Objective: To summarize advancement of diagnosis and surgical intervention of popliteal artery entrapment syndrome (PAES).
Methods: From March 2006 to August 2009, 11 patients (14 limbs) underwent surgical procedures, including 9 males (81.8%), with a median age of 22 years old (arranged from 15 to 56 years old). Three cases (27.2%) had both limbs involved. The chief complaint contained intermittent claudication in 8 cases and rest pain in 3 cases. The time from onset to admission arranged from 3 weeks to 10 years. 14 limbs were diagnosed as PAES through multidetector spiral computed tomography. Eleven cases were diagnosed as Delaney's type II or III, 1 case as type V and 2 cases as type I. Two limbs underwent popliteal artery release only, 8 limbs underwent popliteal artery release, thromboendarterectomy and angioplasty with a venous or prosthetic patch, 2 patients complaining acute limb ischemia underwent catheter-based thrombolysis and popliteal artery release subsequently, 2 patients with a occlusive segment longer than 5 cm in popliteal artery underwent below-knee femoral-popliteal artery bypass with in-situ greater saphenous vein graft. All the patients undertook anticoagulation treatment with coumadin after the operation.
Results: All the patients had their clinical symptoms released after the operation. One patient (1 limb) was recurrent 20 months after the operation and underwent embolectomy successfully. At a median follow up of 13 months (range 1 to 36 months), the primary patency rate was 92.9% (13/14), the total patency rate was 100% (14/14) and limb salvage rate was 100%. The ankle brachial index at neutral position improved significantly after the surgery in the 12 occluded limbs (1.11 +/- 0.10 vs. 0.62 +/- 0.14, P < 0.01).
Conclusions: Multidetector spiral computed tomography is much helpful in diagnose and typing of PAES. Surgery should be performed as soon as the PAES is diagnosed. Appropriate surgical intervention can achieve satisfying effect according to different character of popliteal artery occlusions.