Vascular entrapment syndromes of the lower extremities represent a diagnostic challenge in athletes, with emerging evidence suggesting sport-specific presentations. This study aimed to characterize and compare patterns of vascular compression, anatomical variants, and hemodynamic consequences across different sporting disciplines. We conducted a retrospective analysis of 210 athletes with confirmed vascular entrapment syndrome from a 10-year cohort (2014-2023). Athletes were categorized as long-distance runners (n=87), cyclists (n=71), triathletes (n=24), soccer players (n=19), and other sports (n=9). All participants underwent standardized clinical assessment and vascular imaging during provocative maneuvers. Multivariable analyses and latent class analysis were performed to identify independent predictors and distinct phenotypes. Sport-specific patterns of vascular compression were identified. Long-distance runners exhibited highest compression during plantarflexion (85.7±8.6%), predominantly with Type III gastrocnemius variants (60.9%). Cyclists demonstrated highest compression during knee extension (79.2±11.4%), with predominant Type II variants (49.3%). Soccer players exhibited primarily Type I variants (57.9%) with lower compression severity. Latent class analysis identified three distinct phenotypes: "runner phenotype" (43.8%), "cyclist phenotype" (37.1%), and "low compression phenotype" (19.0%), each with characteristic anatomical, hemodynamic, and clinical features. Sport category remained an independent predictor of compression severity after adjusting for potential confounders (p<0.001). Vascular entrapment syndrome manifests with distinct sport-specific patterns reflecting the interplay between anatomical predisposition and functional demands. The identification of sport-specific phenotypes provides a framework for tailored diagnostic approaches and management strategies. Recognition of these characteristics may enhance diagnostic accuracy, inform individualized treatment, and improve outcomes for affected athletes across diverse sporting disciplines.