Working Diagnosis:
Recurrent bilateral popliteal artery entrapment syndrome

Treatment:
A myectomy of the proximal medial gastrocnemius head was performed because it abutted the popliteal artery and appeared uncut. There was also an arteriolysis of the popliteal artery around the knee joint due to extensive scarring that appeared to entrap the artery. Neurolysis of the posterior tibial nerve was also performed as there was extensive scarring of the nerve.

Outcome:
She reported resolution of pain and started physical therapy 3 weeks after the surgery.

Author's Comments:
Popliteal artery entrapment syndrome (PAES) is a rare vascular disorder typically seen in young people under the age of 30. Diagnosis is difficult and requires an interprofessional team including radiology and vascular surgery. Recurrence of popliteal artery entrapment once surgically treated is rare and is often due to scar tissue. If left untreated, it eventually progresses to luminal narrowing, thrombosis, and total occlusion.

Editor's Comments:
PAES can be either congenital or acquired with resultant compression of the popliteal artery and/or vein. The presentation can be chronic or acute (limb ischemia). Thus, PAES needs to be considered for any patient presenting with exertional lower extremity pain in order to ensure timely diagnosis and optimal outcomes. While PAES is often a condition of young adult athletes, it has also been reported in the pediatric population, demonstrating the importance of keeping a broad differential diagnosis when evaluating patients.

References:
Hameed M, Coupland A, Davies AH Popliteal artery entrapment syndrome: an approach to diagnosis and management. British Journal of Sports Medicine 2018;52:1073-1074.
Davis DD, Shaw PM. Popliteal Artery Entrapment Syndrome. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441965/
Radonić V, Koplić S, Giunio L, Bozić I, Masković J, Buća A. Popliteal artery entrapment syndrome: diagnosis and management, with report of three cases. Tex Heart Inst J. 2000;27(1):3-13. PMID: 10830621; PMCID: PMC101010.
Slavin B, Thorson W, Velazquez O, Thorson C. Bilateral Popliteal Artery Entrapment Syndrome in a 4-Year-Old Child with Cerebral Palsy. Annals of Vascular Surgery, Volume 86, 2022, 31-32.

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