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Objectives: Popliteal artery entrapment syndrome (PAES) is a low-frequency disease that causes leg ischemia as well as vein and nerve compression. Operative management consists of releasing the constricting muscle or tendons and reconstructing the popliteal artery, when symptomatic. We have identified a subgroup of patients presenting with occlusion of the popliteal artery secondary to PAES, who have worse long term outcomes than those without popliteal artery occlusion.
Methods: We reviewed our database of patients surgically treated for PAES.
Results: Between 2000 and 2010, 9 patients (3 female, 6 male, median age; 32) were identified with PAES. All patients presented with intermittent claudication alone. Preoperative workup included duplex ultrasound (n=6, 67%), MRI (n=5, 56%), MRA (n= 6, 67%), CTA (n=2, 22%), and catheter angiogram (n=8, 89%).
Seventy-eight percent (7/9) of patients had a thrombosed popliteal artery identified during the initial evaluation. Four underwent preoperative intervention with thrombolysis and stenting; only two were recanalized. At the time of surgery, five patients had thrombosed popliteal arteries; a posterior approach to the popliteal artery was used in 8/9 to allow for a myotomy, with or without arterial reconstruction; one patient had a bypass through a medial incision. Arterial reconstructions included interposition vein grafts (n=4), of which two occluded postoperatively requiring thrombolysis, but remain patent, and one prosthetic bypass which thrombosed and was unable to be salvaged.
The average follow up has been 26.5 + 23.4 months with a 0% amputation rate and a 100% survival. When comparing patients with thrombosed (n=5) versus patent (n=4) popliteal arteries at the time of operation, preoperative intervention rates were 40% versus 25%, arterial reconstructions were required in 100% versus 25%, primary patency of the popliteal artery or reconstruction were 40% versus 100%, secondary patency rates were 80% versus 100%, and secondary intervention rates were 60% versus 0%, respectively.
Conclusion: Patients with PAES who require reconstruction of a thrombosed popliteal artery require more secondary interventions than those without occlusion, possibly due to intimal damage of the artery from thrombus. Early surveillance after repair of a thrombosed popliteal artery is recommended. A multi-institutional study is underway to better define treatment options for these patients.