External iliac artery endofibrosis in an elite female endurance cyclist

Abstract

External iliac artery endofibrosis is a rare pathology that affects high-level endurance athletes, especially cyclists. Classical symptoms include pain, loss of power, and/or cramp in the affected limb while training at maximal effort. The patient’s lack of atherosclerotic risk factors makes clinical suspicion of arteriopathy challenging. Moreover, the best management of such patients is still a subject of discussion. We report the case of a 36-year-old professional female endurance cyclist who presented with lower extremity pain during training. Right external iliac artery endofibrosis was diagnosed and the patient underwent surgical treatment. At two-months follow-up, she reported significant improvement in symptoms. This case highlights the importance of diagnosing peripheral vascular disease in young patients and athletes, who do not fit the ordinary profile of patients with atherosclerotic risk factors.

Exertional Lower Extremity Pain in a Triathlete Caused by External Iliac Artery Endofibrosis

“…Endofibrosis is a stenotic endovascular lesion that occurs as a result of such mechanical stress. It is characterized by intimal hyperplasia set in moderately loose cellular connective tissue with variable amounts of elastin, collagen, and smooth muscle cells 4,9 .…”

“…Several operative procedures for endofibrosis have been reported, including transluminal balloon angioplasty 10,13 , endoluminal stent placement, and arterial shortening with endofibrosectomy 9,11,14 ; however, the gold standard method is still not clear. There are some advantages and disadvantages to each procedure.…”

Die iliakale Endofibrose im Hochleistungssport - eine diagnostische interdisziplinäre Herausforderung

“…Überraschenderweise gibt es Hinweise darauf, dass die Latenz bis zur korrekten Diagnosestellung bei Profiathleten länger ist als bei ambitionierten Hobbysportlern, wobei die Gründe hierfür nicht bekannt sind [21]. Eine hohe Trainingsbelastung und Fahrleistung sind nach aktuellem Stand der Wissenschaft die Hauptrisikofaktoren in der Pathogenese der IE [47].…”