Athlete Gets Back in the Game After Being Sidelined with Rare Vascular Disorder

For Eleni Kytzidis, life is all about sports. “Soccer has meant the world to me ever since I was a little girl,” says the 20-year-old Philadelphia native. “There were times where I was on six or seven soccer teams at a time just because I could not get enough of it. I had dreams to play in collegiate Division 1 competitive soccer.”

But chronic pain in her legs and lower back throughout her high school years had the aspiring soccer star worried she would be forced to hang up her cleats and give up her dream of playing competitive soccer. Ms. Kytzidis says the pain was getting progressively worse but she was reluctant to let it take her away from the sport she loves.

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(Watch now: Eleni Kytzidis endured debilitating pain throughout high school in order to play the sports she loves but was forced to hang up her cleats until a specialist at Baptist Health Miami Cardiac & Vascular Institute offered a life-changing diagnosis. Video by Eduardo Morales.)

“It started in the spring of my freshman year at high school. I was having really bad calf pain, calf cramps. I took off sports for two months but as soon as I started running, it hurt again,” Ms. Kytzidis recalls. “It went on for about a year until I was eventually diagnosed with chronic exertional compartment syndrome.”

Ms. Kytzidis had surgery in the winter of her sophomore year but says that didn’t work. “I went back to the doctors a year later and they found blood clots in my legs, so I had those removed in the spring of my junior year but a year later the pain still hadn’t gone away,” she says. “The pain was terrible but it was really hard for me to think about giving up soccer so I ended up really pushing it,” admits Ms. Kytzidis. “I played through the pain for too long and apparently made things even worse.”

With the pain in her legs growing progressively severe, Ms. Kytzidis thought perhaps her clots had come back. Further testing confirmed this to be the case. The young student-athlete was forced to stop playing soccer altogether and she underwent another surgery during her senior year of high school. “Soccer meant the world to me. When I wasn’t able to play, that was really hard. It was pretty heartbreaking,” she says.

More than just blood clots

During her freshman year of college in South Florida, unable to play soccer or endure even a mild workout, Ms. Kytzidis sought the help of a vascular interventional specialist at Baptist Health Miami Cardiac & Vascular Institute, whom she had been referred to by one of her doctors in Philadelphia.

Alex Powell, M.D., interventional radiologist at Baptist Health Miami Cardiac & Vascular Institute

“Eleni was originally diagnosed as having some sort of clotting disorder and her doctors back home had found some clots in her arteries,” recalls Alex Powell, M.D., an interventional radiologist at Baptist Health Miami Cardiac & Vascular Institute. After a comprehensive physical examination and various tests – none of which revealed any structural abnormality – Dr. Powell felt strongly that there was more going on with her than just a problem with blood clots. “She was quite symptomatic and I kept thinking there had to be something more. Something was wrong with this young woman.”

Although all prior studies had failed to diagnose arterial compression from adjacent calf muscles, Dr. Powell remained suspicious given her symptoms and physical exam. He then performed a catheterization procedure that also used intravascular ultrasound for Ms. Kytzidis. “We put an ultrasound probe inside her artery, then we activated her calf muscles by having her push down,” he explains. “As we did this ultrasound, you could see her artery go from a normal size at rest to becoming markedly compressed with muscle activation. This clinched the diagnosis.”

Ms. Kytzidis had a severe case of Popliteal Artery Entrapment Syndrome (PAES), an under-diagnosed condition that is very rare but most commonly seen in young to middle-aged patients. An angiogram of the affected area may not always reveal this condition, Dr. Powell says, which is why he says PAES often goes undiagnosed. “If you’re not suspicious of PAES, you could perform a standard angiogram and accept it as normal and not look any further,” he says.

PAES symptoms to watch for

According to a study by the National Institutes of Health (NIH), the hallmark of PAES is “a vascular compromise within the popliteal fossa resulting in an insidious, progressive course of exercise intolerance and calf pain with exertion relieved by rest (claudication).” The study also notes that “while the incidence of this disease has risen slightly in recent years, the true prevalence is unknown as the number of cases is likely underreported.”

Symptoms of PAES include:

• Pain, cramping or discomfort during exercise

• Tingling sensation or temperature changes in the calf

• Swelling in the calf

• Skin discoloration around the calf

• Blood clots in the lower leg

• Pain in the lower leg and feet when at rest

If PAES is detected and managed early in the course of the disease, the prognosis is generally good. “However, if it is detected late when extensive arterial damage has already happened, then the patient is at risk of having permanent claudication,” the study notes. “In the most severe cases, PAES can result in or limb amputation but this is extremely rare because the arterial occlusion is usually slow and develops over many years.”

Finally, a definitive diagnosis

After years of treatment by various doctors and being unable to find lasting relief for the pain that had crippled her ambition of playing collegiate soccer, at last Ms. Kytzidis had an answer. “When Dr. Powell finally made the diagnosis through this procedure, I was very emotional,” she says. “I had expected that I was going to just have to live in pain for the rest of my life and just manage it.”

Armed with a definitive diagnosis from Dr. Powell, Ms. Kytzidis returned home to Philadelphia where she underwent successful surgery on both legs to release the entrapped arteries. “They eventually had to remove part of the muscle in my left leg because it was wrapped around the artery,” she says. “Then they put everything back in the right place and sure all my nerves were good. They said that it was probably from over-development of my left calf, from overtraining.”

Today, Ms. Kytzidis is back on her feet and enjoying a full and active life, free of the debilitating pain she endured for far too long. “I really couldn’t believe it. And quite frankly, I was a little angry that no one else had found it because I really wanted to play soccer forever. That was always my dream,” says Ms. Kytzidis. “I was just happy that I was going to get treatment and be able to feel better.”

Back in the game again

Since recovering from her surgery, Ms. Kytzidis has completed a triathlon and a half marathon and she credits Dr. Powell for his role in her return to sports. “Without the help of Dr. Powell and his diagnosis, I wouldn’t have had that opportunity to get better and get healthy,” she says. “I just love playing so much, so it’s really awesome. I’ve been able to join the club soccer team and am getting back to being active and working out every day.”

Dr. Powell remarks that he is glad he was able to establish an accurate diagnosis and help get Ms. Kytzidis back to the sport she loves. “Here is a young woman who was really struggling. She was accepting a life that would be basically sedentary when she was formerly this soccer player,” he says. “And now, she’s back to doing all of those activities. How can that not be about the best thing in the world?”