Clinical Snapshot
Popliteal Artery Entrapment Syndrome
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A 25-year-old, physically active male patient without cardiovascular risk factors had a 24-month history of numbness in the right foot and progressive symptoms of crural claudication. Physiotherapy, electrical stimulation therapy, and shoe insoles proved unsuccessful. A pulse deficit was apparent in the right popliteal artery and lower leg arteries. The ankle–brachial index (ABI) was 0.6 (normal >0.9). Duplex ultrasound showed occlusion of the popliteal artery with medial displacement and separation of the artery from the vein—which normally runs immediately parallel—by a muscle strand. Magnetic resonance imaging confirmed the diagnosis of popliteal artery entrapment syndrome (PAES) type 1 (Figure). PAES (incidence unknown, autopsy prevalence <1–3.5%) is an important differential diagnosis in young adults with intermittent claudication. It is caused by congenital musculotendinous variants or hypertrophy of the gastrocnemius muscles (functional entrapment syndrome), leading to compression of the adjacent vessels. Treatment comprises decompression via resection of the compressing structures; if vessel wall damage is identified, vascular reconstruction is additionally required. In the present case, surgery was waived in agreement with the patient due to his mild symptoms and the fact that vascular occlusion had already occurred. The contralateral leg was not affected.
Dr. med. Simon Häfner, Dr. med. Jens Putzbach, Klinik für Innere Medizin IA, Angiologie, Internistische Intensivmedizin und Akutmedizin, Bundeswehrkrankenhaus Ulm, simonhaefner@bundeswehr.org
Dr. med. Daniel Halt, Klinik für Radiologie und Neuroradiologie, Bundeswehrkrankenhaus Ulm
Conflict of interest statement: The authors state that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Häfner S, Putzbach J, Halt D: Popliteal artery entrapment syndrome. Dtsch Arztebl Int 2026; 123: 252a. DOI: 10.3238/arztebl.m2025.0212
