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Functional Popliteal Artery Entrapment Syndrome
Popliteal Artery Entrapment Syndrome (fPAES) is a vascular disease that affects the legs, specifically the popliteal artery. This condition is often seen in young athletes.
Symptoms
Symptoms typically include pain and cramping in the calf muscle during exercise, and can also involve numbness, and a feeling of coldness in the affected foot.
Specialist
A vascular surgeon is best equipped to diagnose and treat PAES.
Diagnostics
Diagnostic tests may include a physical examination, ultrasound, MRI, CT scan, and sometimes angiography.
Tests to diagnose PAES
Popliteal artery entrapment syndrome (PAES) is a vascular condition that can cause pain, swelling, or claudication (cramping and weakness) in the leg due to compression of the popliteal artery. There are two types of of PAES. Anatomic PAES (aPAES) is caused by abnormal positioning of the muscles or tendons in relationship to the artery and is due to congenital factors. Functional PAES (fPAES) results with normal positioning of the muscles, but compression of the artery occurs by enlarged muscles or tight and stiff tendons. fPAES is more common, but often under-recognized.
Here are some tests that could be used to diagnose PAES:
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Physical Examination: A healthcare provider might perform a physical exam to understand the symptoms better. They might look for certain signs, such as abnormal pulses in the foot when the foot is positioned in certain ways or after exercise.
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Ankle-Brachial Index (ABI): This simple, non-invasive test measures the blood pressure in the ankle and in the arm. If the pressure in the ankle is significantly lower, this could be a sign of PAES.
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Doppler Ultrasound: This non-invasive test uses sound waves to create images of the blood flow in your arteries. It can show whether blood flow is decreased or blocked, which could indicate PAES.
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Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): These imaging techniques can show the relationship between the popliteal artery and the surrounding muscles and tendons, potentially identifying abnormal positioning that might be causing entrapment. They can also help rule out other potential causes of symptoms.
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Angiography: This is a type of medical imaging that visualizes the inside of blood vessels. It can be performed using CT (CT angiography), MRI (MR angiography), or traditional methods that involve inserting a catheter into the blood vessels (catheter angiography). This test can show if the popliteal artery is compressed or narrowed.
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Exercise Testing: Because symptoms of PAES often occur or worsen with exercise, an exercise test might be conducted. The patient exercises (often on a treadmill or stationary bike) until symptoms occur, and then one or more of the above tests are performed immediately after.
Treatments
The primary treatment is surgery to release the entrapped artery. Some patients may require bypass grafting, which is more common in aPAES. Post-operative physiotherapy is required.
Though surgery is the most common route, non-surgical interventions can be useful for managing PAES,, although the effectiveness can vary depending on the severity of the condition. Patients with fPAES are very unlikely to have any narrowing or damage to the popliteal artery at rest, so there is minimal risk of developing issues in the leg due to lack of blood flow. Patients with aPAES can get chronic narrowing or even blockages in the artery which can compromise blood flow to the leg even at rest and may mandate a surgical repair to prevent further damage.
Here are some of the non-surgical approaches:
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Activity Modification: Similar to exertional compartment syndrome, reducing or avoiding activities that trigger symptoms is often recommended.
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Physiotherapy: Exercises to stretch and strengthen the muscles around the knee may be suggested, which could potentially alleviate symptoms.
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Botox (Botulinum toxin) injections: explored as a potential treatment for fPAES. Botox works by blocking the nerve signals that cause muscle contraction, thereby reducing the muscle hypertrophy and compression of the artery by the muscle and tendons. Research on this treatment option is relatively limited and the results have been mixed. It's important to note that the use of Botox in treating fPAES is not a commonly accepted practice and is generally considered experimental. It may also carry risks, including muscle weakness and other side effects.
It's important to note that while these measures may help manage symptoms, they may not address the underlying causes of these conditions, especially in severe cases. Furthermore, the effectiveness of non-surgical treatment can vary widely among individuals. Therefore, ongoing consultation with healthcare professionals is crucial to monitor the conditions and adjust the treatment plan as necessary.
If non-surgical treatments fail to alleviate symptoms, or if the conditions are severe, surgical intervention may be necessary. As always, the decision to pursue surgery should be based on a thorough discussion of the risks, benefits, and alternatives with the healthcare provider.
Consider
Diagnosis of PAES often involves a team of specialists including vascular surgeons, sports medicine doctors, and orthopedic surgeons. Careful diagnosis is critical as it shares symptoms with other conditions such as Compartment Syndrome. Click here for more information.
Questions
When consulting with your physician about your pain, diagnosis and treatment path, asking questions is an important element of making an informed decision. Click here for some suggested questions.
Information
The information of this site is limited and intended to provide an overview of the chronic exertional lower leg conditions which can cause pain and functional limitations. Click here for more information on Functional Popliteal Artery Entrapment Syndrome (fPAES)..