Fig. 7.

Popliteal artery entrapment syndrome (PAES) in a 38-year-old woman with a 4-week history of right foot pain, admitted to the hospital for gangrenous fourth toe. (a) Digital subtraction angiogram shows total occlusion of the right popliteal artery (arrow), with filling defects of the distal superficial femoral artery (arrowheads) consistent with thrombus, and multiple collaterals around the knee. PAES was suspected and patient underwent CT angiogram. (b) Maximum-intensity projection reconstruction from lower extremity CT angiogram demonstrated total occlusion of the right popliteal artery (arrow) extending into the proximal anterior tibial artery, with distal reconstitution (dashed arrow). (c) Axial CT angiography image shows occlusion of the right popliteal artery (arrow), and an extra slip of muscle lateral to it (red transparent overlap). No comparable structure is seen on the left side, which suggests right PAES. Green transparent overlapping areas of the normal gastrocnemius heads bilaterally are added to display the asymmetrical appearance between right and left knees. (d) Coronal reconstruction of CT angiography showing the gastrocnemius heads (green transparent overlap) with an extra slip of muscle (red transparent overlap) causing asymmetric appearance, and possibly originating from the lateral head