Lower limb vascular dysfunction in cyclists

Abstract

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.

Internal aorto‐iliac thrombosis in a Thoroughbred: Unsuccessful surgical thrombectomy, a proposed aetiopathogenesis and spontaneous partial regression

“…A recent review of the human literature assessing sports‐related vascular insufficiency in cyclists supports the theory of alterations in haemodynamics, postulating that the main aetiological factor is mechanical strain secondary to posture and performance intensity (di Alencar et al . ). Lesions were commonly identified in the external and internal iliac arteries, with 81.5% (119/146) of cases being male and 18.5% (27/146) being female.…”

“…It is also suggested that a combination of the repetitive movements and vascular compression causes the endothelium to convert from an antithrombogenic to a prothrombotic state, resulting in the production of fibronectin and von Willebrand factor (di Alencar et al . ). Unlike the horse, the primary lesion is endofibrotic stricture of vessels, which can cause secondary arterial thrombosis if severe.…”

“…Tortuosity caused by flexion of the coxofemoral joint and arterial compression by the psoas muscle during pedalling are the proposed factors responsible for blood flow reductions, with increased arterial tension resulting in endothelial damage, stenosis and claudication. It is also suggested that a combination of the repetitive movements and vascular compression causes the endothelium to convert from an antithrombogenic to a prothrombotic state, resulting in the production of fibronectin and von Willebrand factor (di Alencar et al 2013). Unlike the horse, the primary lesion is endofibrotic stricture of vessels, which can cause secondary arterial thrombosis if severe.…”