In young patients, generally defined as those under 40 years of age, intermittent claudication (IC) is relatively rare and represents a different spectrum of pathology from IC in older patients. Atherosclerosis in older patients is the most common etiology, but appears to represent a distinct clinical entity with a more virulent course. Furthermore, other causes of lower extremity ischemia play a more prominent role in young patients. These include: (1) popliteal artery entrapment syndrome; (2) traumatic occlusion; (3) adventitial cystic disease; (4) exercise induced compartment syndrome; (5) repetitive trauma; (6) congenital arterial anomalies; and (7) ergotism. We outline the important features of the various causes of (IC) in the young and review the facets of diagnosis and management of these patients.
Levy PJ, Hornung CA, Haynes JL, et al. Lower extremity ischemia in adults younger than forty years of age: a community-wide survey of premature atherosclerotic arterial disease . J Vasc Surg1994;19:873-881
2.
Sise MJ, Shackford SR, Rowley WR, et al. Claudication in young adults: a frequently delayed diagnosis . J Vasc Surg1989;10:68-74
3.
Jelnes R., Gaardsting O., Jensen KH, et al. Fate in intermittent claudication: outcome and risk factors . Br Med J1986;293:1137-1140
4.
Porter JM, Taylor LM, Harris EJNonatherosclerotic vascular disease. In: Moore WS, ed. Vascular surgery, a comprehensive review. Philadelphia: WB Saunders;1993:108-145
5.
McCready RA, Vincent AE, Schwartz RW, et al. Atherosclerosis in the young: a virulent disease. Surgery1984;96:863-868
6.
Bouhoutsos J. , Martin P.The influence of age on prognosis after arterial surgery for atherosclerosis of the lower limb. Surgery1973;74:637-640
7.
Valentine RJ , MacGillavray DC, DeNobile JW, et al. Intermittent claudication caused by atherosclerosis in patients aged forty years and younger. Surgery1990 ;107:560-565
8.
De Bakey ME, Crawford ES, Garrett HE, et al. Occlusive disease of the lower extremities in patients 16 to 37 years of age. Ann Surg1964;159:873-890
9.
Levy PJ, Gonzales MF, Hornung CA, et al. A prospective evaluation of atherosclerotic risk factors and hypercoagulability in young adults with premature lower extremity atherosclerosis . J Vasc Surg1996;23:36-45
10.
Eldrup-Jorgensen J., Flanigan DP, Brace L., et al. Hypercoagulable states and lower limb ischemia in young adults. J Vasc Surg1989 ;9:334-341
11.
DeLaurentis DA, Friedman P., Wolferth CC, et al. Atherosclerosis and the hypoplastic aortoiliac system. Surgery1978;83:27-37
12.
Levy PJ, Tabares AH, Olin JWLower extremity arterial occlusions in young patients with Crohn's colitis and premature atherosclerosis: report of six cases. Am J Gastroenterol1997;92:494-497
13.
VanGoor H., Boontje AHResults of vascular reconstructions for atherosclerotic occlusive disease of the lower limbs in young adults. Eur J Vasc Endovasc Surg1995;10:323-326
14.
Gibson MHL , Mills JG, Johnson GE, et al. Popliteal entrapment syndrome. Ann Surg1977;18 5:341-348
15.
Persky JM, Kempczinski RF, Fowl RJEntrapment of the popliteal artery. Surg Gynecol Obstet1991;173:84-90
Di Marzo L. , Cavallaro A., Sciacca V., et al. Diagnosis of popliteal artery entrapment syndrome: the role of duplex scanning. J Vase Surg1991;13:434-438
20.
Erdoes LS, Devine JJ, Bernhard VM, et al. Popliteal vascular compression in a normal population. J Vasc Surg1994;20:978-986
21.
Lambert AW, Wilkins DCPopliteal artery entrapment syndrome: collaborative experience of the Joint Vascular Research Group. Br J Surg1998;85:1367-1368
Flanigan DP , Burnham SJ, Goodreau JJ, et al. Summary of cases of adventitial cystic disease of the popliteal artery. Ann Surg1979;189:165-175
24.
Miller A., Salenius JP, Sacks BA, et al. Noninvasive vascular imaging in the diagnosis and treatment of adventitial cystic disease of the popliteal artery. J Vasc Surg1997;26: 715-720
25.
Do DD, Braunschweig M., Baumgartner I., et al. Adventitial cystic disease of the popliteal artery: percutaneous US-guided aspiration. Radiology1997;203:743-746
26.
Martens MA, Moeyersoons JPAcute and recurrent effort-related compartment syndrome in sports . Sports Med1990;9:62-68
27.
Biedert RM, Marti B.Intracompartmental pressure before and after fasciotomy in runners with chronic deep posterior compartment syndrome. Int J Sports Med1997;18:381-386
28.
Padhiar N., King JBExercise induced leg pain-chronic compartment syndrome. Is the increase in intra-compartment pressure exercise specific?Br J Sports Med1996;30: 360-362
29.
Cook PS, Erdoes LS, Selzer PM, et al. Dissection of the external iliac artery in highly trained athletes . J Vasc Surg1995;22:173-177
30.
Abraham P., Chevalier JM, Leftheriotis G., et al. Lower extremity arterial disease in sports. Am J Sports Med1997;25:581-584
31.
Rousselet MC , Saint-Andre JP, L'Hoste P., et al. Stenotic intimal thickening of the external iliac artery in competition cyclists. Hum Pathol1990;21:524-529
32.
Shanley CJ, Stanley JCCoarctation and hypoplasia of the subisthmic thoracic and abdominal aorta . In: Ernst CB, Stanley JC eds. Current Therapy in Vascular Surgery. St Louis: Mosby;1995:359-363
33.
Hallett JW, Brewster DC, Darling RC, et al. Coarctation of the abdominal aorta: current options in surgical management. Ann Surg1980;191:430-437
34.
Scott HW, Dean RH, Boerth R., et al. Coarctation of the abdominal aorta: long-term results of surgical therapy. Ann Surg1979;189:746-755
35.
Mickley V., Fleiter T.Coarctations of the descending thoracic and abdominal aorta: current options in surgical management. J Vasc Surg1998;28:206-214
36.
Sproul G., Pinto J.Coarctation of the abdominal aorta. Arch Surg1972;105:571-573
Brantley SK , Rigdon EE, Raju S.Persistent sciatic artery: embryology, pathlogy, and treatment. J Vasc Surg1993;18:242-248
39.
Bower EB, Smullens SN, Parke WWClinical aspects of persistent sciatic artery: report of two cases and review of the literature. Surgery1977 ;81:588-595
40.
Greene FL, Ariyan S., Stansel HCMesenteric and peripheral vascular ischemia secondary to ergotism . Surgery1977;81:176-179
41.
Braunlich S. , Kroger K., Massalha K., et al. Ergotamine-induced intermittent claudication . Vasa1999;28:123-126
42.
Merhoff GC, Porter JMErgot intoxication: historical review and description of unusual clinical manifestations. Ann Surg1974;180:773-779
