Popliteal artery entrapment (PAE) syndrome is an uncommon disease, seen in young men and women, causing intermittent claudication in the lower extremities. Bilateral entrapment syndrome has been described in the literature.
PAE syndrome is the result of anomalous relationships between the popliteal artery and the neighbouring muscular and/or tendinous structures. Abnormal lateral attachment of the medial head of the gastrocnemius muscle or accessory muscle slips can cause external popliteal artery compression. PAE syndrome is classified into five subtypes.
The clinical diagnosis of PAE syndrome is difficult and this diagnosis must be borne in mind in young patients reporting intermittent claudication. In most patients the diagnosis is only reached after several years of symptoms. Post-stenotic aneurysm formation and embolisation are usually present at the time of diagnosis. Distal embolisation to the tibial arteries or the foot arch is common.
Angiography shows the typical findings: medial displacement of the proximal popliteal artery, stenosis or occlusion in its midportion, poststenotic dilatation, and distal embolisation. Although angiography shows the luminal findings, MRI better demonstrates the extravascular structures.
PAE syndrome should be treated surgically. Distal embolisation may compromise the results of surgical treatment.