Typical History of Popliteal Artery Entrapment Syndrome
Patients with popliteal artery entrapment syndrome (PAES) characteristically present as young, athletic individuals with calf claudication, paresthesia, and swelling during exercise—symptoms that occur without atherosclerotic risk factors. 1
Patient Demographics
- Young age at presentation: Mean age is 20-40 years, with an average of 35 years 2, 3, 4
- Male predominance: Approximately 83% of patients are male 4
- Athletic population: Commonly affects physically active individuals and athletes 1, 5, 4
- Absence of atherosclerotic risk factors: This is a non-atherosclerotic peripheral arterial disease affecting otherwise healthy young adults 1, 3
Classic Presenting Symptoms
- Intermittent claudication: The most frequent presenting symptom, occurring in approximately 80% of cases (70 of 88 limbs in one series) 2
- Calf pain with exercise: Pain specifically occurs during or after physical activity, particularly running or jogging 1, 3, 5
- Foot paresthesia: Numbness or tingling in the foot during exertion 5, 4
- Symptoms relieved by rest: Pain and paresthesia resolve when the patient stops exercising 3
- Progressive limitation: Patients often report decreasing exercise tolerance over time (e.g., previously running 10 kilometers, now claudicating at 500 meters) 4
Bilateral Involvement
- High rate of bilateral disease: Approximately 83% of patients have bilateral popliteal entrapment (40 of 48 patients in one series) 2
- Asymmetric presentation: Despite bilateral anatomic involvement, symptoms may initially be unilateral 5, 4
Advanced Presentations
- Severe ischemia: Approximately 20% of limbs present with severe ischemia due to popliteal artery occlusion (18 of 88 limbs) 2
- Acute limb ischemia: Sudden onset of pain, pallor, and loss of pulses can occur with acute thrombosis 6
- Chronic occlusion: Some patients develop chronic popliteal artery occlusion with collateral vessel formation, which may be asymptomatic 5
Key Distinguishing Features from Other Conditions
- Unlike atherosclerotic PAD: Occurs in young patients without traditional cardiovascular risk factors 1, 3
- Unlike Baker's cyst: Symptoms are intermittent and exercise-related, not present at rest 7
- Provocative maneuvers: Symptoms and arterial compression occur specifically with plantar flexion, not ankle extension 1
Common Pitfall
The most critical pitfall is delayed diagnosis due to lack of recognition of this syndrome in young, athletic patients presenting with claudication. 6, 3 Early diagnosis is essential because continued arterial wall degeneration from chronic compression leads to thrombosis, stenosis, distal thromboembolism, or aneurysm formation. 6, 2 Once popliteal artery occlusion occurs, the prognosis worsens significantly, with some patients requiring amputation. 2