Gourgiotis et al If detected and treated early, the outcome of PAES after surgery is generally good (Di Marzo et al 1997). However, if this condition is treated late when there is extensive arterial damage, then permanent claudication or even limb loss may be inevitable. Nonetheless, it is important to note that limb loss is a rare event because the arterial occlusion in PAES is usually a slow and chronic process allowing collateral formation. Conclusions PAES is an unusual but important cause of peripheral vascular insufﬁciency. It should be included in the differential diagnosis of acute popliteal artery occlusion, claudication or bizarre leg pains in young patients, especially men. Early diagnosis and surgical intervention is important for good operative outcome. It is usually diagnosed by radiological methods; angiography and CTA appears to be the most use- ful single investigation in the diagnosis of PAES but each imaging modality has its place and it may be appropriate to use several in combination to make a ﬁrm diagnosis. Popliteal artery release alone or with vein bypass is the treatment of choice when intervention is indicated. References Akkersdijk WL, de Ruyter JW, Lapham R, et al. 1995. Colour duplex ultra- sonographic imaging and provocation of popliteal artery compression. Eur J Vasc Endovasc Surg, 10:342–5. Barabas AP, Macfarlane R. 1985. Popliteal artery entrapment syndrome. Br J Hosp Med, 34:304–6. Beregi JP, Djabbari M, Desmoucelle F, et al. 1997. Popliteal vascu- lar disease: evaluation with spiral CT angiography. Radiology, 203:477–83. Bouhoutsos J, Daskalakis E. 1981. Muscular abnormalities affecting the popliteal vessels. Br J Surg, 68:501–6. Delaney TA, Gonzalez LL. 1971. Occlusion of popliteal artery due to muscle entrapment. Surgery, 69:97–101. Di Marzo L, Cavallaro A, Sciacca V, et al. 1991. Diagnosis of popliteal artery entrapment syndrome: the role of duplex scanning. J Vasc Surg, 13:434–8. Di Marzo L, Cavallaro A, Sciacca V, et al. 1994. Natural history of entrap- ment of the popliteal artery. J Am Coll Surg, 178:553–6. Di Marzo L, Cavallaro A, Mingoli A, et al. 1997. Popliteal artery entrapment syndrome: the role of early diagnosis and treatment. Sur- gery, 122:26–31. Elias DA, White LM, Rubenstein JD, et al. 2003. Clinical evaluation and MRI imaging features of popliteal artery entrapment and cystic adven- titial disease. AJR Am J Roentgenol, 180:627–32. Erdoes, LS, Devine, JJ, Bernhard, et al. 1994. Popliteal vascular compres- sion in a normal population. J Vasc Surg, 20:978–86. Fong H, Downs AR. 1989. Popliteal artery entrapment syndrome with distal embolization: a report of two cases. J Cardiovasc Surg, 30:85–8. Fowl RJ, Kempczinski RF, Whelan TJ. 1995. Popliteal artery entrapment. In: Rutherford RB ed. Vascular Surgery. 4th ed. Philadelphia, Penn- sylvania: Saunders WB, pp 889–94. Gibson MHL, Mills JG, Johnson GE, et al. 1977. Popliteal entrapment syndrome. Ann Surg, 185:341–8. Gyftokostas D, Koutsoumbelis C, Mattheou T, et al. 1991. Post stenotic aneurysm in popliteal artery entrapment syndrome. J Cardiovasc Surg, 32:350–2. Haimovici H, Sprayregen S, Johnson F. 1972. Popliteal artery entrapment by ﬁbrous band. Surgery, 72:789–92. Hamming JJ, Vink M. 1965. Obstruction of the popliteal artery at an early age. J Cardiovasc Surg, 6:516–24. Hoelting T, Schuermann G, Allenberg JR. 1997. Entrapment of the popli- teal artery and its surgical management in a 20-year period. Br J Surg, 84:338–41. Insua JA, Young JR, Humphries AW. 1970. Popliteal artery entrapment syndrome. Arch Surg, 101:771–5. Jasinski Masselink BA, Partridge RW, Decking BG, et al. 1987. Adventitial cystic disease of the popliteal artery. Radiology, 163:153–5. Lambert AW, Wilkins DC. 1998. Popliteal artery entrapment syndrome: collaborative experience of the Joint Vascular Research Group. Br J Surg, 85:1367–8. Levien LJ, Veller MG. 1999. Popliteal artery entrapment syndrome: more common than previously recognized. J Vasc Surg, 30:587–98. Love JW, Whelan TJ. 1965. Popliteal artery entrapment syndrome. Am J Surg, 109:620–4. Murray A, Halliday M, Croft RJ. 1991. Popliteal artery entrapment syn- drome. Br J Surg, 78:1414–9. Ohara N, Miyata T, Oshiro H, et al. 2001. Surgical treatment for popliteal artery entrapment syndrome. Cardiovasc Surg, 9:141–4. Persky JM, Kempezinski RF, Fowl RJ. 1991. Entrapment of the popliteal artery. Surg Gynecol Obstet, 173:84–90. Rich NM, Collins GJ Jr, McDonald PT, et al. 1979. Popliteal vascular entrapment: it’s increasing interest. Arch Surg, 114:1377–84. Rich NM. 1982. Popliteal entrapment and adventitial cystic disease. Surg Clin North Am, 62:449–65. Schurmann G, Mattfeldt T, Hofmann W, et al. 1990. The popliteal artery entrapment syndrome: presentation, morphology and surgical treatment of 13 cases. Eur J Vasc Surg, 4:223–31. Steurer J, Hoffmann U, Schneider E, et al. 1995. New therapeutic approach to popliteal artery entrapment syndrome (PAES). Eur J Vasc Endovasc Surg, 10:243–7. Stuart TPA. 1879. Note on a variation in the course of the popliteal artery. J Anat Physiol, 13:162–5. Turnipseed WD. 2001. Popliteal entrapment syndrome. J Vasc Surg, 35:910–5. Whelan TJ. 1976. Popliteal artery entrapment syndrome. In: Haimovici Hed Vascular Surgery ed. Principles and Techniques. New York: McGraw-Hill. p 493–504. Zund G, Brunner U. 1995. Surgical aspects of popliteal artery entrapment syndrome: 26 years of experience with 26 legs. Vasa, 24:29–33. 88 Vascular Health and Risk Management 2008:4(1)