Intraoperative duplex and functional popliteal entrapment syndrome: strategy for effective treatment

Functional popliteal entrapment syndrome (FPES) was first described by Rignault and colleagues in 1985 (Int. Angiol. 1985;4:341-343). This syndrome results from compression of the popliteal artery by a hypertrophied medial head of the gastrocnemius muscle with no other identifiable anatomical abnormality. The incidence, significance, natural history, and appropriate treatment of this syndrome remain controversial. We present three cases of FPES where intraoperative positional duplex scans guided gastrocnemius muscle resection and confirmed appropriate resection. Additionally, B-mode duplex obtained during one of the cases demonstrated intimal changes consistent with repetitive vessel trauma. All patients had resolution of their claudication and normal physiological testing postoperatively.