An 18-year-old male athlete complains of right calf claudication after running, present for six months. Pulses are palpable and the resting ankle-brachial index is 1.0. The ankle-brachial index falls to 0.6 after sustained plantar flexion against resistance. MRI shows medial deviation of the popliteal artery around an abnormal fibrous band. Which statement is correct?

• A He most likely has premature atherosclerosis and needs antiplatelet therapy alone
• B The diagnosis is popliteal artery entrapment and treatment is surgical release of the entrapping structure ✓
• C Endovascular stenting of the popliteal artery is the preferred first-line treatment
• D His normal resting ankle-brachial index excludes significant arterial pathology

Explanation

Popliteal artery entrapment syndrome affects young athletic men, caused by a congenital anomalous relationship between the popliteal artery and the medial head of gastrocnemius or a fibrous band. Resting pulses and ankle-brachial index are typically normal because compression occurs only with muscle contraction, hence the provocative plantarflexion test. Treatment is surgical division of the offending band or muscle reattachment before repetitive trauma causes irreversible arterial damage such as stenosis or post-stenotic aneurysm. Stenting does not address the mechanical cause, and a normal resting study does not exclude the condition.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.