Endofibrosis of the external iliac artery in bicycle racers: an unrecognized pathological state

Abstract

Since December 1985, we have operated upon seven bicycle racers for endofibrosis of the external iliac artery. In all instances, the athletes had started cycling early in life and were engaged in top level competition by the age of 17. The principal complaint was intermittent claudication of one lower limb at "near-maximal" exercise. Pain could be reproduced by exertional tests on an ergometric bicycle, and in all cases except one, measurement of ankle systolic pressure of that limb compared with the opposite side and brachial pressures showed a marked decrease on the involved side. Arteriography, performed with multiple views and positions, documented a 5 to 6 cm moderately stenotic (less than 40% diameter) segment, associated with arterial lengthening. Surgical treatment consisted of endarterectomy and shortening of the artery. Four patients were able to return to competition. The origin of this pathology is discussed, based on gross and histologic findings. Under certain predisposing anatomic conditions, abnormal hemodynamics, probably due to a high flow arterial state and an aerodynamic position on the bicycle, provoke repeated trauma which eventually produces the lesion. Practically unrecognized until now with only two previous publications on the subject in the literature, this entity is probably not uncommon.

Endofibrose de l’artère iliaque externe diagnostiquée par écho-doppler post-effort

“…L'endofibrose iliaque est une pathologie de l'athlète de haut niveau décrite la première fois en 1986 et dont la prévalence est difficile à estimer, mais peut aller de 10 à 20 % des cyclistes professionnels [1]. Elle est en effet sous-diagnostiquée car les symptômes sont volontiers pris à tort pour des problèmes neurologiques, musculaires ou ostéo-articulaires dans cette population d'athlètes [2].…”

Nonatherosclerotic PAD: Approach to Exertional Pain in the Lower Extremities

“…It is most frequently observed in competitive cyclists and runners, however, has also been described in speed skaters and cross-country skiers [24]. The median age at presentation is 25 years, and there does not appear to be a gender predilection [25].…”

Results of external iliac artery reconstruction in avid cyclists

“…1,2 Since that time, it has been reported in several series and case reports, largely from European Centers, and although it is seen predominantly in competitive cyclists, it has also been reported in long-distance runners, triathletes, speed skaters, and more. [3][4][5][6][7][8] The diagnosis can be challenging in these young and extremely fit individuals.…”

“…The hallmark symptom is claudication during extreme exertion only, with no symptoms present at rest or even with moderate activity. 1,2,4,9 While typical claudication symptoms can be appreciated, including pain, numbness, weakness, or cramping, in some patients, the only notable change is lack of power or an inability to perform at the level to which they are accustomed. 5 External iliac arteriopathy is distinct from either atherosclerosis or fibromuscular dysplasia and has gained recognition as a unique vascular disorder.…”

“…5 Several mechanisms for these changes have been proposed, including exaggerated hemodynamic forces acting on the vessel, cyclist positioning while riding, and anatomic fixation of the external iliac artery and other branch vessels. 1,2,4,9,10 Likewise, several methods of treatment have been employed, although surgical repair remains the preferred intervention. 2,4,6,11 The largest series reported to date have been from France and The Netherlands.…”