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Neubauer TM, Chin JJ, Hill RD, Hu YWE. Popliteal Artery Entrapment Syndrome: Updates for Evaluation, Diagnosis, and Treatment. Curr Sports Med Rep 2024; 23:310-315. [PMID: 39248400 DOI: 10.1249/jsr.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
ABSTRACT Popliteal artery entrapment syndrome remains difficult to diagnose. Meanwhile, our limited knowledge and understanding make treatment decisions complex. The list of differential diagnoses for exertional leg pain is broad. Oftentimes, patients exhibit confounding and coexisting diagnoses. However, accurate and rapid diagnosis of popliteal artery entrapment syndrome is essential to reduce potential lasting damage to the popliteal artery. A combination of clinical history, physical examination, ankle-brachial index, along with dynamic and static imaging such as duplex ultrasound, computed tomography angiogram, and magnetic resonance angiography, aids diagnosis. Surgical treatment may be definitive depending on the type of popliteal artery entrapment syndrome, but there have been recent advances in diagnostics with intravascular ultrasound and nonsurgical treatment with botulinum toxin type A. Further research is needed to standardize diagnostic criteria, uncover innovative diagnostic methods, and validate promising nonoperative treatment options.
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Affiliation(s)
- Thomas M Neubauer
- Department of Sports Medicine, Alexander T. Augusta Military Medical Center, National Capital Consortium Sports Medicine Fellowship, Fort Belvoir, VA
| | - Justin J Chin
- Department of Sports Medicine, Alexander T. Augusta Military Medical Center, National Capital Consortium Sports Medicine Fellowship, Fort Belvoir, VA
| | - R Dillon Hill
- Department of Sports Medicine, Alexander T. Augusta Military Medical Center, National Capital Consortium Sports Medicine Fellowship, Fort Belvoir, VA
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Bellomo TR, Hsu C, Bolla P, Mohapatra A, Kotler DH. Concurrent Chronic Exertional Compartment Syndrome and Popliteal Artery Entrapment Syndrome. Diagnostics (Basel) 2024; 14:1825. [PMID: 39202313 PMCID: PMC11353322 DOI: 10.3390/diagnostics14161825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024] Open
Abstract
Exertional leg pain occurs with notable frequency among athletes and poses diagnostic challenges to clinicians due to overlapping symptomatology. In this case report, we delineate the clinical presentation of a young collegiate soccer player who endured two years of progressive bilateral exertional calf pain and ankle weakness during athletic activity. The initial assessment yielded a diagnosis of chronic exertional compartment syndrome (CECS), predicated on the results of compartment testing. However, her clinical presentation was suspicious for concurrent type VI popliteal artery entrapment syndrome (PAES), prompting further radiographic testing of magnetic resonance angiography (MRA). MRA revealed severe arterial spasm with plantarflexion bilaterally, corroborating the additional diagnosis of PEAS. Given the worsening symptoms, the patient underwent open popliteal entrapment release of the right leg. Although CECS and PAES are both known phenomena that are observed in collegiate athletes, their co-occurrence is uncommon owing to their different pathophysiological underpinnings. This case underscores the importance for clinicians to be aware that the successful diagnosis of one condition does not exclude the possibility of a secondary, unrelated pathology. This case also highlights the importance of dynamic imaging modalities, including point-of-care ultrasound, dynamic MRA, and dynamic angiogram.
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Affiliation(s)
- Tiffany R. Bellomo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (P.B.); (A.M.)
| | - Connie Hsu
- Division of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (C.H.); (D.H.K.)
| | - Pavan Bolla
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (P.B.); (A.M.)
| | - Abhisekh Mohapatra
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (P.B.); (A.M.)
| | - Dana Helice Kotler
- Division of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA; (C.H.); (D.H.K.)
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Fitzgibbon JJ, Heindel P, Abdou M, Goudreau B, Dieffenbach BV, Aicher B, Menard MT. Contemporary outcomes of surgical decompression for functional popliteal entrapment syndrome. J Vasc Surg 2024; 79:1412-1419. [PMID: 38301807 DOI: 10.1016/j.jvs.2024.01.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Functional popliteal entrapment syndrome (FPES) is an under-recognized source of leg pain caused by dynamic compression of the popliteal vessels by surrounding musculature in the absence of anatomic abnormality. Late recognition and difficulty capturing this entity across imaging modalities can lead to significant morbidity in an often young and active patient population. Surgical outcomes and optimal diagnostic strategies remain uncertain. METHODS We performed a retrospective cohort study of all patients undergoing surgical decompression for FPES at an academic medical center between 2018 and 2022. Preoperative symptoms, patient characteristics, imaging, operative details, and follow-up were captured. The primary outcome was symptomatic improvement at last clinic visit. Secondary outcomes included symptomatic improvement at 6 months and postoperative complications. RESULTS A total of 24 extremities (16 patients) were included. The mean ± standard deviation age was 23.3 ± 6.4 years and 75.0% of patients were female. The median symptom duration before decompression was 27 months (interquartile range, 10.7-74.6 months). Preoperative symptom severity in the affected extremity was as follows: 33.3% limited from peak exercise, 25% unable to exercise, and 41.7% with debilitating symptoms that affected activities of daily living. Preoperative imaging with provocative maneuvers included duplex ultrasound (87.5%), magnetic resonance angiography (100%), and digital subtraction angiography (100%). Using digital subtraction angiography as the gold standard, the sensitivity for detection of FPES was 85.7% for duplex examination and 58.3% for magnetic resonance angiography. The median follow-up was 451 days (interquartile range, 281-635 days). Most patients demonstrated durable improvement in the affected extremity, with 29.2% realizing complete resolution of symptoms and 37.5% reporting symptomatic improvement at last clinic visit for a total of 66.7%; 20.8% had initial improvement, but developed recurrent symptoms and were found to have elevated compartment pressures consistent with chronic exertional compartment syndrome and were treated with formal fasciotomy. Repeat decompression was required in one extremity (4.2%) owing to recurrent symptoms. Two patients (8.3%) had minimal or no improvement in their affected extremity and workup for the cause of continued discomfort was ongoing. CONCLUSIONS Delays in diagnosis of FPES are common. Provocative maneuvers until replication of symptoms across multiple imaging modalities may be necessary to reliably identify the disease process. Surgical decompression improved or completely resolved symptoms in two-thirds of extremities. Treating physicians should maintain suspicion for comorbid chronic exertional compartment syndrome, especially if symptoms recur or persist after decompression.
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Affiliation(s)
- James J Fitzgibbon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Patrick Heindel
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Magda Abdou
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bernadette Goudreau
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Brittany Aicher
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Renier SA, Voight AM, Trost EJ, Roberts WO. Exertional calf pain at kilometer five - Finding the cause. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:89-93. [PMID: 38463664 PMCID: PMC10918351 DOI: 10.1016/j.smhs.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/26/2023] [Accepted: 10/07/2023] [Indexed: 03/12/2024] Open
Abstract
A 23-year-old professional distance runner with several years of exertional calf pain was diagnosed with a unique mixed type III and functional popliteal artery entrapment syndrome (PAES). Surgical reduction of the obstructing tissue allowed her to return to professional running. This case highlights the importance of including PAES in the differential for chronic intermittent lower extremity claudication and outlines the work-up required to diagnose this vascular obstruction in younger athletes.
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Affiliation(s)
- Samuel A. Renier
- St. John's Hospital Family Medicine Residency, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Angela M. Voight
- Summit Orthopedics, Woodbury Clinic, 2090 Woodwinds Dr., Woodbury, MN, 55125, USA
| | - Emilee J. Trost
- Minnesota Distance Elite, 4007Forest Rd, Minneapolis, MN, 55416, USA
| | - William O. Roberts
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 516 Delaware St. SE, 6-240 Phillips-Wangensteen Building, Minneapolis, MN, 55455, USA
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Dyrek P, Kuwabara A, Fredericson M. A Rare Case Report of Exertional Leg Pain. Clin J Sport Med 2024; 34:149-151. [PMID: 37526496 DOI: 10.1097/jsm.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
ABSTRACT The accurate diagnosis of exertional leg pain in athletes is often delayed because of vague presenting symptoms and nonspecific physical examination findings. This case report outlines exertional leg pain in a runner caused by combined popliteal artery entrapment and soleal sling syndromes, 2 uncommon causes of exertional leg pain. This case report highlights the overlapping clinical presentation of these 2 diagnoses and the intricate differences in diagnostic workup and surgical approach to management.
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Affiliation(s)
- Paige Dyrek
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, California
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Armando C, Sherbondy P, Simoni E, Cole S. Type III Popliteal Artery Entrapment Syndrome with Concurrent Chronic Exertional Compartment Syndrome: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00035. [PMID: 38422191 DOI: 10.2106/jbjs.cc.23.00602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
CASE The patient, a 21-year-old female Division I track and field athlete, presents with bilateral calf pain, tightness, numbness, and swelling during activity. Initially diagnosed with chronic exertional compartment syndrome (CECS), she underwent bilateral four-compartment fasciotomies. After 4 months, she experienced persistence of some of her prefasciotomy symptoms and was referred to vascular surgery. A fibrous band was compressing the popliteal artery, making the diagnosis of popliteal artery entrapment syndrome (PAES). She underwent bilateral popliteal artery decompressions. She had a successful recovery with no recurrence of numbness, weakness, or pain. CONCLUSION Recognize that structural PAES may coexist with CECS.
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Affiliation(s)
- Chenée Armando
- Penn State College of Medicine, University Park, Pennsylvania
| | - Paul Sherbondy
- Department of Orthopedic Surgery, Penn State College of Medicine, University Park, Pennsylvania
| | - Eugene Simoni
- Division of Vascular Surgery, Penn State College of Medicine, University Park, Pennsylvania
| | - Sandra Cole
- Vascular Surgery, Muskegon Surgical Associates, Muskegon, Michigan
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Bosnina F, Padhiar N, Miller S, Girotra K, Massoura C, Morrissey D. Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review. J Foot Ankle Res 2023; 16:82. [PMID: 37990284 PMCID: PMC10662794 DOI: 10.1186/s13047-023-00680-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Numerous conditions are grouped under the generic term exercise-induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions. METHODS Three online databases were searched from inception to April 2022 for any English language original manuscripts identifying, describing, or assessing the clinical presentation and diagnostic criteria of the nine most common conditions that cause EILP. We included manuscripts considering all adults with any reported diagnostic criteria for EILP in any setting. Methodological quality was assessed using the Mixed Method Appraisal tool. Condition definitions were identified and categorised during data charting. Twenty-five potential elements of the history, 24 symptoms, 41 physical signs, 21 investigative tools, and 26 overarching diagnostic criteria, were identified and coded as counts of recommendation per condition, alongside qualitative analysis of the clinical reasoning. Condition definitions were constructed with 11 standardised elements based on recent consensus exercises for other conditions. RESULTS One hundred nineteen retained manuscripts, of which 18 studied multiple conditions, had a median quality of 2/5. A combination of the history, pain location, symptoms, physical findings, and investigative modalities were fundamental to identify each sub-diagnosis alongside excluding differentials. The details differed markedly for each sub-diagnosis. Fifty-nine manuscripts included data on chronic exertional compartment syndrome (CECS) revealing exertional pain (83% history), dull aching pain (76% symptoms), absence of physical signs (78% physical findings) and elevated intercompartment pressure (93% investigative modality). Twenty-one manuscripts included data on medial tibial stress syndrome (MTSS), revealing persistent pain upon discontinuation of activity (81% history), diffuse medial tibial pain (100% pain location), dull ache (86% symptoms), diffuse tenderness (95% physical findings) and MRI for exclusion of differentials (62% investigative modality). Similar analyses were performed for stress fractures (SF, n = 31), popliteal artery entrapment syndrome (PAES, n = 22), superficial peroneal nerve entrapment syndrome (SPNES, n = 15), lumbar radiculopathy (n = 7), accessory/low-lying soleus muscle syndrome (ALLSMS, n = 5), myofascial tears (n = 3), and McArdle's syndrome (n = 2). CONCLUSION Initial diagnostic frameworks and definitions have been developed for each condition of the nine most common conditions that cause EILP, suitable for clinical consideration and consensus confirmation.
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Affiliation(s)
- Fatma Bosnina
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Nat Padhiar
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
- London Sportswise, London, UK.
| | - Stuart Miller
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Krishna Girotra
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Chrysovalanto Massoura
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Dylan Morrissey
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Barts Health NHS Trust Physiotherapy Department, London, UK
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Deveze E, Bruneau A, Raimondeau D, Henni S, Abraham P, Picquet J. Long-Term Functional Outcomes After Surgery of Functional Popliteal Artery Entrapment Syndrome. Ann Vasc Surg 2023; 97:405-409. [PMID: 37244483 DOI: 10.1016/j.avsg.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Functional popliteal artery entrapment syndrome (fPAES) is a subtype of PAES without anatomic abnormalities entrapment of the popliteal artery. One of the management of symptomatic fPAES is surgical exploration of the popliteal region with popliteal artery release with lysis of fibrous bands. There is a lack of data regarding the long-term functional results of this surgery, most of the studies focusing on vascular patency in anatomical PAES. The aim of this study was to assess the efficacy of surgery in functional PAES, focusing on long-term physical activity return after surgery with the Tegner activity scale. METHODS All patients who underwent surgery for fPAES from January 1, 2010, to December 31, 2020, were searched. After ethical approval, all patients were called to evaluate physical activity since surgery. The Tegner activity scale is a numerical scale with each value (0 to 10) representing specific activity. The aim was to evaluate everyday activity limitations and participation restriction after surgery. The results for each patient were recorded: "before symptoms," "before surgery," and "after surgery." RESULTS Over the study period, 33 patients were included with 61 symptomatic legs. The mean time between surgery and phone call was 38.6 ± 21.9 months. The median score of the Tegner activity scale "before symptoms" was 7 (4-7), the median score "before surgery" was 3 (2-3), and the median score at the time of the phone call "after surgery" was 5 (3-7). P value was <0.0001 by comparing results "before surgery" and "after surgery." CONCLUSIONS Results demonstrated that the sport activity and intensity level is significantly higher after surgery even if patients did not reach their initial sport activity level.
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Affiliation(s)
- Eva Deveze
- Vascular and Thoracic Surgery, University Hospital, Angers, France.
| | | | | | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France; UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital, Angers, France; UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
| | - Jean Picquet
- Vascular Medicine, University Hospital, Angers, France; UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
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Parwani D, Ahmed MA, Mahawar A, Gorantla VR. Peripheral Arterial Disease: A Narrative Review. Cureus 2023; 15:e40267. [PMID: 37448414 PMCID: PMC10336185 DOI: 10.7759/cureus.40267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral arterial disease (PAD) describes the partial or complete occlusion of blood flow in the distal arteries of the body. A decreased arterial patency may occur due to a reduction in the elasticity or diameter of the vessel. The goal of interventions is to decrease incidence and reduce complications by identifying and minimizing the primary causes. This paper discusses PAD affecting the aortoiliac, common femoral, and femoropopliteal arteries. In a significant portion of the population, PAD may lack usual symptoms such as limb pain, claudication, and diminished pulses. Imaging techniques become crucial to ensuring timely diagnosis, monitoring treatment effectiveness, and preventing recurrence. Duplex ultrasound (DUS) is a cheap and non-invasive preliminary technique to detect atherosclerotic plaques and grade arterial stenosis. Magnetic resonance angiography (MRA) provides the added advantage of minimizing artifacts. Digital subtraction angiography (DSA) remains the gold standard for grading the degree of stenosis but is only employed second-line to DUS or MRA due to the high dose of nephrotoxic contrast. Computed tomography angiography (CTA) is able to overcome the anatomical limitations of DUS and MRA and proves to be a suitable alternative to DSA in patients with renal disease. Preventative measures involve monitoring blood pressure, cholesterol levels, and tobacco usage. First-line treatment options include endovascular procedures as well as surgical interventions in cases of significant arterial involvement. Endovascular treatments involve the use of balloon angioplasty, drug-coated balloons, and drug-coated stents, to name a few, that serve as minimally invasive techniques to manage PAD. Surgical procedures, although more complex, are considered gold-standard treatment options for long and intricate lesions. Endovascular methods are generally preferred over surgical options as the complication risk is severely reduced and the rates of reintervention are comparable to surgical options.
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Affiliation(s)
- Divya Parwani
- Anatomical Sciences, St. George's University School of Medicine, St.George's, GRD
| | - Mohamed A Ahmed
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Anmol Mahawar
- Anatomical Sciences, St. George's University School of Medicine, St.George's, GRD
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Síndrome de atrapamiento de la arteria poplítea secundario a osteocondroma tibial como causa poco frecuente de claudicación intermitente. Semergen 2023; 49:101870. [PMID: 36434866 DOI: 10.1016/j.semerg.2022.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/07/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
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Burnham KJ, Poudel M. Diagnostic Challenges in an Athlete with Popliteal Artery Entrapment Syndrome: A Case Report. Curr Sports Med Rep 2023; 22:52-54. [PMID: 36757123 DOI: 10.1249/jsr.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Kevin J Burnham
- Departments of Internal Medicine and Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Sacramento, CA
| | - Manoj Poudel
- Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Sacramento, CA
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Abou-Ghaida J, Thapaliya D, Rua I. Differential Diagnosis of Popliteal Artery Entrapment Syndrome in Light of an Atypical Clinical Manifestation. Cureus 2023; 15:e34889. [PMID: 36925978 PMCID: PMC10012767 DOI: 10.7759/cureus.34889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
Popliteal artery entrapment syndrome (PAES) is a type of arterial obstruction seen in athletic and young patients with no cardiovascular risk factors. It is caused by aberrant anatomy affecting the position of the popliteal artery or gastrocnemius muscle or functional obstruction resulting from a hypertrophied gastrocnemius muscle. Rich's classification has been used to define the various entities. PAES presents as unilateral claudication exacerbated by physical exertion. However, such a clinical presentation is shared amongst not only vascular diseases but also musculoskeletal diseases. Therefore, a wide array of differential diagnoses must be considered when popliteal artery entrapment-induced claudication is suspected.
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Affiliation(s)
- Jaafar Abou-Ghaida
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Deekshya Thapaliya
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Ignacio Rua
- Vascular Surgery, Baptist Health South Florida, Miami, USA
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The reliability of duplex ultrasound in diagnosing popliteal artery entrapment syndrome: An observational pilot study. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.100472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Deveze E, Bruneau A, Hersant J, Ammi M, Abraham P, Picquet J. Popliteal entrapment syndrome: diagnostic, surgical management and short-term results of a ten-year experience. Ann Vasc Surg 2022; 88:139-144. [PMID: 35810946 DOI: 10.1016/j.avsg.2022.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Popliteal artery entrapment syndrome (PAES) is a rare cause of lower limb claudication in young sportsperson without cardiovascular risk factor. We reported our diagnostic approach, surgical management and short term outcomes of this syndrome, over a 10-year period. MATERIAL AND METHOD Sportsperson with intermittent claudication systematically received color duplex ultrasonography with dynamic maneuvers in the sport medicine department. In case of PAES suspicion, diagnosis was confirmed by dynamic computed tomography or dynamic magnetic resonance angiography. Each patient was then evaluated by a vascular surgeon and surgery was performed. We retrospectively screened patients who underwent PAES surgery between 2010 and 2020 in the department of surgery in Angers university hospital. RESULTS Between January 2010 and December 2020, 38 patients with 67 symptomatic legs underwent surgery for PAES. Twenty three (60.5%) were men. The mean age at the time of surgery was 24.7 +/- 9 years. Clinical presentation was bilateral in 30 patients (81.1%). Duplex ultrasound demonstrated severe stenosis or occlusion in 45 legs (77%). When performed, CT-scan demonstrated popliteal artery compression in all cases (100%). According to Whelan and Rich classification, 36 patients (94.7%) had type 6 PAES. There was no mortality or severe complication after surgery. Morbidity included 4 post-operative hematoma (6%) and 8 prolonged healing (13%). The mean time of follow-up was 2.3 months +/- 1.2 months. After surgery, D-scan showed no signs of remaining popliteal artery compression in 92.5% of the case. Twelve patients (33.3%) were able to resume sport, 18 (50%) partially and 6 (16.6%) did not resume sport yet. CONCLUSION We report a cohort of 38 patients who underwent surgery for popliteal artery entrapment syndrome. Among them, 36 (94.7%) were functional PAES. Morbidity included 13% of prolonged healing. Two months follow-up demonstrated good results at dynamic D-scan without signs of remaining popliteal artery compression in 92.5% of the cases. These short-term results showed that one third of patients able to resume sport activity at initial level.
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Affiliation(s)
- Eva Deveze
- Department of Vascular Surgery, University Hospital of Angers, Angers, France.
| | - Antoine Bruneau
- Department of Sport Medicine, University Hospital of Angers, Angers, France
| | - Jeanne Hersant
- Department of Vascular Medicine, University Hospital of Angers, Angers, France
| | - Myriam Ammi
- Department of Vascular Surgery, University Hospital of Angers, Angers, France
| | - Pierre Abraham
- Department of Sport Medicine, University Hospital of Angers, Angers, France; Department of Vascular Medicine, University Hospital of Angers, Angers, France
| | - Jean Picquet
- Department of Vascular Surgery, University Hospital of Angers, Angers, France
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Update on Management of Leg Pain in Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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