Diagnosis In A Competitive Cyclist: An Uphill Battle

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Diagnosis In A Competitive Cyclist: An Uphill Battle - Page #4

Working Diagnosis: Right external iliac artery endofibrosis Treatment: Right common iliac to femoral bypass grafting. Outcome: One week postoperatively, patient was able to walk normally without any symptoms in her right leg that she initially presented with and was so limited by. She was cleared by vascular surgery to return to cycling at 8 weeks postoperatively. Author's Comments: This patient had a relatively quick onset of unilateral leg symptoms following a period of intense training. Her constellation of symptoms was reasonably explainable by lumbosacral radiculopathy (specifically of S1) which led to a delay in diagnosis of 6 months after her initial visit. External Iliac Artery Endofibrosis is a very rare pathology, but usually involves competitive cyclists when it does occur, and is thought to be a result of repetitive hyperflexion the hip. The patient has engaged heavily with the cycling community since her diagnosis and treatment and has found 3 other cyclists who also had the condition and were similarly misdiagnosed for months, and even years. Editor's Comments: This case is a great reminder for a clinical entity we shouldn't forget to consider, external iliac artery endofibrosis. The key findings in this case include the patient's history of claudication, her sport (cycling), as well as her symptoms which she feels both above and below the knee, which distinguishes this entity from other exertional causes of leg pain such as chronic exertional compartment syndrome or popliteal artery entrapment. References: Abraham P, Saumet JL, Chevalier JM. External iliac artery endofibrosis in athletes. Sports Med. 1997 Oct;24(4):221-6. doi: 10.2165/00007256-199724040-00001. PMID: 9339491. Franco A, Rigberg DA, Ruehm SG. Bilateral Common Iliac Artery Endofibrosis in a Recreational Cyclist: Case Report and Review of the Literature. Ann Vasc Surg. 2016 Aug;35:203.e11-5. doi: 10.1016/j.avsg.2016.02.016. Epub 2016 Jun 3. PMID: 27263822. Return To The Case Studies List.		Back
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