PAES Prevalence in Young Athletes
PAES is the most common cause of surgically correctable lower-extremity vascular insufficiency in young adults, though it remains rare overall and is frequently underdiagnosed in athletic populations. 1
Epidemiological Context
While the ACR Appropriateness Criteria explicitly identifies PAES as "the most common cause of surgically correctable lower-extremity vascular insufficiency in young adults," 1 the condition remains surprisingly uncommon in absolute terms. 2 The guidelines do not provide specific prevalence rates or percentages for athletic populations, but consistently emphasize that:
- PAES predominantly affects young, active individuals and athletes 3, 4
- The condition is rare but underdiagnosed, meaning actual prevalence may be higher than reported 3, 4
- It typically presents in young men more than women, though both genders are affected 2, 5
Clinical Significance for Athletes
The importance of PAES in young athletes stems not from high prevalence but from:
- High index of suspicion required: The condition should be considered in every young patient with unexplained leg ischemia or exercise-induced claudication 4
- Potentially limb-threatening complications if diagnosis is delayed 4, 6, 7
- Overlap with musculoskeletal conditions: Symptoms like calf pain, cramping, and paresthesia mimic common athletic injuries, leading to missed diagnoses 4
Key Diagnostic Red Flags in Athletes:
- Exercise-induced calf claudication in young patients without atherosclerotic risk factors
- Bilateral symptoms (common in functional PAES) 5
- History of exertional compartment syndrome (36% of surgical cases had prior compartment syndrome operations) 5
- Decreased ankle-brachial index after exercise 5
Common Pitfalls
The primary issue is not that PAES is common, but that it is commonly missed. 3, 4 Clinicians often attribute symptoms to:
- Chronic exertional compartment syndrome
- Musculoskeletal overuse injuries
- Shin splints or stress fractures
This diagnostic delay can result in arterial damage requiring reconstruction rather than simple decompression, and may prevent return to competitive athletics even after successful surgery. 3
Bottom line: While PAES represents the leading surgically correctable vascular cause of claudication in young adults, it remains an uncommon diagnosis that requires heightened clinical awareness in athletic populations presenting with exertional leg symptoms.