Dynamic Vascular Imaging Unveils Popliteal Artery Entrapment Syndrome in an Atypical Patient: A Case Report.

Popliteal artery entrapment syndrome (PAES) is a rare vascular disorder resulting from abnormal anatomical relationships between the popliteal artery and adjacent musculotendinous structures. This case highlights a 39-year-old female with a 10-year history of exertional calf pain, worsened by walking and stair descent. Multiple static imaging tests failed to diagnose her condition. However, dynamic Doppler ultrasound revealed arterial occlusion during dorsiflexion of the ankle, and dynamic arteriography confirmed PAES. Surgery uncovered a fibrous band and hypertrophied medial gastrocnemius muscle compressing the artery. She underwent fibrous band release, muscle resection, and arterial decompression, resulting in full symptom resolution and restored blood flow. This case underscores the diagnostic challenges of PAES in atypical patients, where lack of vascular risk factors and normal resting studies can mislead clinicians. Dynamic vascular imaging is vital for accurate diagnosis. PAES should be considered in all patients with unexplained exertional leg pain, and timely surgical treatment can yield excellent outcomes.