Overview of Treatment Options for Popliteal Artery Entrapment Syndrome

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Abstract Purpose of Review Popliteal artery entrapment syndrome (PAES) is a rare non-atherosclerotic cause of exertional lower-extremity ischemia that primarily affects young and active individuals. This review summarizes contemporary diagnostic strategies, non-surgical and surgical treatment options, postoperative management, and emerging technologies in the management of anatomic and functional PAES. Recent Findings Recent studies support the use of dynamic provocative testing, including exercise ankle–brachial indices and dynamic duplex ultrasonography, to improve diagnostic accuracy. Advanced imaging with CTA, MRA, and IVUS further refines anatomic characterization and operative planning. Functional PAES may respond to targeted physical therapy and botulinum toxin A injections, while anatomic PAES often requires surgical decompression with or without vascular reconstruction depending on the degree of arterial injury. Summary Early recognition and a stepwise dynamic diagnostic approach are critical for preventing irreversible vascular injury and optimizing long-term outcomes in PAES. Surgical decompression remains the cornerstone of treatment for anatomic disease, whereas conservative management strategies may be appropriate in selected patients with functional PAES. Future priorities include multicenter registries, standardized diagnostic criteria, and prospective comparative studies evaluating conservative and surgical treatment pathways.