Popliteal artery entrapment syndrome: a case report and review of the literature

Abstract

BACKGROUND: Popliteal Artery Entrapment Syndrome (PAES) is an uncommon but important cause of lower limb ischemia affecting young, active individuals without traditional atherosclerotic risk factors. The condition has an estimated prevalence of 0.17–3.5% in the general population and accounts for approximately 3–5% of claudication cases in patients under 40 years without atherosclerotic risk factors. PAES results from abnormal anatomical relationships between the popliteal artery and surrounding structures, causing compression and intermittent claudication. Early diagnosis is crucial to prevent complications such as thrombosis, aneurysm formation, or irreversible ischemia.

CASE REPORT: A 36-year-old previously healthy male presented with right lower-limb claudication, limiting walking to less than 100 metres. Physical examination revealed absent right distal pulses, and Doppler ultrasound showed a peak systolic velocity of 400 cm/s in the right popliteal artery, corresponding to 90–99% stenosis. Magnetic resonance angiography confirmed type 3 PAES with sub-occlusive popliteal artery stenosis. Surgical treatment comprised myotomy of the lateral accessory head of the medial gastrocnemius muscle and popliteal artery interposition grafting from P1 to P3 using the contralateral inverted great saphenous vein via a posterior approach. The patient recovered uneventfully, with restored distal pulses, and remained symptom-free at one-year follow-up.

CONCLUSION: This case highlights the importance of considering PAES in young patients presenting with claudication without atherosclerotic risk factors. Successful surgical management demonstrates that timely intervention yields excellent functional outcomes. The case emphasises the need for greater PAES awareness among healthcare providers, as early recognition and intervention improve patient outcomes and reduce the long-term burden of undiagnosed vascular disease.