Long-term follow-up of patients with popliteal artery entrapment syndrome treated by endoluminal revascularization.

The popliteal artery entrapment syndrome (PAES), a rare cause for leg ischemia, is usually treated by surgical removal of the compressing structure and either venous bypass or interposition graft. However, endovascular revascularization followed by surgery to release the artery has been reported as a feasible alternative. So far long-term results of this approach are not known. We report the follow-up of three patients with PAES and thrombotic occlusion of the popliteal and calf arteries treated by local lysis, percutaneous thrombembolectomy and angioplasty followed by musculotendinous dissection. One patient had an uneventful follow-up of 11 years while the second patient developed a popliteal aneurysm four months after the index procedure. In the third patient, angioplasty of a stenosis of the popliteal artery was performed after two years. However, occlusion of the artery occurred two years later due to a small popliteal aneurysm. Endovascular revascularization followed by surgical release of the artery may be a viable alternative in the treatment of PAES especially in cases with distal embolization. However, careful follow-up by duplex ultrasound is mandatory because of the high risk of reocclusion or development of a popliteal aneurysm.