# Functional Outcome After Surgery for Popliteal Artery Entrapment Syndrome

## TL;DR

Surgery for popliteal artery entrapment syndrome improves quality of life and artery function, but few patients return to their previous athletic performance.

## Contribution

This study provides the first detailed functional outcomes and long-term patency data for surgical treatment of PAES using patient-reported measures.

## Key findings

- VascuQOL scores showed significant improvements in activity, symptoms, pain, and social domains after surgery.
- Five-year primary patency rate after surgery was 94.4%.
- Only six of 13 previously active patients returned to pre-symptomatic athletic levels.

## Abstract

Popliteal artery entrapment syndrome (PAES) is a rare but underdiagnosed vascular disorder in young, active individuals, frequently athletes. Although surgery is considered the gold standard, data on functional outcomes, return to sport, and long term quality of life remain scarce. This study aimed to evaluate the functional outcomes of the surgical management of PAES using validated patient reported measures.

Pre- and post-operative functional assessments were performed using the VascuQOL (Quality of Life)-25 questionnaire, complemented by sport specific questions. Imaging (dynamic duplex ultrasound, computed tomography angiography, magnetic resonance imaging when indicated) guided diagnosis was according to the Whelan classification. Primary outcomes were changes in VascuQOL scores; secondary outcomes included arterial patency, return to physical activity, and correlations with PAES type.

Fourteen patients (18 limbs) were analysed (mean age, 30.3 ± 13.6 years; ten men and four women). Most patients presented with exertional claudication; imaging identified predominantly type VI (functional) and type V PAES. VascuQOL-25 scores demonstrated statistically significant improvements in activity, symptoms, pain, and social domains, with overall total score increasing from 4.3 ± 1.2 to 5.2 ± 1.5 (p = 0.002). At a mean follow up of 70.4 months, one and five year primary patency rates were 94.4%. Nevertheless, only six of 13 previously active patients returned to pre-symptomatic athletic levels.

Surgical treatment of PAES yields excellent long term patency and significant quality of life gains. However, return to pre-symptomatic athletic performance was limited, highlighting the importance of realistic counselling, tailored rehabilitation, and multidisciplinary management strategies to optimise recovery.

•Surgery for Popliteal Artery Entrapment Syndrome (PAES) provides favourable functional results•The VascuQOL score significantly improves after PAES surgery.•Surgery tends to benefit young athletes with non-functional PAES.•Primary patency of PAES surgery is 94% at five years.

Surgery for Popliteal Artery Entrapment Syndrome (PAES) provides favourable functional results

The VascuQOL score significantly improves after PAES surgery.

Surgery tends to benefit young athletes with non-functional PAES.

Primary patency of PAES surgery is 94% at five years.