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.

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.

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.

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.