Popliteal Artery Entrapment Syndrome: Causes, Symptoms

Popliteal artery entrapment syndrome (PAES) is an uncommon condition affecting the major artery behind the knee. That artery is known as the popliteal artery. In this illness, the calf muscle is either swollen or positioned wrongly. The muscle compresses the artery. The foot and lower leg cannot receive enough blood when the artery becomes occluded.

Popliteal artery entrapment syndrome affects athletes most frequently.

Causes Of Popliteal Artery Entrapment Syndrome

Popliteal artery entrapment syndrome is caused by an unequal muscle in the calf, most commonly the gastrocnemius muscle (PAES).

The illness could be present from birth or develop later in life. The calf muscle or nearby artery begins in the wrong place during pregnancy and stays there after delivery. Later in life, calves born to individuals with the syndrome are larger than normal.

The primary artery behind the knee is compressed by the alterations in the calf muscle. Consequently, there is less blood supply to the lower leg. Pain and cramps in the back of the lower thigh during periods of exertion are caused by a reduction in blood flow.

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Symptoms Of Popliteal Artery Entrapment Syndrome

Lower leg pain or back cramping is the main symptom of popliteal artery entrapment syndrome or PAES. The term "calf" refers to the back of the lower leg. The pain is caused by exercise and subsides with rest. Other indications and manifestations could be:

• Chills after exercise.
• You may feel tingling or burning in your calf.
• Sensation around the calf area.

If another nearby vein, the popliteal vein, is also trapped by the calf muscle, you could have:

• A feeling of heaviness in the leg.
• Nighttime cramps in the lower legs.
• Soreness surrounding the calf.
• Changes in skin tone in the area of the calf muscle.
• A lower leg blood clot is known as deep vein thrombosis.
• Generally, adults under 40 are usually affected.

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Risk Factors Of Popliteal Artery Entrapment Syndrome

The following factors raise the risk of the disorder.

• Age: The disease primarily affects people in their late teens or early 20s. For people over 40, diagnoses are rare.
• Sex: Although anyone can be impacted by PAES, young men are much more prone to do so.
• Participation in physically rigorous sports: Runners, bikers, and athletes who try to bulk up fast with weight training or severe circuit training are the most vulnerable.

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Diagnosis Of Popliteal Artery Entrapment Syndrome

After examining you and discussing your symptoms and medical history, a medical team will diagnose you with popliteal artery entrapment syndrome (PAES). But, as the majority of PAES patients are young and typically well, detecting the condition can occasionally be difficult. A physical examination typically yields no significant results.

Examinations are performed to rule out other possible reasons for leg discomfort, including strained muscles, stress fractures, and peripheral artery disease, which is the consequence of clogged arteries.

The following could be tested:

• The ankle-brachial index (ABI) measurement is usually the first test performed to identify PAES. Blood pressure is measured in the arms and legs while walking on a treadmill and afterward. To calculate the ABI, divide the ankle pressure by the arm pressure. It is anticipated that the legs will have higher blood pressure than the arms. On the other hand, your ankle pressure drops when you exercise and have PAES.
• Duplex ultrasonography of the calf uses high-frequency sound waves to measure the blood flow rate through the leg arteries. This test can be taken before or after the working exercise. If you are asked to flex your foot up and down, your calf muscles will be worked.
• Magnetic resonance imaging, or MRA, ascertains whether the calf muscle is trapping the artery. It can also be used to measure the degree of popliteal artery narrowing. It may be necessary for you to press or flex your foot against a board during this examination. The blood flow in your lower leg is more noticeable as a result.
• CT angiography can also be used to identify the leg muscle that is causing the arterial entrapment. This test may need you to move your foot, just like the MRA.
• Catheter-based angiography, it is feasible to see the blood flow to and from the lower leg in real time. It is performed if other less invasive imaging tests are unable to yield a definitive diagnosis.

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Treatment Of Popliteal Artery Entrapment Syndrome

If symptoms of popliteal artery entrapment syndrome (PAES) significantly interfere with everyday or sports activity, surgery may be indicated. Surgery is the only way to free the trapped artery and heal the calf muscle.

In a hospital or other medical facility, surgery is carried out under general anaesthesia. During the surgery, the physician makes an incision in the inner calf, either right below or behind the knee. This loosens up the calf muscle to give the artery more room. The calf muscle is no longer compressing the artery.

Popliteal artery entrapment syndrome surgery takes about one hour. Typically, you will need to stay in the hospital for one day.

An arterial bypass may be necessary if the problem has been present for a long time and there is significant narrowing of the arteries.

The function of the leg is usually unaffected by surgery performed to release the calf muscle and artery. The goal of an early diagnosis and treatment plan should be a full recovery and the elimination of symptoms.

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Complications Of Popliteal Artery Entrapment Syndrome

The popliteal artery may narrow under continuous pressure. It's known as arterial stenosis. Walking is among the smallest activities that could aggravate pain and cramps.

The leg's muscles and nerves may be harmed in severe circumstances or in cases when a diagnosis is made incorrectly. Lower limb blood clots are likely to occur. In cases where older athletes exhibit signs of popliteal artery entrapment syndrome, it is imperative to investigate arterial ballooning or bulging. We call this a popliteal aneurysm.

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