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      Popliteal Artery Entrapment Syndrome in a Young Baseball Pitcher: A Case Report

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          Abstract

          Background

          Popliteal artery entrapment syndrome (PAES) is a rare disease in young adults and is thought to be under-diagnosed, and its main cause is the abnormal structure between the popliteal artery and gastrocnemius muscle. The patients experience symptoms after the blood vessels are compressed. Failure to diagnose and treat PAES can cause serious sequelae.

          Case

          A 19-year-old male baseball pitcher with PAES type 2 suffered from left calf muscle tension and foot numbness and was mis-diagnosed for nearly a year. Finally, the lesion was detected by ultrasonography and confirmed by magnetic resonance imaging. After surgical intervention, he quickly returned to sport.

          Discussion/Conclusion

          PAES has 6 types. Type 2 (25%) and type 3 (30%) are the most common. Patients with this syndrome suffer from aching pain, numbness, and cramping in the calf area when they exercise. It is necessary to include this disease in differential diagnosis to implement early diagnosis, and ultrasonography is a more cheap and simple method for early detection.

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          Most cited references 24

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          Popliteal artery entrapment syndrome: more common than previously recognized.

          This report summarizes our experience with the popliteal entrapment syndrome in 88 limbs (48 patients) treated during a 10-year period. The study cohort consisted of a retrospective analysis of those patients who were seen with symptoms of claudication or severe ischemia by a single surgical group and in whom unequivocal evidence of popliteal entrapment was shown either with angiography or at the time of operation. The cases were collected prospectively in a private vascular surgical practice. Bilateral popliteal entrapment was found in 40 of the 48 patients. The mean age at the time of presentation was 35.0 years (SD, 11.6 years). Claudication was the most frequent presenting symptom (70 of 88 limbs). Types I, II, III, and IV popliteal entrapment were found in 58 limbs (15 arteries occluded), and 30 limbs (three occlusions) were seen with a "functional" popliteal artery entrapment (apparent absence of a developmental anatomic abnormality). Of the 18 limbs with severe ischemia and associated occlusion of the popliteal artery, 15 underwent bypass grafting with reversed saphenous vein grafts, all of which remained patent during the follow-up period (median follow-up, 4.2 years; range, 1 to 10 years). One popliteal artery occlusion that was treated with thrombectomy and vein patching occluded within 6 months and necessitated subsequent vein grafting. Two limbs with inoperable occluded popliteal arteries were not subjected to reconstruction (one necessitated amputation because of advanced ischemia, and the second had extensive thrombosis of the distal run-off). In two patients (four limbs), moderate presenting symptoms abated without surgery after the discontinuation of an extreme exercise program. The remaining limbs underwent surgical decompression (all popliteal arteries remained patent, with a median follow-up of 3.9 years). The popliteal entrapment syndrome is more prevalent than has formerly been appreciated. On the basis of observations made in this series and in the surgical literature, we advise surgical correction in all cases of types I, II, III, and IV entrapment at the time of diagnosis to avoid occlusion as a result of continued arterial wall degeneration. In contrast, decompression is only advised in those patients with "functional entrapment" if they have discrete and typical symptoms because up to 50% of the normal population may display transient popliteal artery compression with extremes of plantar flexion or dorsiflexion. On the basis of the severe histologic changes found in those popliteal arteries that had undergone occlusion at the time of presentation, it is advised that the popliteal artery should be completely replaced, ideally with a vein graft, when significant degeneration or occlusion of the popliteal artery is noted at the time of operation.
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            Popliteal entrapment syndrome.

            Popliteal entrapment syndrome (PES) is a rare but important cause of intermittent claudication in young people. Controversy exists about optimal strategies for diagnosis and management, particularly for variants such as functional popliteal entrapment. The aim of this review was to systematically catalog the published English-language literature on PES and to determine if evidence-based guidelines for management could be formulated.
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              Popliteal artery disease: diagnosis and treatment.

              The popliteal artery is a relatively short vascular segment but is affected by a unique set of pathologic conditions. These conditions, which may be common throughout the arterial system or exclusive to the popliteal artery, include atherosclerosis, popliteal artery aneurysm, arterial embolus, trauma, popliteal artery entrapment syndrome, and cystic adventitial disease. The clinical manifestations, imaging appearances, and treatment options associated with these pathologic conditions differ significantly. Consequently, the radiologist should be familiar with these conditions to direct imaging for accurate diagnosis and treatment and to prevent loss of limb. Copyright RSNA, 2004
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                21 April 2020
                2020
                : 13
                : 777-781
                Affiliations
                [1 ]Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare , Taichung, Taiwan
                [2 ]Department of Occupational Therapy, Asia University , Taichung, Taiwan
                Author notes
                Correspondence: Chung-Liang Lai Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare , 199 San Min Road, Sec. 1, Taichung, Taiwan403, Taiwan Email laipeter57@yahoo.com.tw
                [*]

                These authors contributed equally to this work

                Article
                236306
                10.2147/JPR.S236306
                7185988
                © 2020 Huang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 4, References: 25, Pages: 5
                Categories
                Case Report

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