Intravascular ultrasound imaging as a novel tool for the diagnosis of endofibrosis

Abstract

Given the rise of high-intensity sport athletes and the paucity of literature on endofibrosis, we describe a novel adjunctive imaging technique to aid in diagnosis. A 41-year-old female triathlete presented with exercise-limiting claudication. Results of lower extremity magnetic resonance angiography, provocative Doppler, angiogram, and digital subtraction angiography with papaverine were nondiagnostic. Intravascular ultrasound imaging was able to delineate an abnormal segment of the proximal external iliac artery with intimal hypertrophy. We report intravascular ultrasound imaging as a superior imaging modality to definitively diagnose endofibrosis and assist proper planning and operative treatment of patients with endofibrosis.

Long-term outcome of percutaneous endovascular stenting in external iliac artery endofibrosis

“…A review of the literature showed an identical pattern in cases who had published IVUS images (Figure 3A) without necessarily elaborating on the features. 11,12 In fact, we could not find a published IVUS image of EIAE which did not have this pattern. This difference of appearance was easily distinguishable.…”

“…By reviewing the literature and published IVUS images, we have come to believe that this finding in the arterial circulation is both pathognomonic and 'sine qua non'. 11,12,20 In other words, if an external iliac artery segment shows this feature, EIAE is present and if it does not show it, the disease is absent. The perfect circle appearance can be explained by the histopathologic findings.…”

Overview of arterial pathology related to repetitive trauma in athletes

“…It may be considered of value when angiography does not demonstrate disease, but a high clinical suspicion remains. 33 The first-line treatment of EIAE is conservative. This treatment involves posture change and a decrease in activities that exacerbate symptoms.…”

Post-Exercise Ankle–Brachial Index Is Reduced in Healthy, Young Individuals at a Level Indicating Peripheral Artery Disease

“…Resting ABI is considered a specific method, but it has been criticized for not being sensitive enough, especially in patients with noncompressible vessels or less severe stenosis [ 4 , 5 ]. For patients with short or minor obstructions, for example, adolescents with endofibrosis or others with short isolated stenoses, resting ABI may be normal, as the stenosis has no hemodynamic significance at rest, but only when the blood flow increases [ 6 ]. Among these patients, an exercise test is recommended, according to the “American Heart Association” (AHA) recommendations.…”