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Popliteal Artery Entrapment Syndrome (PAES)

Popliteal Entrapment

What is popliteal artery entrapment syndrome?

The popliteal artery is the dominant source of blood supply to the leg below the knee. Due to an abnormal course of the popliteal artery and the calf muscle group, the artery can be compressed and reduce blood flow. The consequence of reduced flow from calf contraction is immediate and leads to cramping and calf pain during exercise. As a secondary effect, in the long term, repetitive trauma to the artery in its abnormal course can physically damage the arterial wall and cause a progressive narrowing known as a stenosis. In the most severe cases, permanent damage to the muscles and nerves of the leg is possible.

Why does popliteal artery entrapment syndrome occur?

The alteration of the popliteal artery course is present in individuals with PAES at birth. During fetal development, as limbs develop, the abnormal transit of the calf muscle around the vascular bundle is thought to be the primary event that leads to PAES. It is not uncommon for PAES to manifest later in the teens and 20s, when many young people engage in athletic activities and weight resistance training; the calf muscle growth incites the problem. Furthermore, the problem can occur in both genders but tends to be more prevalent in males. This may stem from rapid muscle mass gains, which are typical of male puberty.

How is popliteal artery entrapment syndrome diagnosed?

The vascular surgery team at Johns Hopkins has expertise in the diagnosis and management of PAES. In many cases, a noninvasive ultrasound can secure the diagnosis, with additional imaging performed in some cases. We strongly advocate for magnetic resonance angiogram and MRI technology, if needed, as this avoids radiation exposure for young patients.

Can stents treat popliteal artery entrapment syndrome?

Metallic stents are commonly used to treat vascular disease that develops due to atherosclerosis (hardening of the arteries). In most cases, patients with PAES have a normal artery, and a stent placement is not durable or successful. Indeed, stent placement can significantly complicate recovery and should be avoided.

Meet Dr. James Black

Dr. Black is the Chief of Vascular Surgery. Dr. Black treats popliteal artery entrapment syndrome and popliteal artery aneurysms. His other clinical focuses include treatments and procedures for aortic diseases, such as implanting fenestrated stent grafts for abdominal aortic aneurysms.

What is the surgical procedure for popliteal artery entrapment syndrome?

Treatment for Popliteal Artery Entrapment

Surgery to relieve abnormal compression of the artery is performed in two approaches. In some types of PAES, a 4- to 6-inch incision behind the knee can provide the necessary exposure to relieve the popliteal artery. In other PAES types, a 4- to 6-inch incision along the inner side of the calf is required for complete relief.

How long is the usual recovery after surgery?

Most patients will spend one to two nights in the hospital. Walking will begin right away in the hospital. Physical therapy that includes stretching and exercise programs is also used after patients go home.

Is surgery successful for popliteal artery entrapment syndrome?

The vast majority of our patients recover fully from their surgery and have normal blood flow to the leg immediately. We will further assess the blood supply at four to six weeks after surgery with ultrasound imaging. 

How do I find an expert in popliteal artery entrapment syndrome?

The vascular surgery team at The Johns Hopkins Hospital can evaluate you for PAES and discuss a plan for treatment. Please call 410-955-5165.

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