Evolution In The Evaluation Of Popliteal Artery Entrapment Syndrome
Thomas J. Gianis, Jr., MD, Kenneth Cherry, MD, Bernadette Goudreau, MD, William D. Clouse, MD, Margaret Tracci, MD, JD.
University of Virginia, Charlottesville, VA, USA.
Objectives: Popliteal artery entrapment syndrome (PAES) is a relatively uncommon disorder affecting primarily young active individuals. Delays in diagnoses are common as the presentation may mimic other conditions such as chronic recurrent exertional compartment syndrome (CRECS). In addition, common vascular imaging studies are often nondiagnostic in this disorder. We hypothesized that the increased use of functional imaging is associated with better sensitivity and specificity for PAES
Methods: Patients who underwent popliteal release for PAES from 2009 to 2019 at single academic institution were identified. Univariate analysis was used to compare pre-operative and intraoperative disease classification to assess diagnostic accuracy and predictive value of available imaging modalities.
Results: 27 patients (17 male, 10 female) were identified, with an average age of 25.9 (range 15-60) 10 patients presented with unilateral and 17 with bilateral disease. A total of 44 limbs were treated surgically. The most common classification was type VI (30 of 44 cases) with type III (9 cases) type V (4 cases), and type I (1 case) being seen less frequently. Post-operative symptom relief was reported in 75% of patients and recurrence during the study period in 4.5% of cases. Patients were evaluated with resting or functional ABI, duplex, CTA, MRA, and angiography. Table 1 summarizes the preoperative imaging performed and the results of these studies. Preoperative MRA demonstrated the highest concordance (65%) with intraoperative findings. Functional angiography was most sensitive, followed by MRA. Patients demonstrating discordance (negative functional MRA, positive functional angiogram) were found to have type 6 PAES.
Conclusions: While popliteal entrapment remains a challenging diagnosis, the incorporation of functional imaging and application of an algorithm to resolve diagnostic discrepancies may be of benefit in improving the sensitivity of clinical evaluation. This may be particularly applicable to patients presenting with type 6 entrapment, without pathognomonic anatomic abnormalities.
|Resting||Cases Performed||Functional||Cases Performed|
|37 (84.1%)||16 Positive|
|Duplex||All Negative||19 (43.1%)||5 Positive |
|CTA||2 Positive |
|11 (25.0%)||All Positive||6 (13.6%)|
|MRA||1 Positive |
|27 (61.3%)||20 Positive|
|Angiogram||All Negative||29 (65.9%)||All Positive||29 (65.9%)|
Table 1: Preoperative imaging
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