Skip to main content

Advertisement

Log in

Unusual causes of intermittent claudication: Popliteal artery entrapment syndrome, cystic adventitial disease, fibromuscular dysplasia, and endofibrosis

  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

In the general population, vascular causes of exercise-induced limb discomfort are most often the result of peripheral artery disease (PAD) due to atherosclerosis. However, several other clinical entities can often mimic the symptoms of atherosclerotic PAD of the lower extremities, particularly among younger patients with fewer risk factors for atherosclerosis, who often are more athletically fit than patients with PAD. Treatment for these entities often requires percutaneous or surgical intervention. This article reviews four uncommon vascular causes of exercise-induced limb discomfort: popliteal artery entrapment syndrome, cystic adventitial disease of the popliteal artery, fibromuscular dysplasia of the lower-extremity arteries, and endofibrosis of the iliac artery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Levien LJ, Veller MG: Popliteal artery entrapment syndrome: more common than previously recognized. J Vasc Surg 1999, 30:587–598.

    Article  PubMed  CAS  Google Scholar 

  2. Gibson MH, Mills JG, Johnson GE, Downs AR: Popliteal entrapment syndrome. Ann Surg 1977, 185:341–348.

    Article  PubMed  CAS  Google Scholar 

  3. Bouhoutsos J, Daskalakis E: Muscular abnormalities affecting the popliteal vessels. Br J Surg 1981, 68:501–506.

    Article  PubMed  CAS  Google Scholar 

  4. Turnipseed WD: Popliteal entrapment syndrome. J Vasc Surg 2002, 35:910–915.

    Article  PubMed  Google Scholar 

  5. Wright LB, Matchett WJ, Cruz CP, et al.: Popliteal artery disease: diagnosis and treatment. Radiographics 2004, 24:467–479.

    Article  PubMed  Google Scholar 

  6. Steurer J, Hoffmann U, Schneider E, et al.: A new therapeutic approach to popliteal artery entrapment syndrome (PAES). Eur J Vasc Endovasc Surg 1995, 10:243–247.

    Article  PubMed  CAS  Google Scholar 

  7. Ortiz MW, Lopera JE, Gimenez CR, et al.: Bilateral adventitial cystic disease of the popliteal artery: a case report. Cardiovasc Intervent Radiol 2006, 29:306–310.

    Article  Google Scholar 

  8. Levien LJ, Benn CA: Adventitial cystic disease: a unifying hypothesis. J Vasc Surg 1998, 28:193–205.

    Article  PubMed  CAS  Google Scholar 

  9. Cassar K, Engeset J: Cystic adventitial disease: a trap for the unwary. Eur J Vasc Endovasc Surg 2005, 29:93–96.

    Article  PubMed  CAS  Google Scholar 

  10. Fox RL, Kahn M, Adler J, et al.: Adventitial cystic disease of the popliteal artery: failure of percutaneous transluminal angioplasty as a therapeutic modality. J Vasc Surg 1985, 2:464–467.

    Article  PubMed  CAS  Google Scholar 

  11. Khoury M: Failed angioplasty of a popliteal artery stenosis secondary to cystic adventitial disease—a case report. Vasc Endovasc Surg 2004, 38:277–280.

    Article  Google Scholar 

  12. Do DD, Braunschweig M, Baumgartner I, et al.: Adventitial cystic disease of the popliteal artery: percutaneous USguided aspiration. Radiology 1997, 203:743–746.

    PubMed  CAS  Google Scholar 

  13. Sieunarine K, Lawrence-Brown MM, Kelsey P: Adventitial cystic disease of the popliteal artery: early recurrence after CT guided percutaneous aspiration. J Cardiovasc Surg (Torino) 1991, 32:702–704.

    CAS  Google Scholar 

  14. di Marzo L, Peetz DJ Jr, Bewtra C, et al.: Cystic adventitial degeneration of the femoral artery: is evacuation and cyst excision worthwhile as a definitive therapy? Surgery 1987, 101:587–593.

    PubMed  Google Scholar 

  15. Stanley J: Renal artery fibrodysplasia. In Renal Vascular Disease. Edited by Novick A, Scoble J, Hamilton G. London: WB Saunders; 1996:21–23.

    Google Scholar 

  16. Plouin PF, Perdu J, La Batide-Alanore A, et al.: Fibromuscular dysplasia. Orphanet J Rare Dis 2007, 2:28.

    Article  PubMed  Google Scholar 

  17. Slovut DP, Olin JW: Fibromuscular dysplasia. N Engl J Med 2004, 350:1862–1871.

    Article  PubMed  CAS  Google Scholar 

  18. Davies MG, Saad WE, Peden EK, et al.: The long-term outcomes of percutaneous therapy for renal artery fibromuscular dysplasia. J Vasc Surg 2008, 48:865–871.

    Article  PubMed  Google Scholar 

  19. Ford SJ, Rehman A, Bradbury AW: External iliac endofibrosis in endurance athletes: a novel case in an endurance runner and a review of the literature. Eur J Vasc Endovasc Surg 2003, 26:629–634.

    Article  PubMed  CAS  Google Scholar 

  20. Maree AO, Ashequl Islam M, Snuderl M, et al.: External iliac artery endofibrosis in an amateur runner: hemodynamic, angiographic, histopathological evaluation and percutaneous revascularization. Vasc Med 2007, 12:203–206.

    Article  PubMed  Google Scholar 

  21. Walder J, Mosimann F, Van Melle G, Mosimann R: Iliac endofibrosis in 2 cycling racers [in French]. Helv Chir Acta 1985, 51:793–795.

    PubMed  CAS  Google Scholar 

  22. Vink A, Bender MH, Schep G, et al.: Histopathological comparison between endofibrosis of the high-performance cyclist and atherosclerosis in the external iliac artery. J Vasc Surg 2008, 48:1458–1463.

    Article  PubMed  Google Scholar 

  23. Chevalier JM, Enon B, Walder J, et al.: Endofibrosis of the external iliac artery in bicycle racers: an unrecognized pathological state. Ann Vasc Surg 1986, 1:297–303.

    PubMed  CAS  Google Scholar 

  24. Alimi YS, Accrocca F, Barthelemy P, et al.: Comparison between duplex scanning and angiographic findings in the evaluation of functional iliac obstruction in top endurance athletes. Eur J Vasc Endovasc Surg 2004, 28:513–519.

    Article  PubMed  CAS  Google Scholar 

  25. Kral CA, Han DC, Edwards WD, et al.: Obstructive external iliac arteriopathy in avid bicyclists: new and variable histopathologic features in four women. J Vasc Surg 2002, 36:565–570.

    Article  PubMed  Google Scholar 

  26. Schep G, Bender MH, van de Tempel G, et al.: Detection and treatment of claudication due to functional iliac obstruction in top endurance athletes: a prospective study. Lancet 2002, 359:466–473.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael R. Jaff.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Korngold, E.C., Jaff, M.R. Unusual causes of intermittent claudication: Popliteal artery entrapment syndrome, cystic adventitial disease, fibromuscular dysplasia, and endofibrosis. Curr Treat Options Cardio Med 11, 156–166 (2009). https://doi.org/10.1007/s11936-009-0016-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-009-0016-6

Keywords

Navigation