External iliac artery dissection secondary to endofibrosis in a cyclist

Abstract

Endofibrosis of the external iliac artery is an uncommon disease affecting primarily young, otherwise healthy, endurance athletes. Thigh pain during maximal exercise with quick resolution postexercise is characteristic of the so-called cyclist's iliac syndrome. We report an unusual case in which the typical endofibrotic plaque was accompanied by dissection of the external iliac artery. The patient was treated surgically with excision of the affected artery segment and placement of an interposition graft. This case highlights an unusual finding in association with external iliac artery endofibrosis and provides an opportunity to briefly review the literature on the subject.

Iliac Artery Endofibrosis in a Middle-Aged Female Long-Distance Runner

“…The acute episode could have resulted from her participation in the Otter Challenge 2 wks before the thrombosis, as enhanced shear forces in the presence of supraphysiologic blood flow has been suggested in the literature. 12 Other contributors that have been described include external compression by an enlarged psoas muscle, nutritional and hemorrheologic factors, a genetic predisposition, and hormonal changes. In individuals with IAE, passionate to continue their sporting activities, surgery with endovascular intervention remains the treatment of choice.…”

“…In individuals with IAE, passionate to continue their sporting activities, surgery with endovascular intervention remains the treatment of choice. 12 Knowledge and appropriate imaging techniques are critical for diagnosis, assessment of location, posttreatment evaluation, and follow-up. 10 Endofibrosectomy with patch angioplasty is the suggested treatment method.…”

Lower limb vascular dysfunction in cyclists

“…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…”

“…According to Abraham,Chevalier and Saumet 23 , this dysfunction may stabilize after training discontinuation, but it is important to consider whether cyclists should undergo surgical procedures if they plan to continue their careers in sports competition 3,23,25,44,60. The recurrence among surgically treated arteries is lower than 10% 25,28,57,60 .…”

“…According to the medical literature, cycling has the largest number of cases of endofibrosis of the external iliac artery, and the left artery 12,44 is significantly more affected than the right 66 .…”