PAES = Popliteal Artery Entrapment Syndrome

According to the Cleveland Clinic, PAES is a rare vascular disease that affects the legs of some young athletes. The muscle and tendons near the knee are positioned so that they compress the popliteal artery – the main artery that runs through and behind the knee. Compression of the artery restricts blood flow to the lower leg and can damage the artery.

BOOM! Sounds intense, right?

 

Who even gets PAES?

From what I’ve learned over the years, a very small percentage of people are born with the condition… 3% to be precise. The majority of them also live out their lives without even knowing that they have it – aka. “The Lucky Ones”.

For the rest of us, symptoms typically arise within athletes, military professionals, and even what some would call the ‘weekend warrior’. I, for instance, fall into this last category, and am by no means a professional athlete.

As the majority of reported cases of PAES have come from military hospitals, historically, a positive diagnosis has been seen in males aged 30 years old and younger. From my understanding, that gap between males and females being diagnosed is slowly closing in due to more female athletes and a better understanding of PAES symptoms.

 

Symptoms:

The textbook symptoms include the following during exercise in the calf muscles:

• Aching pain
• Numbness
• Leg/Muscle Swelling
• Cramping

My PAES symptoms included:

• Cramping in one leg more than the other during exercise
• Some swelling in the calf muscles of the leg in pain
• Difficulty walking for extended periods of time

 

How I was diagnosed with PAES:

The PAES symptoms for me originated during my junior year of high school and continued through my first two years of college. Due to a pre-existing stress fracture in my lower back (which I somehow had when I was 9 years old), my doctors assumed the pain was coming from a slipped disc pressing on a nerve.

As we now know that was not the case, the below is what I can remember from my original diagnosis and process:

• UMD student: continued feeling leg cramping when walking across campus, so I signed up to see the UMD sports medicine doctor
  • Upon first whiff of my back issue, the doctor assumed that’s where the pain stemmed from
• Still a student at UMD: I remember calling my mom in tears because I couldn’t easily walk to my classes without pain.
• My Mom, being the dedicated sweetheart that she is, found a sports therapist that worked with the Baltimore Ravens to take me ASAP
• Ravens sports therapist: had me walk on a treadmill and could see that my left leg cramped up a lot faster than my right leg (my left leg was the one with the pain). He immediately sent me to a vascular surgeon.
• Vascular Surgery Associates at GBMC took me in and ran the following tests before identifying PAES:
  • Ultrasound with me extending and flexing my feet. They also tried to nail down my pulses in each leg which proved difficult.
  • Angiogram: I was put under a light anesthetic for the outpatient procedure. The doctors had me laying on a table with x-ray screens above me. They then proceeded to inject dye into my right femoral artery to track my blood flow.

Voila! That angiogram, as uncomfortable as it was, helped to diagnose me with PAES. My left leg’s popliteal artery is occluded for about 1.5 inches due to extreme compression and scar tissue build-up. From my understanding, the arterial walls in the left popliteal artery had compressed so many times during exercise that scar tissue had formed, ultimately blocking my artery.

At the time, my right leg had not yet occluded, and my next step was surgery. The doctors aimed to ‘save’ my right leg. The left was already too far gone.

 

*Pro-tip for anesthesia during the angiogram*

If you’re like me and are terrified of needles, doctors, hospitals and the medical field in general, one of the best lessons I learned was to always ask for anti-nausea medication in your IV drip. I’ll never forget coming back to life from the procedure and feeling extremely nauseous.

Because they went through the femoral artery at the time, if I were to have vomited or had any sudden movements, I would’ve been in DEEP trouble. Thankfully they gave me food and some anti-nausea meds after the fact, but I highly recommend asking for it prior to going under.

Before any procedure you’ll have a chance to talk with your anesthesiologist. Regardless of whether it’s the right part of the process, I tell everyone from the nurse that checks me in all the way to my surgeon while I’m on the table that I need a healthy dose of anti-nausea meds – please and thank you! You’ll feel crappy waking up regardless, might as well not make it worse by vomiting.

 

*Pro-tip for finding the right doctor*

I happened to get extremely lucky this time around during my diagnosis. As you’ll learn in my future post about Compartment Syndrome, my luck had run out.

Regardless of my initial run-in with my college campus sports doctor, a professional clinic will fully assess all symptoms before determining that a medical issue is caused by a pre-existing condition. I’ve learned the hard way to not be afraid to push back and stick to your gut instinct. Doing your due diligence by research online (although be careful not to go down the Google search rabbit hole which I’ve done many a time) coupled with getting multiple opinions will help you to see a clearer picture of your condition and the best ways to get help.

Unfortunately, I cannot remember for the life of me what that sports medicine clinic in Baltimore was called, but I do highly recommend the Vascular Surgery Associates at GBMC. My doctors were Dr. Peter Mackrell and the late (and amazing) Dr. Peter Golueke. They were incredibly thorough and treated me like an extended member of the family and not just another patient. I am forever grateful for their dedication to my case and help through a tough surgery.

More about my surgery can be found here (link to come).