Symptomatic popliteal artery entrapment syndrome: a challenging diagnosis and treatment

We analysed the diagnostic accuracy, patient selection, and postoperative outcomes of patients surgically treated for popliteal artery entrapment syndrome (PAES).

All patients diagnosed with PAES in our hospital between January 2019 and March 2025 were included. Diagnosis was made on the positive triad of symptoms, decreased ankle-brachial index (ABI) and compression on angiography. Conservative and operative treatments were offered to all patients. Retrospective analysis of demographic, clinical, and surgical data was performed.

Thirty-two patients were diagnosed with PAES with a total of 57 affected legs. Thirty-five legs in 21 patients underwent surgical decompression. Functional success was achieved in 60.0% and technical success in 85.7% of the operated legs. Positive evolution in the ABI is seen with prolonged follow up. Fourteen legs experienced no functional improvement after surgery, despite evidence of technical success in nine legs (25.7%). Five patients were postoperatively diagnosed with other causal pathologies than PAES and two patients experienced symptom relieve with botulinum toxin infiltration postoperatively.

PAES is a pathology with a broad differential diagnosis. The difference between postoperative functional and technical success in patients with popliteal artery compression indicates that other pathologies may be responsible for the patient's symptoms and that the popliteal compression may be an asymptomatic coincidence. PAES should be considered a diagnosis of exclusion in a multidisciplinary setting when the positive triad is present, to maximize the postoperative functional success. To determine technical success, prolonged ABI follow-up is recommended, as improvement may occur over time.