Popliteal Artery Entrapment Syndrome Leading to Arterial Occlusıon: A Case Report

Isgandarlı T., Canbay Sarılar Ç., Akdoğan B., Bozbuğa N.

29th International Medical Sciences Student Congress, İstanbul, Türkiye, 18 - 19 Nisan 2026, ss.50, (Özet Bildiri)

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: İstanbul
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.50
  • İstanbul Üniversitesi Adresli: Evet

Özet

Introduction:

Popliteal Artery Entrapment Syndrome (PAES) is a rare vascular anomaly where aberrant myofascial structures in the popliteal fossa cause arterial compression. Classified into six types by the Whelan/Rich system, PAES typically affects young, active males; however, chronic entrapment can lead to secondary intimal damage and occlusion in older populations. We report a rare case of Type III PAES in a 61-year-old male, where an accessory slip of the gastrocnemius muscle resulted in focal fibrotic stenosis and complete popliteal artery occlusion.

Material and Method:

A 61-year-old male with hypertension and coronary artery disease presented with left lower extremity claudication. Physical examination revealed weak (biphasic) distal pulses, and CT angiography confirmed a short-segment occlusion of the proximal popliteal artery. During surgical exploration via a posterior approach, Type III Popliteal Artery Entrapment Syndrome (PAES) was identified, characterized by an accessory slip of the gastrocnemius muscle causing mechanical compression. Management involved excision of the accessory muscle slip, popliteal endarterectomy of a focal fibrotic segment, and venous patchplasty using the small saphenous vein (VSP). Postoperative distal pulses were palpable, and limb perfusion was successfully restored without complications.

Discussion & Conclusion:

Although Popliteal Artery Entrapment Syndrome (PAES) is typically seen in young athletes, it is a critical differential for localized arterial occlusion in older patients. In this case, Type II PAES-an accessory gastrocnemius slip-caused chronic mechanical trauma to the popliteal artery. This repetitive "conflict" triggered focal intimal damage and fibrotic stenosis, distinct from systemic atherosclerosis. In conclusion successful limb salvage in chronic entrapment requires a dual-stage surgical approach: anatomical decompression (myotomy) followed by definitive arterial reconstruction (endarterectomy and patchplasty). Clinicians must consider myofascial anomalies in all cases of atypical claudication to ensure timely surgical intervention.

Keywords: Popliteal Artery Entrapment Syndrome (PAES), Type III PAES, Focal Fibrotic Stenosis, Popliteal Endarterectomy, Venous Patchplasty, CT Angiography