Bilateral Common Iliac Artery Endofibrosis in a Recreational Cyclist: Case Report and Review of the Literature

Franco, Arie; Rigberg, David A.; Ruehm, Stefan G.

doi:10.1016/j.avsg.2016.02.016

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…6,9 Some collateral vessels that anchor the EIAs to the psoas muscle may shorten the mobile portion of the artery and, together with the excessive length of the vessel, constitutes a risk factor for kinking and increased mechanical stress. 10 Besides all these extrinsic mechanical and anatomical mechanisms, the pathophysiologic mechanism could also be related to intrinsic factors, such as high cardiac output causing shear stress and stimulating endothelial dysfunction. 6,9 The histological findings of endofibrosis are quite distinct from those of atherosclerosis, which reveals loose connective tissue with moderate to high cellularity.…”

Section: Discussionmentioning

confidence: 99%

“…7 Even though arterial endofibrosis is more common in competitive cyclists, it has also been described in other endurance sports such as running, race walking, rugby, and soccer. 7,10 The main segment involved is the EIA, in 90% of the cases, with the endofibrotic segment measuring between 2 to 6 cm. Involvement of common iliac, common femoral, or profunda femoris arteries has also been reported.…”

Section: Discussionmentioning

confidence: 99%

“…12 CTA and MRI enable accurate assessment of the diameter and length of endofibrosis, and digital subtraction angiography is useful for detecting arterial branches to the psoas muscle and for better evaluation of severe stenosis or occlusion. 7,10 Management of this pathology involves a variety of modalities. 1,7,10 The vascular surgeon will feel conflicted with regard to the best management approach in such young and athletic patients.…”

Section: Discussionmentioning

confidence: 99%

“…7,10 Management of this pathology involves a variety of modalities. 1,7,10 The vascular surgeon will feel conflicted with regard to the best management approach in such young and athletic patients. As emphasized by Hinchliffe, 13 in athletes, the demands imposed on vascular surgical reconstruction, such as long-term-patency or durability, far outweigh those that may be required or considered normal for most patients within standard clinical vascular practice.…”

Section: Discussionmentioning

confidence: 99%

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External iliac artery endofibrosis in an elite female endurance cyclist

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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External iliac artery endofibrosis in an elite female endurance cyclist

et al. 2021

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“…Both unilateral and bilateral cases have been reported, probably in relation with the type activity. 1,5 Histological studies of IAE show subintimal dense loose connective tissue deposits rich in elastin and actin-positive smooth muscle cells, making a clearly different disease when compared to atherosclerosis or other vascular diseases histology. Instead, atherosclerotic disease shows more densely packed collagen deposits; extensive calcification is present in almost all cases, while in endofibrotic disease this is uncommon.…”

Section: Introductionmentioning

confidence: 99%

Management of a complicated triathlete’s bilateral iliac artery endofibrosis

Drobnic¹,

Dilmé²,

Villalba³

et al. 2018

MOJAP

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Introduction: Iliac artery endofibrosis (IAE) is an uncommon disease, poorly studied pathology with devastating effects and different therapeutic approaches affecting young people who practise intensive sports, especially cyclists. The evolution of the process not only depends on the diagnosis and therapeutic action, but also on the acceptance and attitude of the patient and subsequent professional guidance.Case description: This is the case description of a professional triathlon athlete that had one previous iliac surgical revascularization for an IAE Iliac and was admitted in our department five times with subacute lower limb ischemia affecting both legs between 2013 and 2016. Clinical findings and image tests are reported, as well as medical procedures performed. Indications based on clinical, functional and imaging ratings were clear, but his professional activity was not completely abandoned. Finally, after four endovascular procedures with good immediate results, he was warned of the seriousness of the process since the etiopathogenic reason. At the present moment patient is asymptomatic, under routine controls, working as successful triathlon coach. Discussion and conclusion:The fact that an external mechanical stress is the reason of repeated iliac artery injury suggests that an open surgical approach correcting the external muscular compression or arterial deformation should be a definitive but also aggressive solution according to literature. However, endovascular procedures and new endovascular devices are an increasingly promising option with a very low surgical risk. No matter the revascularization performed, the persistence of sports intensive practice carries a high risk of recurrence. Sport practise cessation is mandatory in some cases in order to assure revascularization long-term patency, but also a well conducted professional orientation is needed to complete the therapeutic action.

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