External Iliac Artery Fibrosis in Endurance Athletes Successfully Treated with Bypass Grafting

Falor, Ann E.; Zobel, Michael J.; Virgilio, Christian de

doi:10.1016/j.avsg.2013.01.012

Cited by 15 publications

(11 citation statements)

References 11 publications

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“…Its etiology is poorly understood and may be multifactorial. Suggested mechanisms include repeated mechanical trauma upon the external iliac artery by a hypertrophied psoas muscle during hip flexion with subsequent arterial kinking [21] and vasospasm [22]. Arterial-brachial pressure indexes typically decrease following exercise [20].…”

Section: Methodsmentioning

confidence: 99%

“…Initial Imaging CTA Lower Extremity. CTA is uncommonly used in the diagnosis of EIAE and has not demonstrated diagnostic superiority to MRA combined with US [21]. CTA allows assessment of arterial kinking, arterial wall thickening, stenosis, and extent of involved arterial segment.…”

Section: Variant 2: Suspected External Iliac Arterymentioning

confidence: 99%

“…MRA is less sensitive than US for detecting intravascular lesions. MRA has proven useful in diagnosing EIAE when used in conjunction with US, a combination that was found to be superior or equal to CTA alone [21].…”

Section: Variant 2: Suspected External Iliac Arterymentioning

confidence: 99%

“…The ability to visualize changes in both flow dynamics and vessel caliber in real time has been paramount in diagnosing EIAE in endurance athletes [21,22]. Dynamic use of US duplex Doppler and segmental Doppler pressures in both hip flexion and extension can accurately depict flow disturbance [21], while its use pre-and postexercise may demonstrate associated exercise-induced vasospasm [20,22]. US duplex Doppler has been found to be superior to MRA in detecting intravascular lesions; however, its sensitivity may be limited in patients with only mildly symptomatic disease [21].…”

Section: Variant 2: Suspected External Iliac Arterymentioning

confidence: 99%

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ACR Appropriateness Criteria® Nonatherosclerotic Peripheral Arterial Disease

Imaging¹,

François

Skulborstad

et al. 2019

Journal of the American College of Radiology

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A broad range of nonatherosclerotic diseases affect the peripheral arteries. The appropriate initial diagnostic imaging studies vary, depending upon the clinical presentation and suspicion of disease. Accurate vascular imaging relies upon visualization of the vessel lumen, vessel wall, and surrounding soft-tissue structures, with some modalities also offering the ability to characterize blood flow direction and velocity. Furthermore, nonvascular findings are often paramount in supporting a suspected clinical syndrome or guiding surgical management. The scenarios discussed in this document include the initial evaluation of suspected popliteal entrapment syndrome, external iliac artery endofibrosis, lower-extremity inflammatory vasculitides, dissection or connective tissue disease, noninflammatory vascular disease, and vascular trauma.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.Disclaimer: The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.

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Section: Methodsmentioning

confidence: 99%

Section: Variant 2: Suspected External Iliac Arterymentioning

confidence: 99%

Section: Variant 2: Suspected External Iliac Arterymentioning

confidence: 99%

Section: Variant 2: Suspected External Iliac Arterymentioning

confidence: 99%

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ACR Appropriateness Criteria® Nonatherosclerotic Peripheral Arterial Disease

Imaging¹,

François

Skulborstad

et al. 2019

Journal of the American College of Radiology

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“…Potential extravascular factors include repetitive stretching of the iliac arteries due to hyperflexion of the hip joint, external compression by psoas muscle hypertrophy, and repeated kinking of the iliac artery during exercise because of its anatomic position relative to the hip joint. 53,54 In addition, high flow due to increased cardiac output can cause internal shear, leading to intravascular trauma. 53,54 The distribution of disease is frequently unilateral, with the left limb affected most often.…”

Section: Iliac Artery Endofibrosismentioning

confidence: 99%

Conditions Presenting with Symptoms of Peripheral Arterial Disease

Sharma

Norton

Zhu

2014

Semin intervent Radiol

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Peripheral artery disease (PAD) is estimated to affect more than 20% of people older than 65 years. The vast majority of patients with symptoms suggestive of PAD have atherosclerosis often associated with conventional vascular risk factors such as smoking, diabetes, dyslipidemia, and inflammation. A minority of people presenting with symptoms suggesting PAD have an alternative etiology. These groups of disorders are often underdiagnosed, and if diagnosed correctly the diagnosis may be delayed. Understanding these pathologies well is important, as they can be very debilitating and optimal treatment may vary significantly. Inappropriate treatment of these disorders can lead to worsening morbidity and mortality. This article discusses the underlying causes of nonatherosclerotic PAD, including the diagnosis and treatment of these disorders.

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