Popliteal Artery Entrapment Syndrome

Joel Patton was the quintessential picture of health, boasting a strong body and mind.

An IT professional working on his PhD, the 35-year-old was a personal trainer during his off hours. In May 2016, his left foot began hurting, and he assumed it was an overworked muscle. When numbness and tingling followed, Mr. Patton sought medical advice.

Several doctor visits found little. But one alert physician recognized something was gravely wrong, and quickly referred him to Rajesh K. Malik, MD, RPVI, FACS, a vascular surgeon with MedStar Heart & Vascular Institute at MedStar Washington Hospital Center.

“By then Mr. Patton’s left foot was red and cold to the touch,” says Dr. Malik. Mr. Patton had a dangerous blood clot in an artery in his leg.

Mr. Patton recalls, “When Dr. Malik described the blood clot and said amputation was a possibility, it was a horror story coming true.”

Rare and Dangerous Thrombosis

A blood clot, or thrombosis, this severe is rare in young adults, Dr. Malik says. He started Mr. Patton on a blood thinner called heparin and began diagnostic tests. He discovered the clot at the popliteal artery, behind Mr. Patton’s knee joint.

“Minimally invasive surgery wasn’t possible, and open surgery was risky,” says Dr. Malik. “In an open procedure, we might have been able to take a piece of vein to create a bypass. But the risk of failure was great.”

Tackling Tough Choices

“But I thought we should sit tight and watch,” Dr. Malik says. Within a few days, some feeling returned to Mr. Patton’s foot. “The blood thinner was doing its job,” says Dr. Malik, but the clot’s cause remained unclear.

An MRI pointed to a rare condition called popliteal artery entrapment syndrome. Mr. Patton’s muscles and tendons near the knee were pressing against the popliteal artery, restricting blood flow to his lower leg. The condition is most often seen in young athletic patients with no other vascular problems.

“The muscle band was not in the correct position,” Dr. Malik says. “And because he was born with it, we knew it would also be present in his right leg.”

Correcting a Birth Anomaly

Dr. Malik believed corrective surgery to release the entrapped muscle would provide a cure and prevent recurrence for Mr. Patton.

“I entered through the back of the knee, and cut into the muscle band,” he says. “A month later, I performed the same procedure on the right leg.”

Months after surgery, Joel is navigating his way back to his active life. “I’m working out smarter now,” he says. “I’m not running and not doing squats, but I’m ready to start intensive physical therapy. I’m grateful I put my confidence in Dr. Malik. He saved my leg.”