Popliteal artery thrombosis

Hey everyone,

I’m looking for some insight or maybe someone with actual medical expertise who can help me make sense of this.

I’m 26. Before this whole vascular mess happened, I was a professional dancer. Back in January 2009, I ended up in the hospital at Los Angeles Lakers Medical Center because a Doppler scan showed an occlusion in my left popliteal artery. It started with this intense pain in my calf, my big toe swelled up, and my entire leg—from the knee down—went totally pale.

Here’s the quick rundown of my history:

Partial thrombosis of the left popliteal artery, treated with selective intra-arterial thrombolysis using alteplase, with suspected cystic degeneration of the popliteal artery adventitia.
Thrombophilia (homozygous for FDA, PAI polymorphism on both alleles - 1).
Homocysteine levels were within the normal range—so no substitution therapy was needed. Activated protein C resistance tests came back normal too.

Six months after being discharged, I was on Marivarin, then they did a follow-up Doppler.
"The popliteal and ATP show continuous flow with satisfactory velocity and preserved spectra. The distal part of the ADP shows slightly weaker flow, but the artery has visible flow and a preserved spectrum; this could be due to spasmodic changes. The distal portion of the fibular artery looks similar but shows normal Doppler spectra. Given that the arterial occlusion had a secondary etiology (prolonged excessive traction stress on the arterial wall, assuming underlying cystic adventitial degeneration) and since more than six months have passed since the vascular incident—combined with the practically normal Doppler findings for the popliteal-crural level of the left leg—I suggest discontinuing anticoagulant therapy."

That was back in the summer of 2009. Everything was fine after that—the pain just vanished. Once I felt better, I started training again, though just recreationally.
Then, out of nowhere, the pain came roaring back recently. I got another Doppler done, and the indices were super low—dorsalis pedis at 0.44 and posterior tibial at 0.59.

I had an MRA done right after, but I’m still waiting on those results.

So, here’s my question. What can actually be done here? If we're talking about a clot again, why would it just show up like this? Or is it the cyst?

Honestly, my biggest worry is staying active post-op. Are there any solutions that would let me get back to full training after surgery? Or am I stuck babying this knee forever because of that specific artery...?

Thanks in advance.

velvetcrane1 said:Hey everyone,

I’m looking for some insight or maybe someone with actual medical expertise who can help me make sense of this.

I’m 26. Before this whole vascular mess happened, I was a professional dancer. Back in January 2009, I ended up in the hospital at Los Angeles Lakers Medical Center because a Doppler scan showed an occlusion in my left popliteal artery. It started with this intense pain in my calf, my big toe swelled up, and my entire leg—from the knee down—went totally pale.

Here’s the quick rundown of my history:

Partial thrombosis of the left popliteal artery, treated with selective intra-arterial thrombolysis using alteplase, with suspected cystic degeneration of the popliteal artery adventitia.
Thrombophilia (homozygous for FDA, PAI polymorphism on both alleles - 1).
Homocysteine levels were within the normal range—so no substitution therapy was needed. Activated protein C resistance tests came back normal too.

Six months after being discharged, I was on Marivarin, then they did a follow-up Doppler.
"The popliteal and ATP show continuous flow with satisfactory velocity and preserved spectra. The distal part of the ADP shows slightly weaker flow, but the artery has visible flow and a preserved spectrum; this could be due to spasmodic changes. The distal portion of the fibular artery looks similar but shows normal Doppler spectra. Given that the arterial occlusion had a secondary etiology (prolonged excessive traction stress on the arterial wall, assuming underlying cystic adventitial degeneration) and since more than six months have passed since the vascular incident—combined with the practically normal Doppler findings for the popliteal-crural level of the left leg—I suggest discontinuing anticoagulant therapy."

That was back in the summer of 2009. Everything was fine after that—the pain just vanished. Once I felt better, I started training again, though just recreationally.
Then, out of nowhere, the pain came roaring back recently. I got another Doppler done, and the indices were super low—dorsalis pedis at 0.44 and posterior tibial at 0.59.

I had an MRA done right after, but I’m still waiting on those results.

So, here’s my question. What can actually be done here? If we're talking about a clot again, why would it just show up like this? Or is it the cyst?

Honestly, my biggest worry is staying active post-op. Are there any solutions that would let me get back to full training after surgery? Or am I stuck babying this knee forever because of that specific artery...?

Thanks in advance.

Why would a clot form again? Does anyone else have a family history of thrombosis? Maybe it happened again because of some genetic predisposition. Did your doctors ever explain that "Thrombophilia - MTHFR homozygote" thing to you? Peace.

I honestly have no clue why this Thrombophilia decided to show up again. My doctors basically told me this specific type isn't even hereditary—they called it some kind of "genetic fluke."

It feels like everyone just shrugged their shoulders at me back then. But look, if this was something I’ve carried my whole life, I don't get why it's "reappearing" now after two years—especially since I went twenty years without a single issue.

Hey there!

I don't have any firsthand experience with arterial thrombosis, but I've dealt with deep vein thrombosis before.
We actually share the exact same genetic mutations—I had a clot back in 2008. I was on anticoagulants for about a year and a half. Once the clot fully dissolved and we finished all the testing, they finally took me off the meds. Now, because of my genetics, I just go in for hematology checkups every six months, which pretty much covers it.

Here’s the thing: these mutations we both have aren't inherently massive risks on their own. They aren't some ticking time bomb unless something "triggers" them—there always has to be a catalyst. Do you know what triggered it for you the first time? Also, did you stay in touch with a hematologist during the gap between your recovery and this latest incident? And what did your vascular specialist suggest for moving forward—just get back to your normal routine, or do you need to play it extra safe?

How are you holding up right now?

If the doctors you're seeing currently can't give you a straight answer as to why this happened to you, then find new ones.

By the way, there's a thread on the forum specifically about deep vein thrombosis. If you have a moment, take a look—it might actually be useful for you.

Take care!

thanks for getting back to me,

So, I finally have an update. I went in for a checkup at Mayo Clinic this morning. The doctor there went through all my tests, checked out my leg, and basically told me it’s not a clot—and never was. Turns out, it's actually "entrapment syndrome" involving my popliteal artery. Apparently, the folks over at the Lakers just totally misdiagnosed it and treated me for the wrong thing entirely.

The fix is surgery to "release" the artery from the muscle that's squeezing it.

Honestly, after being bounced around with so many different diagnoses, I’m pretty skeptical now. I’m going to hunt down a few more second opinions before I decide if I’m actually doing this.

The vascular specialist's advice? Just ramp up my activity levels and push right through the pain threshold every single time until the pain eventually gives up.

I don't have a hematologist—they never even mentioned I needed one. Any suggestions?

I'm moving out of the States in three months anyway, so I'll be switching doctors regardless. I just wanted to see if they could actually do anything useful for me while I'm still here.

velvetcrane1 said:thanks for getting back to me,

So, I finally have an update. I went in for a checkup at Mayo Clinic this morning. The doctor there went through all my tests, checked out my leg, and basically told me it’s not a clot—and never was. Turns out, it's actually "entrapment syndrome" involving my popliteal artery. Apparently, the folks over at the Lakers just totally misdiagnosed it and treated me for the wrong thing entirely.

The fix is surgery to "release" the artery from the muscle that's squeezing it.

Honestly, after being bounced around with so many different diagnoses, I’m pretty skeptical now. I’m going to hunt down a few more second opinions before I decide if I’m actually doing this.

The vascular specialist's advice? Just ramp up my activity levels and push right through the pain threshold every single time until the pain eventually gives up.

I don't have a hematologist—they never even mentioned I needed one. Any suggestions?

I'm moving out of the States in three months anyway, so I'll be switching doctors regardless. I just wanted to see if they could actually do anything useful for me while I'm still here.

Hey!

The diagnosis from Magdalena actually sounds plausible. If there was constant pressure on that spot, it’s perfectly logical that a clot would form—especially when you factor in genetics. Thrombosis isn't exactly rare. Definitely get that second opinion, though!

You absolutely need a hematologist because of those mutations they found. My guess is nobody has even bothered explaining them to you properly. Once you get pregnant, you'll be under the watchful eye of both a hematologist and an OB-GYN. They’ll likely put you on low-molecular-weight heparin, which means you'll be giving yourself injections. These mutations tend to flare up during pregnancy, leading to miscarriages or DVT. That’s why the heparin is non-negotiable, provided you're supervised by a hematologist. If you want to hear about actual experiences, there's a thread on this forum about blood clotting disorders during pregnancy.

I can highly recommend my hematologist, Dr. Zupančić over at Rebro. Since you already have all your lab work ready, you should book an appointment now. The number is 555-012-3456. She’s currently out on medical leave, so the nurse is booking patients for May. Try your best to squeeze in. If you can't, look for someone else at Rebro—they really are the best. They have great vascular specialists too, if you end up wanting another opinion.

Hope this helps a little. Try to get as much done as possible while you're still here, and once you move, find yourself a solid hematologist. Also, if you have a sister, she should probably get tested for the same mutations you have—just to be safe regarding future pregnancies.

Best!