1. Popliteal artery Entrapment Syndrome
Sachin Khullar

3. PAES- Some Facts Uncommon Clinical Entity Potentially Limb Threatening
30-50% asymptomatic patients can occlude popliteal artery by knee extension and plantar flexion
Relative force of Plantar flexion occluding the artery is more important
Not helped by rest or medication
May be unilateral

4. PAES- (no) Anatomical Torture
Popliteal artery arises from
Superficial Femoral artery
Popliteal artery lies in Popliteal fossa
Popliteal fossa lies at the back
of the knee
PAES can be Functional
Levien and Veller,1999

5. PAES- Presentation
Pain, paraesthesia or weakness induced by exercise, but possibly positional and/or at rest.
Pain develops and dissipates quickly
Usually painful superficial posterior Compartment ( not a rule)
Not helped by rest or medication
May be unilateral
Pulses may/may not be absent
Hislop, Sanjay, 2015

6. Popliteal artery Development
Levien et al, 1999; Hislop, 2014

7. PAES- Entrapment Sites
Between plantaris and (MHGM)
Between plantaris and popliteus
At the soleal sling
Between the MHGM and the LFC
Plantaris
Popliteus
MHGM
(reflected)
Popliteal
Artery
Soleal
sling

8. PAES- Anatomical Types
Rich et al, 1989

9. Asymptomatic Occluders
PAES- Clinical Types
Asymptomatic Occluders
Functional PAES
Anatomical PAES

10. PAES- Diagnosis Clinical Tests Doppler provocative protocols
MRI and MRI angiography with stress testing
Digital subtraction Angiography

11. Clinical Provocative test
No validated test
Pulse examination and bruit
Provocative heel drops eccentrically for times – looking for clinical S/S and Bruit
Single leg hops
ABI

12. DOPPLER and Provocative tests

13. Digital Subtraction Angiography
Tercan et al, 2005

14. MRI-A in PAES Complete occlusion of flow
In popliteal artery in left leg L

15. MRI-A with DF and PF
Occluded Artery
Patent Artery

16. PAES-Treatment

17. BOTOX injection- Definitive or intermediate step
Proposed mechanism of action:
Paralysis of Muscle
Associated atrophy
Arterial Smooth Muscle dilatation
20-40 Units injected
Ultrasound Guidance
Safe
Takes 4-6 days to act
Can be topped up
Gradual return to Play

18. PAES- Surgery
At present surgical correction is advised for the presence of Anatomical PAES (Types 1-5) where the occlusion is often more severe, and risk of adventitial injury to the artery
Anatomical dissection of the artery
Myotomy MHGM

19. Hislop et al, 2014

20. THANK YOU