Long-term treatment outcomes of popliteal artery entrapment syndrome by the Korean Rare Vascular Ailment Research Experts.

Abstract

Objective: Popliteal artery entrapment syndrome (PAES) results from an anomalous relationship between the popliteal artery and the myofascial structures of the popliteal fossa. The long-term treatment outcomes are not well-known because of the rarity of the disease. This study aimed to establish a nationwide collective dataset and analyze treatment outcomes.

Materials and methods: The Korean Rare Vascular Ailment Research Experts performed nationwide retrospective data collection on PAES from 2003 to 2023. Fourteen tertiary medical centers participated, and data from 111 limbs of 96 patients who received invasive treatment with sufficient baseline and follow-up data were used for statistical analysis.

Results: The median age was 37.5 years (range, 14-82 years), and 92.8% were male. Eighty-one percent of the patients presented with claudication, and 13.5% with rest pain. The popliteal arteries were stenotic in 24.3% and occluded in 75.6%. A total of 109 open surgeries and two endovascular treatments were performed. The primary patency rates at 1, 5, and 9 years were compared according to the surgery type: musculotendinous section (MTS) only group (n = 25), 94.7%, 94.7%, and 94.7%; MTS with in situ revascularization group (n = 55), 90.1%, 77.0%, and 77.0%; and bypass surgery group (n = 29), 88.6%, 82.7%, and 68.9%, respectively. In multivariate analysis for the loss of primary patency, bypass using PTFE graft (hazard ratio, 9.676; 95% confidence interval, 1.032-90.736; P = .047) was a statistically significant risk factor.

Conclusion: Patients with early-stage PAES treated with MTS alone showed excellent long-term primary patency. When arterial reconstruction was needed in PAES, MTS with in situ revascularization and bypass surgery showed comparable long-term primary patency. However, bypass surgery using PTFE graft should be avoided due to the high risk of occlusion.