Bilateral Exertional Calf Pain - Page #4

Working Diagnosis:
Functional popliteal artery entrapment syndrome

Underwent bilateral functional popliteal artery release, which involves releasing a constricted popliteal fossa outlet created by soleus muscles. Intra-operatively, patient was also found to have an enlarged popliteus muscle.

He is now 1 year post-op from bilateral functional popliteal artery entrapment release, has returned to full activity and is completely asymptomatic.

Author's Comments:
Physical exam, PDI ultrasound and ABI were consistent with popliteal artery entrapment syndrome. However, MRI/MRA demonstrated no anatomic variation in the gastrocnemius muscles and no vascular entrapment with provocation. Given this the final diagnosis was functional popliteal artery entrapment syndrome. In symptomatic patients what is the role of non-invasive testing such as PDI US and ABI in the diagnosis of FPAES?

Editor's Comments:
This case highlights a fairly unusual cause of exertional calf pain. Recent literature suggests dual-source CT angiography and ultrasound as non-invasive studies useful in establishing this diagnosis. Further, classification systems exist which may be helpful in discerning those patients that need decompression vs decompression with bypass vs angioplasty.

Sun X, et al. Dual source CT angiography in popliteal artery entrapment syndrome. J Med Imag and Rad Onc 57(2013): 156-160.

Causey MW, et al. Ultrasound is a critical adjunct in the diagnosis and treatment of popliteal entrapment syndrome. J Vasc Surg 57(2013): 1695-97.

Whelan TJ, Haimmovici H. Vascular surgery: principles and techniques. 2nd ed. New York: McGraw-Hill,
1984; pp 557-567.

Rich NM, Collins GJ, McDonald PT, et al. Popliteal vascular entrapment. Its increasing interest. Arch Surg
1979; 114: 1377-84.

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