Outcomes of Surgical Decompression for Functional Popliteal Artery Entrapment Syndrome

Functional popliteal artery entrapment syndrome (FPAES) is a rare cause of claudication, predominantly affecting young females. The optimal workup, approach and outcomes remains poorly defined. We aim to evaluate our institutional experience in surgical decompression of FPAES.

This is a retrospective review of all patients undergoing surgical decompression for FPAES between January 2010 and January 2024 at our institution. Preoperative imaging, operative approach, reintervention, and symptomatic improvement at the last follow-up were analyzed.

Sixty-six patients (109 limbs) with a mean age of 25 ± 12 years were identified. 53 patients (80.3%) were female. Median time from onset of symptoms to surgical management was 34 months. All patients underwent preoperative magnetic resonance imaging and ultrasound with provocative maneuvers and 39 patients (59.1%) underwent preoperative angiogram. Nine patients (13.6%) had undergone previous popliteal artery decompression at outside institutions and were referred for refractory or recurrent symptoms. A medial approach to popliteal decompression was utilized in 84 limbs (77.1%). Posterior approach was utilized in 25 limbs. Perioperative complications occurred in 6 patients (9.1%). Median follow-up was 10.5 months (interquartile range, 4-27 months). Initial symptomatic improvement was reported in 85 limbs (81.0%), 12 (14.1%) of which, had recurrent symptoms at the last follow-up. A reintervention was performed due to recurrent or persistent symptoms in 10 limbs (9.5%). Symptomatic improvement at the last follow-up in patients undergoing first-time intervention was reported in 78.9% of limbs and was similar for medial versus posterior approach. Symptomatic improvement in patients undergoing redo popliteal artery decompression was reported in 42.9% of limbs.

Surgical decompression for the treatment of FPAES can be an effective treatment for selected symptomatic individuals. However, persistent or recurrent symptoms require further study for proper patient selection. A multidisciplinary team and evolving multimodal testing are required to achieve optimal results.