R E V I E W Diagnosis and surgical approach of popliteal artery entrapment syndrome: a retrospective study Stavros Gourgiotis1 John Aggelakas1 Nikolaos Salemis1 Charalabos Elias2 Charalabos Georgiou1 1Second Surgical Department, 401 General Army Hospital of Athens, Greece; 2Second Surgical Department, 417 NIMTS Veterans General Hospital of Athens, Greece Correspondence: Stavros Gourgiotis Address: 41 Zakinthinou Street, 15669, Papagou,Athens, Greece Tel/fax +30 21 0652 5802 Email drsgourgiotis@tiscali.co.uk Background: Popliteal artery entrapment syndrome (PAES) is a rare but potentially limb threatening peripheral vascular disease occurring predominantly in young adults. This study is a retrospective review of 49 limbs in 38 patients with PAES treated surgically over an 8-year period. Patients and methods: From 1995 to 2002, 38 patients with a mean age of 21 years (range, 18–29 years) underwent surgery for PAES at a single institution. The patients’ demographic data and clinical features are recorded. The preoperative diagnosis of PAES was made based on various combinations of investigations including positional stress test, duplex ultrasonography, computed tomography, computed tomographic angiography, and angiography. Results: Nine, 33, and 7 patients had Delaney’s type I, II, and III PAES respectively. The surgical procedures consisted of simple release of the popliteal artery in 33 limbs (67.3%), autogenous saphenous vein (ASV) patch angioplasty with or without thromboendarterectomy (TEA) in 5 limbs (10.2%) and ASV graft interposition or bypass in 11 limbs (22.5%). At a median follow up of 34 months (range, 8–42 months), there were no postoperative complications and all the patients were cured of their symptoms. Conclusions: PAES is an unusual but important cause of peripheral vascular insufﬁciency especially in young patients. Early diagnosis through a combined approach is necessary for exact diagnosis. Popliteal artery release alone or with vein bypass is the treatment of choice when intervention is indicated for good operative outcome and to prevent limb loss. Keywords: popliteal artery, entrapment syndrome, diagnosis, surgery, treatment Introduction Popliteal artery entrapment syndrome (PAES) is an anomalous relationship between the popliteal artery and its surrounding musculotendinous structures. In 1879, TP Anderson Stuart, an Edinburgh medical student, described an anatomical variant of the popliteal artery which he had dissected from a gangrenous limb (Stuart 1879). The signiﬁcance of this anomaly was not recognized until 1959 when Hamming and Vink (1965) in the Netherlands described the clinical syndrome which is associated with entrapment of the popliteal artery. In their study of 1,200 patients suffering from calf and foot claudication, 12 (1%) were less than 30 years of age and ﬁve of these had PAES. PAES is a rare condition, and reports of this condition in the literature have been limited to a number of small series (Schurmann et al 1990; Di Marzo et al 1997; Hoelting et al 1997; Levien and Veller 1999; Ohara et al 2001). The incidence of PAES has been reported to range from 0.17% (Bouhoutsos and Daskalakis 1981) to 3.5% Gibson et al 1977) in a review of 20,000 asymptomatic Greek soldiers and a study of autopsy specimens, respectively, leading the authors to conclude that only a small Vascular Health and Risk Management 2008:4(1) 83–88 © 2008 Gourgiotis et al, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 83