Incidence, diagnosis and treatment of popliteal artery entrapment syndrome in current vascular practice in Japan
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ORIGINAL ARTICLE
Incidence, diagnosis and treatment of popliteal artery entrapment syndrome in current vascular practice in Japan Naoki Fujimura1,2 · Kyousuke Hosokawa2 · Hideaki Obara2 · Kimihiro Igari3 · Daijirou Akamatsu4 · Hidetoshi Matsumoto5 · Atsunori Asami6 · Shintaro Shibutani7 · Takurin Akiyoshi8 · Masao Nunokawa9 · Hirohisa Harada10 · Kyozo Inoue11 · Atsuhiro Koya12 · Tadashi Furuyama13 · Daisuke Sagara14 · Tsunehiro Shintani15 · Terutoshi Yamaoka16 · Yoshinobu Akiyama17 · Yoshinori Inoue18 · Katsuyuki Hoshina19 Received: 2 August 2020 / Accepted: 16 September 2020 © Japanese Association of Cardiovascular Intervention and Therapeutics 2020
Abstract Few data regarding popliteal artery entrapment syndrome (PAES) is available in Japan. In this study, we investigated incidence, diagnosis and treatment of PAES in current vascular practice. A retrospective analysis of all patients with PAES visiting 31 participating institutes between 2003 and 2015 was conducted. Thirty-five limbs (28 patients) were identified during the 13-year study period, and the incidence of PAES was 0.12% of all peripheral artery disease cases revascularized. Mean age was 32.0 ± 16.9 years old, and 60 and more years old was 10.7%. Also, 92.9% were male and 39.3% were athletes. Most frequent initial symptoms were intermittent claudication in 23 limbs (65.7%); 4 limbs (11.4%) had chronic limb-threatening ischemia. CT scan was most frequently (94.3%) used for the diagnostic imaging followed by MRI (45.7%) and duplex ultrasound (45.7%). Stress test such as dorsal flexion during duplex ultrasound was used only in 28.6%. Thirty-two limbs (91.4%) received surgical treatment, including 23 arterial reconstructions (71.9%); there were no major perioperative complications. All patients achieved improvement of their symptoms, and the average ankle brachial index increased from 0.69 ± 0.22 to 1.00 ± 0.14 post-surgery. The average postoperative follow-up period was 26.0 months with only one reintervention during the follow-up. In conclusion, PAES was a rare condition and traditional surgical treatment was solid. However, given a broad spectrum of clinical feature of PAES and less usage of diagnostic duplex ultrasound with stress test, there might be a miss- or delayed diagnosis of PAES even in the current vascular practice. Keyword Popliteal artery entrapment syndrome · Peripheral arterial disease · Surgical reconstruction · Diagnosis
Introduction Popliteal artery entrapment syndrome (PAES) is an extremely rare disease entity that typically causes intermittent claudication in young people. It is different from arteriosclerosis as it is a condition where the musculotendinous structures in the popliteal fossa such as the gastrocnemius muscle compress the popliteal artery [1]. Recurrent popliteal artery compression by the musculotendinous structures causes intimal damage, thrombosis, distal embolization, post-stenotic dilatation, and true aneurysm formation, which ultimately leads to an irreversible ischemic damage and limb loss [2, 3]. Hence, timely
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