It is common for elderly people to suffer arterial obstructions in the lower limbs. When this occurs, the patient presents muscle pain when walking that increases with the distance covered, with the speed and with the incline. The pain disappears with rest. These symptoms are called intermittent claudication.
The problem arises when these symptoms appear in young, healthy and sporty people.
When a patient with this profile “comes to our clinic with symptoms of intermittent claudication, we should think about and rule out Popliteal Artery Entrapment Syndrome (SAAP),” says the Dr. Pablo Gallo Gonzalez Head of the Angiology and Vascular Surgery Unit of the Ruber Internacional Hospital.
What Causes Popliteal Artery Entrapment Syndrome?
The popliteal artery is the one that runs behind the knee, at the transition between the femur bone and the tibia.
This anatomical region is called the ‘popliteal fossa’. It is made up of several muscles, and it is one of those muscles that traps the artery.
“The muscle that in this region can give rise to entrapment of the popliteal artery is the internal calf”, indicates the Dr. Marta Garnica Urenavascular surgeon at the Angiology and Vascular Surgery Unit of Hospital Ruber Internacional.
As Dr. Pablo Gallo González explains, there are numerous congenital diseases that generate anatomical abnormalities of the internal twin.
Whether this muscle is abnormally large or abnormally situated in the calf, it can cause sustained shearing (entrapment) of the popliteal artery. And that, over time, can injure the artery and give symptoms related to arterial obstruction.
Symptoms of Popliteal Artery Entrapment
According to this expert, the first symptoms that these patients will present will be similar to intermittent claudication: pain and a sensation of cramps.
Being young and athletes, these discomforts will be related to exercise, at which time a greater entrapment of the internal calf is performed on the popliteal artery.
In addition, “in the early stages of the disease, patients will improve when they finish the exercise,” says Dr. Gallo.
But if these patients are not evaluated early by an Angiology and Vascular Surgery team, the situation can worsen. Serious manifestations related to arterial obstruction, such as thrombosis, can occur.
“This is because the popliteal artery at first is only compressed when performing the exercise, but over time the artery can be damaged, causing a thrombosis, that is, an occlusion of the artery that can put the artery at risk of amputation.” affected lower extremity”, warns doctor Marta Garnica.
How to diagnose it
As indicated by the doctor santiago zubicoaresponsible for the Interventional Vascular Radiology Unit of the Ruber Internacional Hospital, the early diagnosis of Popliteal Artery Entrapment Syndrome (SAAP) is made by means of a dynamic echo-doppler of the lower limbs.
A non-invasive technique that allows blood flow to be measured using ultrasound.
Subsequently, the diagnosis will be confirmed with a dynamic arteriography also of both lower extremities.
“Once the imaging tests have been carried out to confirm the diagnosis of SAAP, we must schedule the surgical treatment,” explains Zubicoa.
Surgery to free the artery
Surgical treatment of popliteal artery entrapment syndrome consists of decompression and repair of the popliteal artery.
Anomalous detachment of the internal twin will be necessary to free the artery from entrapment.
“After that, if the artery was damaged, it would have to be repaired by exchanging the artery for a prosthesis in the shear zone, and this is known as bypass,” says Dr. Pablo Gallo.
As stated by Dr. Marta Garnica, although the symptoms are only reported in one lower extremity, the assessment of the other extremity is very important. This is because it is usually a congenital affectation that affects both lower extremities.
If, indeed, the other artery is also affected by this anomaly in the internal calf, the treatment will also be carried out in the asymptomatic limb. This will prevent future complications.
Both surgeons insist on stating that, although popliteal artery entrapment is a rare pathology, due to its seriousness, we must take it into account when a healthy and young person suffers this type of muscle pain.