Arterial Endofibrosis in Endurance Athletes: Angiographic Features and Classification

Abstract

This study assessed 180 patients (161 men, 19 women) with 195 symptomatic limbs (136 left-side limbs; P < .001). Angiography depicted 28 abnormalities in the CIA (27 stenoses, one dissection), 185 in the EIA (17 thromboses, 167 stenoses, one dissection), one in the common femoral artery (dissection), and 14 in the deep femoral artery (one thrombosis, 13 stenoses). CIA and EIA stenoses predominantly involved the distal and proximal third of the artery respectively. They were mild (CIA and EIA mean severity, 19% ± 7 and 26% ± 11, respectively) and long (45% ± 26 and 51% ± 26 of the artery, respectively). EIA stenoses were significantly longer in women (P < .003). Upon hip flexion, 23 CIA and 116 EIA stenoses showed kinking (mean amplitude, 76° ± 23 and 76° ± 30, respectively). All deep femoral artery stenoses were diaphragm-like and involved the lateral circumflex femoral artery. CIA, EIA, and femoral lesions were not randomly associated (P< .001). ConCLUSION: Arterial endofibrosis mainly affects the central part of the iliac artery and the lateral circumflex femoral artery. The CIA, EIA, and femoral lesion classification may help to distinguish patterns of associated lesions.

Diagnosis and Management of Iliac Artery Endofibrosis: Results of a Delphi Consensus Study

“…8e10 A consensus that exercise tests should be standardised was reached, which is an important step forward, and a description of this technique was recently published. 11,12 Patients should be exercised until they develop symptoms and the pressures (ankle and ABPI) should be measured if possible within 1 minute of exercise cessation with the patient in a supine position (and for this some units have adopted automatic systems to measure pressures simultaneously and rapidly in both lower limbs). Some institutions, which consider kinking to be a potential important cause of flow limitation, test the ankle pressures with the patient on a cycle ergometer in an upright position (with a correction being applied for vertical height difference) and with hips flexed.…”

Cyclist Endofibrosis (Exercise-Induced Arterial Endofibrosis) Treated by Drug-Coated Balloon Angioplasty

“…Other symptoms include hardening of the thigh, cramps, and/or paralysis. Symptoms occur more commonly on the left side [ 9 ]. In 1995, Beck studied 164 cases of arterial endofibrosis and found that 50% of these patients complained of a paralyzing pain, a swollen thigh in 23%, both previous manifestations in 17%, typical claudication in 9%, and 1% had critical ischemia [ 10 ].…”

ACR Appropriateness Criteria® Nonatherosclerotic Peripheral Arterial Disease

“…The most frequent finding of EIAE at DSA is smooth, long, and eccentric stenosis, with thrombosis and dissection present less frequently [1]. Although the external iliac artery is most frequently affected, the common iliac artery can be involved in approximately 15% of patients [32]. A benefit of arteriography, relative to other modalities, is that the pressure gradient across the narrowing can be measured at baseline as well as during various maneuvers, including following the administration of vasodilators [33].…”

“…A benefit of arteriography, relative to other modalities, is that the pressure gradient across the narrowing can be measured at baseline as well as during various maneuvers, including following the administration of vasodilators [33]. Acquiring images during hip flexion frequently reveals a kink in the iliac arteries at the site of stenosis [32].…”