- Title: Overview of arterial pathology related to repetitive trauma in athletes
- Open Access: Ja
- Language: English
- Year: 2019
- DOI/URL: https://doi.org/10.1016/j.jvs.2019.02.002
- Publication Date: 01-08-2019
- Journal: Elsevier - Journal of Vascular Surgery
- Pubmed ID: 31113722
Background/objective: Sport-related vascular trauma is an important consequence of increased physical activity. Repetitive, high-intensity movements predispose athletes to vascular disease, including arterial pathology, by exerting increased pressure on neurovascular structures. This is an important source of morbidity in an otherwise young and healthy population. Arterial pathology associated with repetitive trauma is often misdiagnosed as musculoskeletal injury. This article increases awareness of sport-related arterial disease by reviewing the symptomatology, investigation, and treatment modalities of this pathology. In addition, prognostic outcomes specific to the athlete are discussed.
Results: Arterial thoracic outlet syndrome and vascular quadrilateral space syndrome are associated with athletes involved in overhead throwing exercises. Sport-related arterial pathology of the lower limb include external iliac artery endofibrosis (EIAE), popliteal artery entrapment syndrome (PAES), and adductor canal syndrome. Vascular stress and kinking secondary to vessel tethering are important contributors to pathology in EIAE. Chronic exertional compartment syndrome must also be considered, presenting with clinical features similar to PAES. In addition, athletes are predisposed to blunt mechanical trauma. Hypothenar hammer syndrome is one such example, contributing to a high burden of morbidity in this population.
Conclusions: In arterial thoracic outlet syndrome and vascular quadrilateral space syndrome, surgery is advocated in symptomatic individuals, with postoperative outcomes favorable for the athlete. Acute limb ischemia may occur as a result of secondary thrombosis or embolization, often without preceding claudication. PAES and adductor canal syndrome are associated with functional entrapment in the athlete, secondary to muscular hypertrophy. Surgical exploration may be indicated. Poorer outcomes are noted when this process is associated with vascular reconstruction. Surgical treatment of EIAE follows failure of conservative management, with limited data available on postoperative prognosis. Investigations for all these conditions should be targeted based on clinical suspicion. A delay in diagnosis can have severe consequences on return to competition in these high-functioning individuals.
- Title: Gefäßerkrankungen bei Triathlete
- Open Access: Nee
- Language: German
- Year: 2019
- DOI/URL: https://doi.org/10.1007/s00772-018-0491-8
- Publication Date: 15-01-2019
- Journal: Springer - Gefässchirurgie
Die überwiegende Mehrzahl der Triathleten weist keinerlei kardiovaskuläre Risikofaktoren auf. Dennoch gibt es bei diesem für uns Gefäßchirurgen untypischen Patientenklientel zunehmend Berichte über arterielle Komplikationen. In der Literatur werden 3 Krankheitsbilder als ursächlich benannt: die iliakale Endofibrose, das Adduktorkanalsyndrom sowie das popliteale Entrapment-Syndrom. Die exogene, kompressionsbedingte Gefäßwandschädigung ist allen 3 Krankheitsentitäten gemeinsam. Die richtige Diagnosestellung erfolgt nicht selten mit einer Latenz von mehreren Jahren. Dies ist erklärbar durch die meist unspezifische Beschwerdesymptomatik, gut tastbare Fußpulse sowie unauffällige Verschlussdrücke in Ruhe. Wegweisend ist ein Abfall des Knöchel-Arm-Index („ankle-brachial index“, ABI) nach Belastung. Die Magnetresonanzangiographie (MRA) wird bei den weiterführenden Schnittbildverfahren der computertomographischen Angiographie (CTA) zur Verringerung der Strahlenbelastung oft vorgezogen. Die digitale Subtraktionsangiographie (DSA) sollte erst nach vorheriger Schnittbilduntersuchung und nur in Kombination mit interventionellen Therapiemaßnahmen verwendet werden. Nur durch die operative Korrektur kann die exogene Gefäßwandaffektion beseitigt werden, weshalb die chirurgische Therapie die besten Langzeitergebnisse aufweist.
- Title: Focus on echovascular imaging assessment of arterial disease: complement to the ESC guidelines (PARTIM 1) in collaboration with the Working Group on Aorta and Peripheral Vascular Diseases
- Open Access: Ja
- Language: English
- Year: 2018
- DOI/URL: https://doi.org/10.1093/ehjci/jey103
- Publication Date: 18-09-2018
- Journal: Oxford Academic - European Heart Journal - Cardiovascular Imaging
- Pubmed ID: 30239635
The main goal of the present document is to provide a set of practical recommendations for ultrasound imagers who are interested in artery diseases or for physicians who intend to undertake vascular procedures. This is the first part of the work. It is dedicated to general principles of ultrasonography, cervicoencephalic, subclavian, aortoiliac and lower extremity arteries, abdominal aorta, and popliteal aneurysms. It also discusses miscellaneous items such as medial arterial calcinosis, arterial embolism, arteritis, arterial stents and bypasses, false aneurysms, aortic dissection, popliteal entrapment syndrome, and iliac endofibrosis.
- Title: Don’t Just Blame it on the Veins: An Update on Vascular Exertional Limb Pain
- Open Access: Nee
- Language: English
- Year: 2018
- DOI/URL: https://doi.org/10.1249/jsr.0000000000000527
- Publication Date: 01-10-2018
- Journal: Wolters Kluwer - Current Sports Medicine Reports
- Pubmed ID: 30300197
Exertional limb pain is a common problem encountered in recreational and competitive athletes. Affecting both the upper and lower extremities, this broad entity can be musculoskeletal, vascular, neurologic, oncologic, or infectious in origin. This article focuses on the vascular causes of exercise-related extremity pain, which encompass a cadre of elusive diagnoses. Specifically, we examine arterial endofibrosis, popliteal artery entrapment syndrome, and chronic exertional compartment syndrome of both the upper and lower extremities. For each of these conditions, we offer updates regarding the respective epidemiology, common signs and symptoms, worthwhile diagnostic modalities, and pertinent treatment options, all based on evidence and reports published over the past year.
- Title: Peripheral Non-atherosclerotic Arterial Disorders: What Radiologists Need to Know
- Open Access: Nee
- Language: English
- Year: 2017
- DOI/URL: https://doi.org/10.1016/j.acra.2016.11.009
- Publication Date: 01-04-2017
- Journal: Elsevier - Academic Radiology
- Pubmed ID: 27940229
Peripheral non-atherosclerotic arterial disorders (NAADs) are a heterogeneous group of rather uncommon conditions that tend to manifest in subjects without atherosclerosis. Each of these conditions has distinctive pathophysiology; however, there are some common clinical and radiological characteristics and in some cases a common treatment approach that unifies these conditions to a specific group, hence the NAADs. Clinicians and radiologists often fail to recognize NAADs, and there might be a delay in the management of such patients; this may result in seriously adverse outcomes that could otherwise have been avoided or minimized. Knowledge of these conditions and of their radiological appearances is therefore important to help establish a correct diagnosis to allow the prompt initiation of treatment. The purpose of this pictorial review is to present a selection of NAADs cases and to discuss the radiological characteristics and the most common lines of therapeutic approaches.