Over 80% of patients returned to sport within six weeks following standardized treatment for functional popliteal artery entrapment syndrome
NEW ORLEANS, LA, June 5, 2025 – Findings from a comprehensive 20-year clinical study demonstrate treatment of functional popliteal artery entrapment syndrome (FPAES), particularly in combination with fasciotomy for exertional compartment syndrome, has shown highly effective outcomes, with 82% of patients returning to prior level of athletics. As the largest reported cohort to date, this research summarizes two decades of experience in standardized radiographic evaluations and surgical decompressive treatments. The paper was presented today during the Society for Vascular Surgery's Vascular Annual Meeting, VAM25, and simultaneously published in the Journal of Vascular Surgery.
FPAES is a rare vascular condition characterized by abnormal constriction of the blood vessels and nerves behind the knee (popliteal artery and vein) by the calf muscles. This disorder is distinct from anatomic congenital entrapments and is typically seen in young active individuals who participate in sports that require extensive amounts of running. Symptoms are exacerbated by physical sport and may include pain, numbness, swelling, and tightness of the legs and toes, thereby limiting athletic performance and quality of life. Although typically seen in young adults, this disorder can affect athletes at all levels of competition, from high school soccer players to middle-aged semi-professional runners. Diagnosis involves imaging with a specialized CT protocol to evaluate which part of the calf muscle is most contributing to the compression, and is followed by surgical treatment to remove and debulk that portion of muscle. FPAES often occurs with concurrent chronic exertional compartment syndrome (CECS), commonly known as “shin splints”, a disorder characterized by elevated pressure in the compartments of the leg underneath the fascia (a tough tissue that surrounds muscles) – therefore, during surgery for FPAES, this study further revealed performing concurrent fasciotomy to relieve this pressure along with the debulking surgery was beneficial.
Beyond reporting outcomes over the experience, the study aimed to identify risk factors that predict an athlete's likelihood of fully returning to their sport or experiencing recurrent symptoms following surgery. Between 2005 and 2025, the Stanford team treated 125 limbs in 73 patients, with all operations performed by Jason T. Lee, MD, senior author on the study. Most patients were female (64.5%) and presented with bilateral symptoms (84.2%). Running and soccer were the most commonly represented sports, with many athletes competing at the collegiate level. Following surgical treatment, 86.5% of patients reported symptom improvement, while 82.4% were able to return to competition at their previous athletic level. Multivariable regression analysis identified male gender and concurrent fasciotomy during the debulking procedure as positive predictors of return to sport.
For those with initial improvement, delayed symptom recurrence was seen in 11.2% of cases at a median time of 369 days. Statistical analysis showed males had significantly lower risk of recurrence compared to females - further highlighting a potential sex-based disparity in outcomes of these patients. Although the authors cannot make any definite conclusions on why this disparity was observed from this data, this study provides a platform for future investigation focused on the outcomes in female athletes.
"Functional popliteal artery entrapment syndrome is a rare and often overlooked condition that can significantly impact an athlete's performance," says John H. Cabot, MD, Vascular Surgery Resident, Stanford University School of Medicine and lead author of the study. "Our research demonstrates that surgical debulking, particularly when coupled with fasciotomies, offers athletes an effective path back to competition, with over 80% returning to their prior competitive level. Importantly, these findings can help set realistic expectations with patients and their families regarding both immediate outcomes and long-term durability of symptom relief.”
Authors note the study provides direction for future research, specifically analyzing sex-based outcomes, rehabilitation protocols, and more long-term follow up to further examine durability of symptom improvement.
Session Details
“Plenary Session 4: Clinical outcomes from a 20-year experience treating functional popliteal artery entrapment syndrome in athletes” [Thursday, June 5, 2025, at 10:45 a.m. CT]
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About SVS
The Society for Vascular Surgery® (SVS) seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. The organization was founded in 1946 and currently has a membership of approximately 6,500. SVS membership is recognized in the vascular community as a mark of professional achievement.
About VAM25
The Society for Vascular Surgery’s annual VAM meeting will be held in New Orleans, LA, on June 4-7. Leading physicians, researchers, and health care professionals in vascular surgery gather for three full days of groundbreaking educational content showcasing the latest data, research, and innovations in vascular surgery and vascular health. For more information, visit Vascular.org.
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