What is a characteristic of popliteal artery entrapment syndrome?

Popliteal Artery Entrapment Syndrome Characteristics

Popliteal artery entrapment syndrome (PAES) is most commonly caused by compression from the medial head of the gastrocnemius muscle, occurring predominantly in males rather than females, and is diagnosed using provocative maneuvers including active plantarflexion or passive dorsiflexion. 1, 2

Epidemiology and Gender Distribution

• PAES demonstrates a strong male predominance 3
• In a surgical case series, 19 males and only 4 females were treated for PAES, confirming the male predisposition 4
• This contradicts option (a) which incorrectly states PAES is more common in females

Diagnostic Approach

• Diagnosis is made through provocative maneuvers that compress the popliteal artery:
  • Active plantarflexion against resistance
  • Passive dorsiflexion of the foot 1, 2
• These maneuvers reproduce symptoms and demonstrate arterial compression on imaging
• Ultrasound is the initial diagnostic test of choice, followed by CTA or MRA with provocative maneuvers for definitive diagnosis 3, 1
• Option (b) is correct as passive dorsiflexion of the foot is indeed used to diagnose PAES

Anatomical Cause

• The medial head of the gastrocnemius muscle is involved in 74.2% of PAES cases 4
• The condition results from an anomalous relationship between the popliteal artery and surrounding myofascial structures, most commonly the medial head of gastrocnemius 1, 2
• Option (c) is correct as PAES most commonly results from compression by the medial head of the gastrocnemius

Bilateral Occurrence

• Approximately 50% of popliteal aneurysms are bilateral 3
• However, PAES does not require bilateral exploration in most cases
• Imaging studies can determine if the contralateral limb is affected
• In one study, bilateral findings were present in only 39% of cases 5
• Option (d) is incorrect as bilateral exploration is not required in most cases

Clinical Presentation

• PAES typically presents in younger, athletic patients without atherosclerotic risk factors
• Common symptoms include:
  • Intermittent claudication in the feet and calves specifically after exercise
  • Sensation of coolness in the posterior leg during exercise
  • Paresthesia of the plantar aspect of the foot 1, 2
• Early diagnosis and intervention is essential to prevent thromboembolic complications and potential limb loss

Treatment Options

• First-line treatment: Conservative management with physical therapy and gastrocnemius stretching
• Surgical intervention when conservative treatment fails:
  • Division of aberrant musculotendinous tissue
  • Vascular reconstruction if arterial damage has occurred
  • Better outcomes are achieved with early intervention before vascular damage occurs 4, 2

Based on the evidence, option (c) is the correct answer, as PAES most commonly results from compression by the medial head of the gastrocnemius muscle.