PMID- 35970305
OWN - NLM
STAT- MEDLINE
DCOM- 20230124
LR  - 20230201
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 77
IP  - 2
DP  - 2023 Feb
TI  - Optimizing the diagnostic approach of functional popliteal artery entrapment 
      syndrome.
PG  - 580-587.e1
LID - S0741-5214(22)02087-0 [pii]
LID - 10.1016/j.jvs.2022.07.185 [doi]
AB  - OBJECTIVE: Functional popliteal artery entrapment syndrome (fPAES) is an 
      underdiagnosed and undertreated etiology of atypical claudication. Symptoms of 
      fPAES include deep posterior muscle cramping and pain with exercise and, unlike 
      anatomic PAES, there are seldom vascular complications. Common noninvasive 
      diagnostic modalities include ankle-brachial index, arterial duplex Doppler 
      ultrasound (DUS) examination, and cross-sectional imaging such as magnetic 
      resonance angiography (MRA). Entrapment can be difficult to reproduce during 
      diagnostic testing, requiring provocative maneuvers. Because we believed 
      different provocative maneuvers provide different diagnostic efficacy, we sought 
      to optimize our diagnostic approach to fPAES. METHODS: We performed a 
      retrospective review of patients before and after optimizing our noninvasive 
      imaging protocol comparing patients with fPAES versus other atypical claudicants 
      with chronic compartment syndrome. RESULTS: Arterial DUS examination and exercise 
      ankle-brachial index were important components of our protocol with a significant 
      decrease in systolic posterior tibial blood pressure of -14 mm Hg after exercise, 
      whereas nonentrapment release patients had an overall increase of 8 mm Hg (P = 
      .006). Arterial DUS examination of the distal PA with forced plantarflexion 
      demonstrated a trend toward an increase in the measured velocity ratio, 
      especially in the middle and distal PA. MRA with stressed plantar flexion 
      findings were positive in 6 of 11 patients with fPAES, with false negatives 
      likely owing to patients' inability to maintain a provocative position for the 
      duration of the MRA. CONCLUSIONS: Diagnosing fPAES is challenging owing to a lack 
      of standardized diagnostic testing and provocative maneuvers. Different maneuvers 
      demonstrated varying diagnostic yields for fPAES. Exercise ABIs were the most 
      reliable vascular laboratory test to detect changes attributable to fPAES and to 
      distinguish it from chronic compartment syndrome. Segmental PA DUS examination 
      seems to be promising as a means of detecting PA impingement. Stress positional 
      MRA effectively demonstrates anatomic PAES, but has a false-negative rate for 
      fPAES.
CI  - Copyright (c) 2022 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Morgan, Courtney
AU  - Morgan C
AD  - University of Wisconsin School of Medicine and Public Health, Madison, WI. 
      Electronic address: morganc@surgery.wisc.edu.
FAU - Huang, Andrew
AU  - Huang A
AD  - University of Wisconsin School of Medicine and Public Health, Madison, WI.
FAU - Turnipseed, William
AU  - Turnipseed W
AD  - University of Wisconsin School of Medicine and Public Health, Madison, WI.
LA  - eng
PT  - Journal Article
DEP - 20220812
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Humans
MH  - *Popliteal Artery Entrapment Syndrome
MH  - Popliteal Artery/diagnostic imaging
MH  - Intermittent Claudication/diagnostic imaging/etiology
MH  - Retrospective Studies
MH  - *Compartment Syndromes
MH  - *Arterial Occlusive Diseases/diagnostic imaging
OTO - NOTNLM
OT  - Diagnostic
OT  - Duplex ultrasound
OT  - MRI/MRA
OT  - Nonatherosclerotic vascular disease
OT  - Noninvasive
OT  - Popliteal entrapment
EDAT- 2022/08/16 06:00
MHDA- 2023/01/25 06:00
CRDT- 2022/08/15 19:25
PHST- 2021/12/30 00:00 [received]
PHST- 2022/07/19 00:00 [revised]
PHST- 2022/07/19 00:00 [accepted]
PHST- 2022/08/16 06:00 [pubmed]
PHST- 2023/01/25 06:00 [medline]
PHST- 2022/08/15 19:25 [entrez]
AID - S0741-5214(22)02087-0 [pii]
AID - 10.1016/j.jvs.2022.07.185 [doi]
PST - ppublish
SO  - J Vasc Surg. 2023 Feb;77(2):580-587.e1. doi: 10.1016/j.jvs.2022.07.185. Epub 2022 
      Aug 12.