Long Term Outcomes of Non-operative Treatment for Popliteal Artery Entrapment Syndrome: A Multicentre Study

Surgical decompression is generally recommended for popliteal artery entrapment syndrome (PAES); however, many young patients are reluctant to undergo surgery. Additionally, there is no consensus on the management of asymptomatic or mildly symptomatic cases. This multicentre study investigated the prognosis of non-operated limbs with PAES and analysed outcomes in limbs undergoing delayed surgical intervention in order to refine management strategies.

Patients diagnosed with PAES and treated in three hospitals between January 1994 and October 2022 were included. Medical records and imaging data were reviewed retrospectively. Symptoms were classified into Rutherford categories, and the anatomical abnormality was classified after image review. Data analysis was performed using R software.

Among 96 limbs diagnosed with PAES, 64 underwent surgery, while 32 received conservative treatment. There were no statistically significant differences in demographics or ankle brachial index between the surgery and no surgery groups; however, smoking and alcohol consumption rates were statistically significantly higher in the surgery group. Additionally, Rutherford classification and extent of arterial occlusion were statistically significantly more severe in the surgery group compared with the no surgery group (p < .001 and p = .015, respectively). Of the 32 limbs treated conservatively, 30 remained stable (94%), and two limbs (6%) underwent delayed surgery during a mean follow up of 68.9 months. None experienced severe complications of amputation, death, or distal embolism.

Patients with PAES with no or mild symptoms who are reluctant to undergo surgery can be safely managed with regular follow up and conservative treatment. Monitoring symptoms through outpatient visits and imaging enables effective management. Surgical intervention can be safely performed if symptoms worsen over time.