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Functional Popliteal Artery Entrapment Syndrome: Poorly Understood and Frequently Missed? A Review of Clinical Features, Appropriate Investigations, and Treatment Options.

Hislop M, Kennedy D, Cramp B, Dhupelia S - J Sports Med (Hindawi Publ Corp) (2014)

Bottom Line: Investigating functional PAES is also fraught with potential problems and if it is performed incorrectly, it can result in false negative and false positive findings.When definitive entrapment is confirmed, it is important to identify the level of entrapment so that precise intervention can be performed.Treatment strategies for functional PAES are discussed, including the possibility of a new, less invasive intervention of guided Botulinum toxin injection at the level of entrapment as an alternative to vascular surgery.

View Article: PubMed Central - PubMed

Affiliation: Brisbane Sports and Exercise Medicine Specialists Clinic, 87 Riding Road, Brisbane, QLD 4171, Australia.

ABSTRACT
Functional popliteal artery entrapment syndrome (PAES) is an important and possibly underrecognized cause of exertional leg pain (ELP). As it is poorly understood, it is at risk of misdiagnosis and mismanagement. The features indicative of PAES are outlined, as it can share features with other causes of ELP. Investigating functional PAES is also fraught with potential problems and if it is performed incorrectly, it can result in false negative and false positive findings. A review of the current vascular investigations is provided, highlighting some of the limitations standard tests have in determining functional PAES. Once a clinical suspicion for PAES is satisfied, it is necessary to further distinguish the subcategories of anatomical and functional entrapment and the group of asymptomatic occluders. When definitive entrapment is confirmed, it is important to identify the level of entrapment so that precise intervention can be performed. Treatment strategies for functional PAES are discussed, including the possibility of a new, less invasive intervention of guided Botulinum toxin injection at the level of entrapment as an alternative to vascular surgery.

No MeSH data available.


Related in: MedlinePlus

MRI angiogram of the popliteal fossa showing complete occlusion of the popliteal artery in the left leg.
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fig2: MRI angiogram of the popliteal fossa showing complete occlusion of the popliteal artery in the left leg.

Mentions: Following these static images, the patient is instructed to dorsiflex and plantarflex their feet whilst acquiring T2 weighted 2D steady state images axially across the popliteal region. Before the final contrast MRI angiogram is performed, the patient is instructed to alternate a neutral ankle position with maximal plantarflexion force until they stimulate the pain that they usually experience (rather than a single sustained forceful contraction). Once they experience this pain, they keep their ankles in plantarflexion whilst we inject the contrast and perform the angiogram (Figure 2). One of the disadvantages of this technique is that there is an approximate 30-second delay before the contrast arrives at the popliteal artery and the angiogram can be performed and the artery may re-establish flow during this time. Patients quite often are in pain and or exhausted during this last series and may shake because of this.


Functional Popliteal Artery Entrapment Syndrome: Poorly Understood and Frequently Missed? A Review of Clinical Features, Appropriate Investigations, and Treatment Options.

Hislop M, Kennedy D, Cramp B, Dhupelia S - J Sports Med (Hindawi Publ Corp) (2014)

MRI angiogram of the popliteal fossa showing complete occlusion of the popliteal artery in the left leg.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4590902&req=5

fig2: MRI angiogram of the popliteal fossa showing complete occlusion of the popliteal artery in the left leg.
Mentions: Following these static images, the patient is instructed to dorsiflex and plantarflex their feet whilst acquiring T2 weighted 2D steady state images axially across the popliteal region. Before the final contrast MRI angiogram is performed, the patient is instructed to alternate a neutral ankle position with maximal plantarflexion force until they stimulate the pain that they usually experience (rather than a single sustained forceful contraction). Once they experience this pain, they keep their ankles in plantarflexion whilst we inject the contrast and perform the angiogram (Figure 2). One of the disadvantages of this technique is that there is an approximate 30-second delay before the contrast arrives at the popliteal artery and the angiogram can be performed and the artery may re-establish flow during this time. Patients quite often are in pain and or exhausted during this last series and may shake because of this.

Bottom Line: Investigating functional PAES is also fraught with potential problems and if it is performed incorrectly, it can result in false negative and false positive findings.When definitive entrapment is confirmed, it is important to identify the level of entrapment so that precise intervention can be performed.Treatment strategies for functional PAES are discussed, including the possibility of a new, less invasive intervention of guided Botulinum toxin injection at the level of entrapment as an alternative to vascular surgery.

View Article: PubMed Central - PubMed

Affiliation: Brisbane Sports and Exercise Medicine Specialists Clinic, 87 Riding Road, Brisbane, QLD 4171, Australia.

ABSTRACT
Functional popliteal artery entrapment syndrome (PAES) is an important and possibly underrecognized cause of exertional leg pain (ELP). As it is poorly understood, it is at risk of misdiagnosis and mismanagement. The features indicative of PAES are outlined, as it can share features with other causes of ELP. Investigating functional PAES is also fraught with potential problems and if it is performed incorrectly, it can result in false negative and false positive findings. A review of the current vascular investigations is provided, highlighting some of the limitations standard tests have in determining functional PAES. Once a clinical suspicion for PAES is satisfied, it is necessary to further distinguish the subcategories of anatomical and functional entrapment and the group of asymptomatic occluders. When definitive entrapment is confirmed, it is important to identify the level of entrapment so that precise intervention can be performed. Treatment strategies for functional PAES are discussed, including the possibility of a new, less invasive intervention of guided Botulinum toxin injection at the level of entrapment as an alternative to vascular surgery.

No MeSH data available.


Related in: MedlinePlus