Popliteal Artery Entrapment Syndrome (PAES)—a Missed Diagnosis

Popliteal artery entrapment syndrome (PAES), a rare vascular developmental anomaly, occurs due to abnormal relationship between popliteal artery and the myofascial structures in the popliteal fossa. It is classically found in young, athletic, and non-smoking male. Patient may be asymptomatic or may present with claudication or rest pain. The signs and symptoms are related to either stenosis, occlusion, aneurysmal dilatation of popliteal artery or due to distal embolization. PAES is classified into six types (type I–VI) depending on relationship between popliteal artery and medial head of gastrocnemius around popliteal fossa. Diagnosis remains challenging as symptoms mimic other vascular conditions like peripheral arterial occlusive disease (PAOD), thromboangiitis obliterans (TAO), adventitial cystic disease (ACD), fibro-muscular dysplasia (FMD), small- and medium-vessel vasculitis etc. CT angiogram and MRI are the investigations of choice and surgery is considered as the mainstay of treatment. Surgery is highly rewarding and recurrence is very rare. We hereby report a case of PAES, which was mis-diagnosed and mis-treated as early onset peripheral vascular disease over a period of three years. PAES with popliteal artery occlusion was suspected clinically, confirmed on imaging and treated successfully by popliteal artery (P1-P3) reverse saphenous vein graft (RSVG) with favorable outcome.