The present article is a review of clinical diagnoses that are to be investigated when a vascular origin of unexplained lower limb pain is suspected, and of the usual results of non-invasive vascular investigations.

While suffering from lower extremity arterial disease, patients rarely report typical vascular claudication, but more often paradoxical pain (popliteal entrapment syndrome) or subjective sensation of swollen thigh (endofibrosis). In most cases investigations at rest are normal. Therefore, the vascular origin of leg or thigh pain should only be excluded in cases of normal investigation after exercise. Ankle to brachial systolic pressure index is a key argument for the arterial origin of unexplained lower limb pain. Nevertheless, the normal limits to be used in exercise tests in athletes are still debated.

Not only is vascular disease a rare occurrence in young sports individuals, but to prove the vascular origin of lower limb exercise-related pain is often puzzling. Future work is needed to increase out knowledge of the physiopathology and diagnostic tests of vascular disease in sports.