Vascular: Popliteal Artery Entrapment Syndrome (PAES)

Basics

• Definition: Popliteal Artery Entrapped Under Calf Muscles
• Presentation: Intermittent Claudication & Loss of Pulses with Plantar Flexion
• Most Common in Male Athletes
• Can be Bilateral

Heidelberg Classification

• Type I: Popliteal Artery Deviated Medially by a Normally Situated Medial Head of the Gastrocnemius
• Type II: Popliteal Artery Deviated Medially by an Abnormally Situated Medial Head of the Gastrocnemius
• Type III: Popliteal Artery Deviated Medially by an Accessory Slip or Fibrous Band from the Medial Head of the Gastrocnemius
• Type IV: Popliteal Artery Lies Deep to the Popliteus Muscle
• Types V: Compression of Both Popliteal Artery & Vein by Types I-IV
• Type VI: Entrapment without an Associated Anatomic Abnormality

Diagnosis

• Diagnosis: Loss of Doppler Signal with Provocative Maneuvers & CT/MRI

Treatment

• Primary Treatment: Myotomy
  • Typically Resect Medial Head of the Gastrocnemius