Vascular problems of the lower extremity in athletes

The vascular anatomy of the lower extremity predisposes the popliteal area to traumatic injury owing to tethering at the adductor hiatus and the soleus arch. Knee dislocations should be followed with arteriography or exploration of the vessels. Epiphyseal separations of the proximal tibia and distal femur, as well as fractures about the knee, should be observed closely for 24 to 48 hours to ensure that the vascular status is intact. Traumatic pseudoaneurysms may arise from seemingly minor trauma and are treated surgically. The etiology of nonspecific claudication in the athletic population requires a careful history and physical examination and may require vascular studies in order to determine if the etiology is one of popliteal artery entrapment syndrome, adventitial cystic disease of the popliteal artery, or adductor canal outlet syndrome. Buerger's disease may be seen more frequently as the use of smokeless tobacco increases in the athletic population and may be distinguished from these other claudication-causing entities by its distribution to the upper and lower extremities in a distal fashion. A sense of alertness to these vascular entities will add to the quality of care of athletes.