Endofibrosis of the External Iliac Artery in Bicycle Racers: an Unrecognized Pathological State

Chevalier, J. M.; Enon, B; Walder, J; Barral, Xavier; Pillet, J.; Megret, Armand; Lhoste, Philippe; Saint-Andre, J.P.; Davinroy, M

doi:10.1016/s0890-5096(06)60123-4

Cited by 118 publications

(81 citation statements)

References 2 publications

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“…During the first three minutes, ABI in left lower limb falls, a hemodynamic result very different from that observed in the right lower disease (PAOD), and its normal value is greater than 0.9. The occurrence of a normal ABI value at rest does not rule out PAOD in cyclists 12,29,45 ; therefore, this test should be performed at submaximal or maximal effort to induce the appearance of the complaints that result from cycling 3,30,65 . For cyclists, the effort test is more reliable when performed in a cycle ergometer or cycle simulator (absolute distance, or Strandness test in French) than when the treadmill test is used, because the ergometer and simulators reproduce the γ of twenty-five cyclists included in the study, there were twenty-seven cases, as two cyclists (1 man and 1 woman) were studied at two different time points and in contralateral limb to the one affected before: 15• l , ten men and five women -8• r , two men and six women, and 4• l,r , three men and one woman.…”

Section: Resultsmentioning

confidence: 99%

“…As symptoms may be overlooked, the delay in diagnosing endofibrosis of the iliac artery in competitive athletes, for example, is two years from symptoms onset, according to Lim et al 11. Until a diagnosis is made, the coaches of many cyclists often label them as lazy or unmotivated 63 , which may force them to drop out of competition 3,11,16,21,23 . In fact, in a highly competitive sport, their blood supply is insufficient for their muscle activity demand 64 .…”

Section: Discussionmentioning

confidence: 99%

“…First, symptoms appear at submaximal effort 15 , then at moderate effort and medium distance, and may later be reported to be felt during walks 13,48,54,59. Among cyclists diagnosed with endofibrosis or thrombosis of the external iliac artery, annual training ranges from 5,000 km to 33,000 km 3,5,8,9,15,17,19,24,44, and symptoms, according to case reports, may appear after distances reach 50,000 km to 380,000 km 9,17,32,44,48. External iliac artery dysfunction in cyclists is not often associated with PAOD characteristics, such as history of thromboembolic disease, abnormal cholesterol levels 30,45 and diabetes…”

Section: Common Iliac Arterymentioning

confidence: 99%

“…At the same time, professional cyclists are more likely to have musculoskeletal lesions as a result of working very close to the threshold between high level training and excess training, particularly when their posture on the bicycle and their training techniques are inadequate 1,2 . The numerous musculoskeletal dysfunctions associated with sports probably contribute to the underestimation of arteriopathy in the lower limbs of cyclists [3][4][5][6] . In the last twenty years, several cases of cyclists with vascular dysfunction in the lower limbs have been diagnosed.…”

Section: Introductionmentioning

confidence: 99%

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Lower limb vascular dysfunction in cyclists

2013

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Sports-related vascular insufficiency affecting the lower limbs is uncommon, and early signs and symptoms can be confused with musculoskeletal injuries. This is also the case among professional cyclists, who are always at the threshold between endurance and excess training. The aim of this review was to analyze the occurrence of vascular disorders in the lower limbs of cyclists and to discuss possible etiologies. Eighty-five texts, including papers and books, published from 1950 to 2012, were used. According to the literature reviewed, some cyclists receive a late diagnosis of vascular dysfunction due to a lack of familiarity of the medical team with this type of dysfunction. Data revealed that a reduced blood flow in the external iliac artery, especially on the left, is much more common than in the femoral and popliteal arteries, and that vascular impairment is responsible for the occurrence of early fatigue and reduced performance in cycling.Keywords: cycling; peripheral arteriopathy; blood flow; stenosis. ResumoO desenvolvimento de insuficiência vascular em membros inferiores relacionada à prática esportiva é incomum e no início do surgimento dos sinais e sintomas frequentemente pode ser confundida com lesão musculoesquelética, a exemplo de casos relatados em ciclistas profissionais, por estarem sempre no limiar entre o treinamento em nível máximo e o excesso de treinamento. O objetivo desta revisão de literatura foi analisar a ocorrência de disfunções vasculares em membros inferiores em ciclistas e as possíveis etiologias. Oitenta e cinco textos, entre artigos e livros publicados de 1950 a 2012 foram utilizados. Segundo a literatura, alguns ciclistas têm o diagnóstico de disfunção vascular realizado tardiamente devido à falta da familiaridade da equipe médica com esta modalidade de disfunção. Os resultados da pesquisa revelaram que a redução do fluxo sanguíneo na artéria ilíaca externa, em especial a esquerda, é bem mais comum que a da artéria femoral e poplítea, e que o comprometimento vascular é responsável pela ocorrência de fadiga precoce e redução do desempenho no ciclismo.Palavras-chave: ciclismo; arteriopatia periférica; fluxo sanguíneo; estenose.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Common Iliac Arterymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lower limb vascular dysfunction in cyclists

2013

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“…Furthermore, publications regarding aetiology and diagnosis of the disease are based on very few patients, thus raising theories about the origin of the IAE that should be verified by clinical studies including a higher amount of patients. 2,3 Most are men, cyclists, but also described in many other sports, probably due to a combination of genetic factors and the greater number of men practising high-intensity sports. 1,3,4 From an anatomical point of view, it is caused by a thickening of the iliac artery intimae that causes hemodynamic stenosis.…”

Section: Introductionmentioning

confidence: 99%

Management of a complicated triathlete’s bilateral iliac artery endofibrosis

Drobnic¹,

Dilmé²,

Villalba³

et al. 2018

MOJAP

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Introduction: Iliac artery endofibrosis (IAE) is an uncommon disease, poorly studied pathology with devastating effects and different therapeutic approaches affecting young people who practise intensive sports, especially cyclists. The evolution of the process not only depends on the diagnosis and therapeutic action, but also on the acceptance and attitude of the patient and subsequent professional guidance.Case description: This is the case description of a professional triathlon athlete that had one previous iliac surgical revascularization for an IAE Iliac and was admitted in our department five times with subacute lower limb ischemia affecting both legs between 2013 and 2016. Clinical findings and image tests are reported, as well as medical procedures performed. Indications based on clinical, functional and imaging ratings were clear, but his professional activity was not completely abandoned. Finally, after four endovascular procedures with good immediate results, he was warned of the seriousness of the process since the etiopathogenic reason. At the present moment patient is asymptomatic, under routine controls, working as successful triathlon coach. Discussion and conclusion:The fact that an external mechanical stress is the reason of repeated iliac artery injury suggests that an open surgical approach correcting the external muscular compression or arterial deformation should be a definitive but also aggressive solution according to literature. However, endovascular procedures and new endovascular devices are an increasingly promising option with a very low surgical risk. No matter the revascularization performed, the persistence of sports intensive practice carries a high risk of recurrence. Sport practise cessation is mandatory in some cases in order to assure revascularization long-term patency, but also a well conducted professional orientation is needed to complete the therapeutic action.

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