Clinical Presentation
A 32-year-old male presented to the outpatient clinic with intermittent left lower extremity calf claudication.
Figure 21-1 Diagnosis of popliteal artery entrapment syndrome. (A) Selected left lower extremity arteriogram with the foot in passive dorsiflexion shows a patent popliteal artery with three-vessel runoff to the lower leg. (B) Repeat selected arteriogram with the foot in active plantar flexion shows extrinsic compression causing complete occlusion of the left popliteal artery.
Radiologic Studies
Angiography
The right common femoral artery was punctured using the Seldinger technique, and a 5-French (F) sheath was inserted. The left external iliac artery was selected. An arteriogram (Fig. 21-1A) with the left foot in passive dorsiflexion showed a patent popliteal artery with three-vessel runoff to the lower leg.
Repeat selected left leg arteriogram (Fig. 21-1B) with the foot in active plantar flexion showed extrinsic compression causing complete occlusion of the left popliteal artery with distal reconstitution by collateral vessels.
Diagnosis
Intermittent obstruction of the left popliteal artery resulting from popliteal artery entrapment syndrome (PAES).
Treatment
The patient underwent surgical decompression and has been symptom-free for 8 months.
Equipment
Puncture needle
5F vascular sheath
5F pigtail catheter
0.035” conventional soft-tipped guidewire
Contrast material
Discussion
Background
PAES describes extrinsic compression of the popliteal artery caused by abnormal position of this vessel in relation to the surrounding structures. PAES has been divided into five types (Table 21-1
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