Challenging differential diagnosis, Management of emergency care, Rare disease
Francisco Cialdine Frota Carneiro Júnior, Eduardo Nazareno dos Anjos Carrijo, Samuel Tomaz Araújo, Luis Carlos Uta Nakano, Jorge Eduardo de Amorim, Daniel Guimarães Cacione
Service of Vascular and Endovascular Surgery, Federal University of São Paulo, São Paulo, SP, Brazil
Am J Case Rep 2018; 19:29-34
Popliteal artery entrapment syndrome (PAES) results from an anomalous relationship between the popliteal artery and the myofascial structures of the popliteal fossa. The most common presenting symptoms include intermittent pain in the feet and calves on exercise, resulting in lameness. PAES can lead to popliteal artery thrombosis, stenosis, distal arterial thromboembolism, or arterial aneurysm. The treatment of PAES includes surgical exploration with fasciotomy, myotomy, or sectioning of fibrous band formation, to release the popliteal artery. However, in cases with thrombotic occlusion, thromboendarterectomy with venous patch arterioplasty, or venous graft arterial bypass surgery may be required. This report describes the presentation and surgical management of a case of PAES presenting with limb pain and includes a review of the literature on this condition.
CASE REPORT: A previously healthy 47-year-old woman presented with a 20-day history of sudden pain in the left lower limb, associated with pallor and a loss of arterial pulses below the knee. Angiography of the affected limb showed occlusion of the left supragenicular popliteal artery, with arterial occlusion, suggestive of arterial thrombus. Imaging of the right popliteal artery, which was not occluded, showed that it was medially deviated. An ipsilateral saphenous vein graft was used to bypass the left supragenicular popliteal artery to the infragenicular popliteal artery, resulting in resolution of the patient’s symptoms.
CONCLUSIONS: PAES is rare and can be under-diagnosed, possibly due to lack of knowledge of this condition. However, if the diagnosis is made early, the prognosis is usually favorable, following appropriate surgical treatment.
Keywords: Arterial Occlusive Diseases, Lower Extremity, Popliteal Artery