Patient-Reported Outcomes of Surgical Management of Functional Popliteal Artery Entrapment Syndrome

ObjectivesFunctional popliteal artery entrapment syndrome (FPAES) results in claudication without an identifiable popliteal fossa anatomic abnormality. The aim of this study was to evaluate patient-reported outcomes of surgical management of FPAES.MethodsData from consecutive patients undergoing FPAE release with myectomy and/or myotomy of gastrocnemius, soleus, popliteus, and plantaris from 2001 to 2019 were reviewed retrospectively. Demographics, anatomic data, operative details, symptom recurrence, reintervention, and patient-reported outcomes through surveys were analyzed.ResultsAmong 57 patients, 70% were female (n = 40) and 67% undertook vigorous physical activity before symptom onset. Symptoms occurred at a median age of 19 years (interquartile range, 16-25 years) and were diagnosed at 23 years (interquartile range, 18-31 years). Symptoms were bilateral in 47, or only right (n = 4) or left (n = 7). Magnetic resonance imaging (52%) or angiogram (48%) demonstrated dynamic partial (41%) or complete (59%) occlusion of popliteal artery (76%), vein (2%), or both (22%). A total of 102 extremities were treated with 91 primary and 22 reinterventions by medial (42%) or posterior (58%) approach. There was one intraoperative nerve injury and five postoperative complications (two hematoma, one deep vein thrombosis, and two wound dehiscence). Median clinical follow-up was 20 months (range, 0-196 months). Three patients were lost to follow-up. Among patients with clinical follow-up in the past year, 90% (n = 18/20) reported complete symptom relief. Two patients reported no symptom relief even after reintervention. Of the remaining 32 patients without any follow-up in the last year, 84% (n = 27) reported symptom relief at some point during follow-up. Short Form-36 QUALITY OF LIFE surveys were sent to the 37 patients either lost to follow-up or without follow-up within the past year. Of the 16 responders, 81% (n = 13) returned to presymptom activity (including two needing reintervention). Three patients reported activity limitation even after reintervention. Patients reported good long-term quality of life in all eight scales comparable to general population (Fig). Outcomes did not differ by surgical approach chosen.Conclusions ObjectivesFunctional popliteal artery entrapment syndrome (FPAES) results in claudication without an identifiable popliteal fossa anatomic abnormality. The aim of this study was to evaluate patient-reported outcomes of surgical management of FPAES. Functional popliteal artery entrapment syndrome (FPAES) results in claudication without an identifiable popliteal fossa anatomic abnormality. The aim of this study was to evaluate patient-reported outcomes of surgical management of FPAES. MethodsData from consecutive patients undergoing FPAE release with myectomy and/or myotomy of gastrocnemius, soleus, popliteus, and plantaris from 2001 to 2019 were reviewed retrospectively. Demographics, anatomic data, operative details, symptom recurrence, reintervention, and patient-reported outcomes through surveys were analyzed. Data from consecutive patients undergoing FPAE release with myectomy and/or myotomy of gastrocnemius, soleus, popliteus, and plantaris from 2001 to 2019 were reviewed retrospectively. Demographics, anatomic data, operative details, symptom recurrence, reintervention, and patient-reported outcomes through surveys were analyzed. ResultsAmong 57 patients, 70% were female (n = 40) and 67% undertook vigorous physical activity before symptom onset. Symptoms occurred at a median age of 19 years (interquartile range, 16-25 years) and were diagnosed at 23 years (interquartile range, 18-31 years). Symptoms were bilateral in 47, or only right (n = 4) or left (n = 7). Magnetic resonance imaging (52%) or angiogram (48%) demonstrated dynamic partial (41%) or complete (59%) occlusion of popliteal artery (76%), vein (2%), or both (22%). A total of 102 extremities were treated with 91 primary and 22 reinterventions by medial (42%) or posterior (58%) approach. There was one intraoperative nerve injury and five postoperative complications (two hematoma, one deep vein thrombosis, and two wound dehiscence). Median clinical follow-up was 20 months (range, 0-196 months). Three patients were lost to follow-up. Among patients with clinical follow-up in the past year, 90% (n = 18/20) reported complete symptom relief. Two patients reported no symptom relief even after reintervention. Of the remaining 32 patients without any follow-up in the last year, 84% (n = 27) reported symptom relief at some point during follow-up. Short Form-36 QUALITY OF LIFE surveys were sent to the 37 patients either lost to follow-up or without follow-up within the past year. Of the 16 responders, 81% (n = 13) returned to presymptom activity (including two needing reintervention). Three patients reported activity limitation even after reintervention. Patients reported good long-term quality of life in all eight scales comparable to general population (Fig). Outcomes did not differ by surgical approach chosen. Among 57 patients, 70% were female (n = 40) and 67% undertook vigorous physical activity before symptom onset. Symptoms occurred at a median age of 19 years (interquartile range, 16-25 years) and were diagnosed at 23 years (interquartile range, 18-31 years). Symptoms were bilateral in 47, or only right (n = 4) or left (n = 7). Magnetic resonance imaging (52%) or angiogram (48%) demonstrated dynamic partial (41%) or complete (59%) occlusion of popliteal artery (76%), vein (2%), or both (22%). A total of 102 extremities were treated with 91 primary and 22 reinterventions by medial (42%) or posterior (58%) approach. There was one intraoperative nerve injury and five postoperative complications (two hematoma, one deep vein thrombosis, and two wound dehiscence). Median clinical follow-up was 20 months (range, 0-196 months). Three patients were lost to follow-up. Among patients with clinical follow-up in the past year, 90% (n = 18/20) reported complete symptom relief. Two patients reported no symptom relief even after reintervention. Of the remaining 32 patients without any follow-up in the last year, 84% (n = 27) reported symptom relief at some point during follow-up. Short Form-36 QUALITY OF LIFE surveys were sent to the 37 patients either lost to follow-up or without follow-up within the past year. Of the 16 responders, 81% (n = 13) returned to presymptom activity (including two needing reintervention). Three patients reported activity limitation even after reintervention. Patients reported good long-term quality of life in all eight scales comparable to general population (Fig). Outcomes did not differ by surgical approach chosen. Conclusions