External Iliac Artery Endofibrosis in Cyclists

Christopher Carcia

doi:10.28985/1526.jsc.03

Authors

Christopher Carcia Colorado Mesa University, Physical Therapy, Grand Junction, CO, USA

DOI:

https://doi.org/10.28985/1526.jsc.03%20

Keywords:

Bicycling, Claudication, Cyclist, Endofibrosis, Endurance Exercise, External Iliac Artery

Abstract

An underrecognized clinical condition that may afflict high level cyclists is external iliac artery endofibrosis (EIAE). EIAE is an intermittent claudication vascular condition that results from intimal narrowing most often of the external iliac artery (EIA). Symptoms are reported as thigh pain and loss of power that occur during high intensity efforts. EIAE is theorized to be a result of the mechanical and hemodynamic stress within the EIA heightened by psoas muscle hypertrophy in conjunction with the repetitive and extreme hip flexion coupled with high cardiac output. A combination of clinical tests (e.g. ankle-brachial index) in concert with imaging and vascular studies (e.g. duplex ultrasound) is necessary to arrive at an accurate diagnosis. The mean time from symptom onset to diagnosis is 3 years. Conservative interventions, which consist of bike hardware adjustments and/or posture modifications while riding, are generally not acceptable for a competitive cyclist. Surgical interventions take the form of percutaneous/endoscopic (e.g. balloon angioplasty, stent insertion) or open procedures (e.g. arterial release, endarterectomy, artery reconstruction) to restore arterial flow. Long-term outcomes following percutaneous procedures have followed a finite number of patients to date and are not recommended as a primary intervention for EIAE. Outcomes following open surgical procedures are strong with most riders being able to return to preinjury levels of competition. Greater awareness of EIAE among the scientific and medical community who work with cyclists is needed to improve the efficiency and overall management of EIAE.

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