Popliteal Artery Entrapment Syndrome: Clinical Features
The correct answer is B: Exercise-induced calf claudication is the hallmark presentation of popliteal artery entrapment syndrome (PAES). 1
Key Clinical Features of PAES
Primary Symptom: Exercise-Induced Claudication
- Patients with PAES characteristically present with calf claudication, paresthesia, and swelling during exercise 1
- The intermittent pain specifically occurs in the feet and calves after exercise and is relieved by rest 2, 3
- This represents the most common cause of surgically correctable lower-extremity vascular insufficiency in young adults 1
- Up to 85% of diagnosed individuals are males, with a mean age of 28 years 4
Anatomic Relationship (Addressing Option C)
- The abnormal relationship involves the popliteal artery and the MEDIAL head of the gastrocnemius muscle, NOT the lateral head 5, 2
- In anatomic PAES (Types I, II, III, and V), extravascular structures within the popliteal fossa compress the popliteal artery during plantar flexion 1
- The artery may undercross the medial head of the gastrocnemius from the medial side 5
Physical Examination Findings (Addressing Option D)
- Compression and stenosis or occlusion occurs during PLANTAR FLEXION, not ankle extension 1
- Decreased ankle pulses would be demonstrated with provocative maneuvers involving plantar flexion 1, 2
- Ankle-brachial indices or Doppler ultrasound with provocative maneuvers (plantar flexion) are used for initial testing 2
Absence of Atherosclerosis (Addressing Option A)
- PAES is explicitly a NONatherosclerotic peripheral arterial disease 1
- It presents in younger, athletic patients WITHOUT atherosclerotic risk factors 2
- The condition occurs due to developmental anomaly with aberrant relationship of the artery with surrounding myofascial structures 2, 3
- While repeated compression can cause trauma to the arterial wall leading to premature localized atherosclerosis as a secondary phenomenon, this is a consequence rather than a defining feature 4
Clinical Pitfalls to Avoid
Delayed Diagnosis Consequences
- Delayed diagnosis leads to severe vascular defects, unnecessary reintervention, and prolonged illness 5
- Calf and foot claudication in young patients should always prompt consideration of PAES as a differential diagnosis 5
- The condition can progress to popliteal artery thrombosis, stenosis, distal arterial thromboembolism, or arterial aneurysm 3