The aim of this article is to report our experience in the diagnosis of two cases of iliac artery endofibrosis or arteriopathy, a rare entity occurring in high-performance athletes, presenting with intermittent claudication (right-sided in both) after maximal exercise. External iliac artery endofibrosis or arteriopathy is a likely diagnosis in competitive athletes free of cardiovascular risk factors who present with leg claudication. Arteriography and a papaverine-assisted mean pressure gradient across the iliac arteries of more than 10 mmHg is a useful diagnostic approach. Moreover, balloon angioplasty of the iliac artery in that patient, in whom a pressure gradient was detected, resulted in symptomatic relief for 2 months followed by mild symptom recurrence. Thus, although balloon angioplasty is feasible and safe, it might not be adequate to treat this entity and, thus, its value remains undefined.
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A 2-year endovascular fellowship of V. Berczi was made possible by Cordis, Johnson and Johnson, UK.
Ford SJ, Rehman A, Bradbury AW (2003) External iliac endofibrosis in endurance athletes: a novel case in an endurance runner and a review of the literature. Eur J Vasc Endovasc Surg 26:629–634CrossRefPubMedGoogle Scholar
Arko FR, Harris EJ, Zarins CK, et al. (2001) Vascular complications in high-performance athletes. J Vasc Surg 33:935–942CrossRefPubMedGoogle Scholar
Schep G, Bender MH, van de Tempel G, et al. (2002) Detection and treatment of claudication due to functional iliac obstruction in top endurance athletes: a prospective study. Lancet 359(9305):466–473CrossRefPubMedGoogle Scholar
Chevalier JM, Enon B, Walder J, et al. (1986) Endofibrosis of the external iliac artery in bicycle racers: an unrecognised pathological state. Ann Vasc Surg 1:297–303CrossRefPubMedGoogle Scholar
Mosimann R, Walder J, van Melle G (1985) Stenotic intimal thickening of the external iliac artery: illness of the competition cyclists? J Vasc Surg 19:258–263CrossRefGoogle Scholar
Shep G, Bender MH, Kaandorp D, et al. (1999) Flow limitations in the iliac arteries in endurance athletes. Current knowledge and directions for the future. Int J Sports Med 20:421–428CrossRefGoogle Scholar
Cook PS, Erdoes LS, Selzer PM, et al. (1995) Dissection of the external iliac artery in highly trained athletes. J Vasc Surg 22:173–177CrossRefPubMedGoogle Scholar
Kral CA, Han DC, Edwards WD, et al. (2002) Obstructive external iliac arteriopathy in avid bicyclists: newand variable histopathologic features in four women. J Vasc Surg 36:565–570CrossRefPubMedGoogle Scholar
Wright IA, Pugh ND, GoodfellowJ, et al. (1997) Dynamic obstruction of the external iliac artery in endurance athletes and its relationship to endothelial function: the case of a long distance runner. Br J Sports Med 31:156–158CrossRefPubMedPubMedCentralGoogle Scholar
Lopez J-F, Magne J-L, Champetier J (1989) The femoral artery and flexion of the hip joint. Surg Radiol Anat 11:275–283CrossRefPubMedGoogle Scholar
Wille J, de Jong JR, Moll F, et al. (1998) Endofibrosis of the external iliac artery in sportsmen: clinical reviewand four newcases. Vasc Surg 32:323–328CrossRefGoogle Scholar
Rousselet MC, Saint Andre JP, L’Hoste PH, et al. (1990) Stenotic intimal thickening of the external iliac artery in competitive cyclists. Hum Pathol 21:524–529CrossRefPubMedGoogle Scholar
Abraham R, Bickert S, Vielle B, et al. (2001) Pressure measurements at rest and after heavy exercise to detect moderate arterial lesions in athletes. J Vasc Surg 33:721–727CrossRefPubMedGoogle Scholar
Schep G, Bender MH, Schmikli SL, et al. (2001) Color Doppler used to detect kinking and intravascular lesions in the iliac arteries in endurance athletes with claudication. Eur J Ultrasound 14:129–140CrossRefPubMedGoogle Scholar
Alimi YS, Accrocca F, Barthelemy P, et al. (2004) Comparison between duplex scanning and angiographic findings in the evaluation of functional iliac obstruction in top endurance athletes. Eur J Vasc Endovasc Surg 28:513–519CrossRefPubMedGoogle Scholar
Gattoni F, Sacrini A, Tonolini M, et al. (1998) Digital rotational angiography in the study of vascular diseases: technical note and initial clinical applications. Radiol Med (Torino) 96:570–573Google Scholar
Lomis NNT, Miller FJ, Whiting JH, et al. (2000) Exercise-induced external iliac artery intimal fibrosis: cionfirmation with intravascular ultrasound. J Vasc Intervet Radiol 11:51–53CrossRefGoogle Scholar
Chevalier JM (1997) Pathologie vasculaire du cyclists. Encycl Med-Chirurg A10:11–675Google Scholar
Gallo D, Soury P, Pilsonnier D, et al. (1996) Aneurism dissecant de l’arterie iliaque externe, une evolution inhabituelle de l’endofibrosie du sportif. J Mal Vasc 21:95–97PubMedGoogle Scholar