnosed with bilateral type I PAES. Multimodality illustration of the radiological findings is presented.

Objectives We present our experience with popliteal artery entrapment syndrome (PAES). Patients and methods 12 cases of PAES were diagnosed in 8 patients with an average age of 38 years. Symptoms consisted of intermittent claudication in 6 limbs; acute ischemia in 3 limbs and 2 were asymptomatic. Diagnoses were made via angio MRI. Type II, III, V and functional entrapments were found. We used a posterior approach in 6 cases and a medial approach in 4 cases. Seven popliteal-popliteal bypasses with reversed saphenous veins, one femoro-popliteal bypass with saphenous vein, one popliteal-tibial-peroneal trunk bypass and one angioplasty with a vein patch were performed. In all cases, decompressions along with myotomy was performed. Results An early bypass occlusion plus one more 5 years later occurred. No amputations were needed. Conclusions PAES is a pathological entity that should be suspected in young adults presenting with intermittent claudication without cardiovascular risk factors. MRA is the most complete diagnostic examination for PAES. Surgical treatment is recommended for types I to V and for symptomatic functional syndromes.

Both popliteal vascular entrapment and adventitial cystic disease of the popliteal artery have been recognized with increasing frequency during approximately the past 20 years. A knowledge of these lesions, which were previously thought to be rare and unusual, is mandatory in evaluating patients, particularly the younger, nonsmoking, nonarteriosclerotic, athletic man who has the sudden onset of intermittent claudication. With the increasing interest in these lesions and increasing consideration of these diagnostic possibilities, it will probably be recognized that these lesions are more common than has been thought.

Popliteal artery entrapment and cystic adventitial disease of the popliteal artery are uncommon conditions which have received little attention in the radiology literature. In both conditions, a resting AP arteriogram may be normal and extra techniques are required to demonstrate or exclude abnormality. To show popliteal entrapment a normal or equivocal arteriogram should be repeated with forced extension of the knee and forced plantar flexion of the ankle, and to demonstrate cystic adventitial disease a lateral view may be needed. Failure to perform these views may lead to misdiagnosis and inadequate treatment, with potentially serious consequences. A case of each abnormality is presented and both conditions are described, with a brief review of the literature.

The intermittent compression of the popliteal artery by the medial of the gastrocnemius muscle is one of the causes of intermittent claudication in young athletes. In this report we present two such cases which emphasize the importance of the clinical aspects of this pathologic entity. Early diagnosis of the entrapped ar teries eventually leads to diagnosis of thrombosis and peripheral ischemia. The popliteal entrapment syn drome should not be confused with chronic posterior compartment syndrome during exercise.

Two young male patients with complete spontaneous resolution of popliteal thrombosis are described. The thromboses had been present for roughly 3½ and 4 months. Such resolution has not been previously reported. The cause of the lesions is unexplained. It is suggested, should such a lesion be encountered, that the correct treatment is exploration to exclude adventitial cysts and popliteal entrapment, and simple evacuation of clot and anticoagulation.

A patient with vascular insufficiency resulting from popliteal entrapment without anatomic abnormality of the course of the artery or attachments of surrounding muscles is presented.

A case of acquired popliteal entrapment occurred in which a vein graft was placed medial to the medial head of the gastrocnemius muscle during bypass of a popliteal aneurysm. After typical manifestations of entrapment occurred the vein graft was relocated to its proper position lateral to the medial head of the gastrocnemius muscle, which relieved the entrapment.

The computed tomographic (CT) findings in a young man with bilateral popliteal entrapment are presented. CT may be the procedure of choice in young adults with intermittent claudication.

To the Editor:— The report of the case of a 39-year-old man with popliteal entrapment cited in the CLINICAL NOTES (208:692, 1969) serves to familiarize us with the uncommon condition of intermittent claudication found in young people caused by an abnormal course of the popliteal artery and subsequent obstruction. The authors are to be commended for their thorough diagnostic study, excellent photographs, and successful final result with this patient.An article from Angiology (20: 119, 1969) described a 20-year-old male with a similar abnormal course of the popliteal artery and a detailed report of his treatment and progress. I should like to point out that (1) this was the 12th case reported in literature to that date and (2) he appears to be the only patient with this entity treated successfully without arterial thrombectomy or reconstruction.Turner et al deserve the gratitude of the medical community for bringing to our