In type V, described by Rich and Hughs in 1967, both the artery and vein are involved, usually with a type I abnormality. Types IV and V are the least common variants. Another variant, functional popliteal entrapment, may be caused by the sharp edge of the soleus hiatus and is classified by some as type VI.
If active plantar flexion and passive dorsiflexion causes the pulse to disappear or diminish by duplex doppler, it supports the diagnosis but 50% of normals will also disappear. Angiogram is still the gold standard, but may be replaced by magnetic resonance angiogram (MRA). Any symptomatic patient should be treated because of the natural progression to irreversible injury to the popliteal artery, with potential complications of thrombosis and aneurysm. If the vessel is healthy, the offending muscle may be divided. Once the vessel is damaged, femoro-posterior tibial bypass is the treatment of choice as in this case.
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