The popliteal artery may be compressed beneath the medial head of the gastrocnemius muscle or deep to the popliteus muscle.
Clinical features:
(1) males are more commonly affected
(2) presence of unilateral or bilateral calf pain during strenuous exercise that is worsened by leg elevation and/or continued exercise
(3) the pain is accompanied by paresthesias and muscle weakness in the effected leg
(4) the pulse in the dorsalis pedis and/or posterior tibial arteries are decreased
(5) the capillary refill time is prolonged in the affected leg
(6) the ankle to brachial index is abnormally low in the affected leg
(7) initially the pain is relieved by stopping the exercise and placing the affected leg in a dependent position
(8) eventually pain persists even during rest
Diagnostic protocol with provocative testing:
(1) Have the patient exercise on a treadmill until symptoms develop.
(2) Measure the ankle to brachial index.
(2) If the index is abnormal then perform an imaging study such as Doppler ultrasound, arteriorgraphy or MRI with contrast.
Differential diagnosis:
(1) chronic exertional compartment syndrome (with increased compartmental pressures)
(2) atherosclerotic disease in the elderly (vs early onset with a vascular anomaly)
