Popliteal artery entrapment syndrome is a well recognised sequelae of anatomical variation in the origin of the medial head of gastrocnemius. It classically presents with distal ischaemia from progressive intimal fibrosis and eventual thrombosis. We present a unique case of acute lower limb ischaemia precipitated by trauma in a young man with undiagnosed popliteal artery entrapment. In this case sudden stress of the lower limb resulted in tearing of the tunica intima of the entrapped artery and exposure of the subendothelium with subsequent thrombus, distal embolisation and acute ischaemia. Successful limb salvage was achieved through endovascular thrombolysis and arterial reconstruction.
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