Functional popliteal artery entrapment syndrome: A poorly understood and often missed diagnosis that is frequently mistreated

• Published in: Journal of vascular surgery 2009-05, Vol.49 (5), p.1189-1195
• Main Author: Turnipseed, William D., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Arterial Occlusive Diseases - complications; Arterial Occlusive Diseases - diagnosis; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Child; Compartment Syndromes - complications; Compartment Syndromes - diagnosis; Compartment Syndromes - physiopathology; Compartment Syndromes - surgery; Constriction, Pathologic; Diagnosis, Differential; Diagnostic Errors - prevention & control; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Exercise Test; Fasciotomy; Female; Humans; Intermittent Claudication - etiology; Intermittent Claudication - pathology; Intermittent Claudication - physiopathology; Intermittent Claudication - surgery; Magnetic Resonance Angiography; Male; Medical sciences; Middle Aged; Orthopedic Procedures; Physical Exertion; Plethysmography; Popliteal Artery - pathology; Popliteal Artery - physiopathology; Popliteal Artery - surgery; Predictive Value of Tests; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Young Adult
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2008.12.005

Objectives Functional popliteal artery entrapment syndrome (FPAES) is an uncommon overuse injury in young physically active adults manifest by neuromuscular symptoms (gastroc/soleus cramping, plantar paresthesias). It is commonly confused with chronic recurrent exertional compartment syndrome (CRECS). This study evaluated the diagnostic testing, mechanism of injury, and treatment differences between FPAES and CRECS. Methods Between 1987 and 2007, 854 patients (557 women, 297 men; mean age, 28.5 years) were surgically treated for the diagnosis of CRECS or FPAES, or both. Compartment pressures were measured in all patients who had anterior lateral or posterior superficial calf symptoms (normal pressure ≤15 mm Hg). Noninvasive stress positional plethysmography was routine. Stress positional magnetic resonance imaging (MRI) or angiography (MRA) was performed on patients with positive plethysmography result and symptoms consistent with FPAES. Results Of the 854 patients, 757 (95%) had elevated compartment pressures (≥25 mm Hg), and fasciectomy was performed for CRECS under local anesthesia (anterior lateral, 508; posterior superficial, 191; distal deep posterior, 101). The result of stress plethysmography was positive in 139 (18%), but they were asymptomatic. Forty-three patients (27 women, 16 men; mean age, 26.6 years) had positive stress plethysmography, appropriate FPAES symptoms, and normal compartment pressures. MRA/MRI in all 43 demonstrated normal musculotendinous anatomy and lateral neurovascular compression with plantar flexion. Under general anesthesia, all had excision of the soleal band, with relief from symptoms. In 19 of the 43 FPAES patients (44%), CRECS releases were done before or after FPAES surgery. Follow-up ranged from 12 to 240 months. Conclusion FPAES and CRECS occur in the same population with similar symptoms but require different treatment.