Trapped by the Entrapment.

Area of Science:

• Vascular Surgery
• Anatomy
• Diagnostic Imaging

Background:

• Popliteal entrapment syndrome (PES) is a rare condition caused by extrinsic compression of the popliteal artery.
• It can lead to limb ischemia and is often misdiagnosed, resulting in suboptimal management.
• This report highlights potential pitfalls in managing PES.

Observation:

• A 23-year-old male initially underwent bypass surgery for presumed traumatic popliteal artery thrombosis.
• Over 13 years, multiple inappropriate procedures were performed due to misinterpretation of the condition.
• Diagnosis of Type V PES was confirmed 19 years later, involving abnormal gastrocnemius muscle insertion compressing the artery and vein.

Findings:

• The patient's previous revascularization failures were attributed to misdiagnosis and the complex nature of the entrapment.
• Surgical release involved resecting the aberrant muscle slip and reconstructing the artery.
• Post-operative imaging revealed asymptomatic contralateral popliteal artery entrapment.

Implications:

• An isolated popliteal artery lesion in young individuals should raise suspicion for PES.
• Definitive surgical release is the preferred treatment strategy for popliteal artery entrapment.
• Accurate diagnosis and appropriate surgical intervention are vital to prevent complications and ensure successful outcomes in PES management.