Popliteal Artery Entrapment Syndrome: A Review of Current Concepts

Although rare, popliteal artery entrapment syndrome (PAES) should be considered in every young patient presenting with unexplained leg ischemia or exercise-induced claudication. Failure to recognize this condition can lead to delayed diagnosis, inappropriate treatment, and even limb-threatening complications. Symptoms such as calf pain, cramping, and paresthesia often overlap with musculoskeletal or vascular conditions, underscoring the need for a high index of suspicion. Diagnosis requires dynamic imaging with provocative maneuvers; while angiography remains the gold standard, Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography are increasingly used for both vascular and soft-tissue assessment. Conservative therapies rarely achieve durable results, and surgical intervention, ranging from myofascial decompression to arterial reconstruction, remains the definitive treatment, with early recognition and timely surgery being essential to prevent arterial damage and irreversible ischemia. This review summarizes the most relevant advances in the understanding of PAES, its anatomy, pathophysiology, clinical presentation, diagnostic strategies, classification, and management, with the goal of providing practical guidance for surgeons.