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Cannot walk without pain in the legs, but can run perfectly well
    Differential Diagnosis[Top] [Nav]
popliteal artery entrapment
    Discussion -- not available online[Top] [Nav]
    Notes[Top] [Nav]
       *A re-review of the literature was performed January 1996. The points below were not mentioned on the Zebra Card.
       *The symptoms are highly dependent on the stage of the disease. The run-good/walk-bad symptom occurs early, before repeated microtrauma to the vessel produces localized atherosclerosis. Once fixed atherosclerosis forms, the symptoms are more like run-of-the-mill claudication. An acute presentation is also possible if the artery thromboses (e.g. Husni). Some reviews did not even mention the run-good/walk-bad symptom.
       *It is no coincidence that athletes and military people get this. The Murray paper states that "a high degree of muscle development... unmasks occult pathology." Thus, "calf cramping after exercise in vigorous young athletes, even in the presence of good pedal pulses, should not be arbitrarily dismissed" (Darling). The Japanese may be predisposed to the condition as well, due to the way they sit (Murray).
       *The case reports reveal only a few instances of the run-good/walk-bad symptom (Darling). None mention a preserved ability to climb, despite one review article (Persky) mentioning this.
       *Another factor contributing to the variability of symptoms is the multiple anatomic variants capable of producing the syndrome. One would not be surprised if the natural history of each anatomic variant differs somewhat from the others.
       *The Chernoff and Erdoes papers discuss a syndrome of "functional popliteal artery entrapment," wherein no anatomic abnormality such as the other papers discuss, but occluded flow through the artery is still possible during calf muscle contraction. About 50% of all normal people have this physiology when studied, but, of course, very few have symptoms. All this article really does is: (1) complicate the diagnosis of popliteal artery entrapment, (2) make us marvel at Nature's engineering challenges.
    Update Comments[Top] [Nav]
  • Puts the problem in a larger perspective. [101]
  • Most interesting thing here is a 1973 normal popliteal arteriogram of 33 yo man with 200m claudication, juxtaposed with a 1982 arteriogram showing occlusion of the artery. [102]
  • Says 300 cases reported to date, including 31 of their own. [108]
  • Functional popliteal entrapment. [105]
  • Functional popliteal entrapment. [106]
  • Haven't seen this paper, but title is intriguing. [107]
  • Series of 14 patients, but lacks individual case histories. [110]
  • 3 cases. All 3 could run better than they could walk. One could run 2 miles, but could walk only 300 yards. One of the paper's authors was probably one of its cases. [111]
  • Two cases. One, a 47 yo man, had right calf pain after walking 300-400m. For years he had slept with right knee bent because straightening it caused numbness and tingling of the foot. [113]
  • Man, 18, with sudden claudication in left foot and calf during football practice. Later developed numbness of toes and feet, especially while sitting with left knee acutely flexed. Six months after initial event, claudication was occuring after 50-100 feet of walking. Thrombosis of popliteal artery found at operation. [114]
  • Two case histories. Nice, clear anatomical drawings; the best article to understand the lesion. [115]
  • Man, 22, first noted pain and coldness on dorsal surface of left foot while walking. Progressed, so that "the first few steps" would precipitate pain in distal third of left foot and leg. Later developed paresthesias in left leg and foot, when he was seated with his knee bent sharply. Also noted delayed growth in left toenails. [117]
  • Another consideration in a young person with intermittent claudication is multiple sclerosis. "These patients have no signs on examination whatsoever unless they are examined immediately after an appropriate walk: a pyramidal distribution of weakness will be found with extensor plantars." [118]
  • A difficult case of claudication-like symptoms. [119]
    Footnotes in Print Edition[Top] [Nav]
    (1) Another young athlete with intermittent claudication. A case report.
  Casscells SW, Fellows B, et al.   Am J Sports Med 1983 May-Jun;11(3):180-2.  Pubmed  Similars
    (2) Intermittent claudication in young athletes: popliteal artery entrapment syndrome.
  Lysens RJ, Renson LM, et al.   Am J Sports Med 1983 May-Jun;11(3):177-9.  Pubmed  Similars
    (-) Setting a trapped artery free.
  Anonymous.   Emergency Medicine. 1984;16(2):65,68.
Ignore this no-longer useful article.
    New References[Top] [Nav]

Review Articles
    101.Chronic leg pain in the athlete.
  Clanton TO, Solcher BW.   Clin Sports Med 1994 Oct;13(4):743-59.  Pubmed+Abstract  Similars
    102.Natural history of entrapment of the popliteal artery.
  di Marzo L, Cavallaro A, et al.   J Am Coll Surg 1994 Jun;178(6):553-6.  Pubmed+Abstract  Similars
    103.Popliteal artery entrapment syndrome.
  Murray A, Halliday M, et al.   Br J Surg 1991 Dec;78(12):1414-9.  Pubmed+Abstract  Similars
    104.Entrapment of the popliteal artery.
  Persky JM, Kempczinski RF, et al.   Surg Gynecol Obstet 1991 Jul;173(1):84-90.  Pubmed+Abstract  Similars

Physiological investigations
    105.Popliteal vascular compression in a normal population.
  Erdoes LS, Devine JJ, et al.   J Vasc Surg 1994 Dec;20(6):978-86.  Pubmed+Abstract  Similars
    106.Asymptomatic functional popliteal artery entrapment: demonstration at MR imaging.
  Chernoff DM, Walker AT, et al.   Radiology 1995 Apr;195(1):176-80.  Pubmed+Abstract  Similars

Case reports
    107.An exceptional case of popliteal entrapment syndrome.
  Cairols MA, Blanes I, et al.   Eur J Vasc Surg 1994 Nov;8(6):754-6.  Pubmed  Similars
    108.Surgical treatment of popliteal artery entrapment syndrome: a ten-year experience.
  di Marzo L, Cavallaro A, et al.   Eur J Vasc Surg 1991 Feb;5(1):59-64.  Pubmed+Abstract  Similars
    109.Entrapment syndrome of the popliteal artery.
  Gost AL, Mestre M, et al.   J Cardiovasc Surg (Torino) 1981 Jul-Aug;22(4):353-9.  Pubmed  Similars
    110.Popliteal vascular entrapment. Its increasing interest.
  Rich NM, Collins GJ Jr, et al.   Arch Surg 1979 Dec;114(12):1377-84.  Pubmed+Abstract  Similars
    111.Intermittent claudication in young athletes: Popliteal artery entrapment syndrome.
  Darling RC, Buckley CJ, et al.   J Trauma 1974 Jul;14(7):543-52.  Pubmed  Similars
    112.Popliteal artery entrapment by fibrous band.
  Haimovici H, Sprayregen S, et al.   Surgery 1972 Nov;72(5):789-92.  Pubmed  Similars
    113.Popliteal artery entrapment syndrome.
  Gaylis H.   S Afr Med J 1972 Aug 5;46(3):1071-5.  Pubmed  Similars
    114.Entrapment of the popliteal artery and its management.
  Husni EA, Ryu CK.   Angiology 1971 Jul;22(7):380-6.  Pubmed  Similars
    115.Popliteal artery entrapment syndrome.
  Insua JA, Young JR, et al.   Arch Surg 1970 Dec;101(6):771-5.  Pubmed  Similars
    116.Popliteal artery entrapment syndrome.
  Turner GR, Gosney WG, et al.   JAMA 1969 Apr 28;208(4):692-3.  Pubmed  Similars
    117.Clinical syndrome of anomalous position of the popliteal artery.
  Servello M.   Circulation. 1962;26:885-890.

    118.Handbook of Clinical Neurology.
  Vinken PJ, Bruyn GW. Amsterdam: North Holland: 1985;47:57.
    119.The illusion of certainty [see comments].
  Wolinsky AP.   N Engl J Med 1996 Jul 4;335(1):46-8.  Pubmed  Similars
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:35 PDT on July 4, 2000.[Top]

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