External Iliac Artery Endofibrosis in Cyclists and Other Endurance Athletes: An Underrecognized Cause of Exercise - Induced Limb Ischemia - A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.77.75967Keywords
iliac artery endofibrosis, cycling, Remove cyclingendurance athlete, exercise-induced ischemia, ankle-brachial index, duplex ultrasonography, return to sportAbstract
External iliac artery endofibrosis (EIAE) is a non-atherosclerotic cause of exercise-induced limb ischemia, reported mainly in cyclists and other endurance athletes. Resting pulses and ankle-brachial index are often normal, which can delay diagnosis. EIAE is linked to repeated hip flexion, high-flow shear stress, arterial fixation, and elongation or kinking. Athletes usually report reproducible unilateral loss of power, thigh or buttock discomfort, cramping, or paresthesia at high workloads. Assessment should reproduce symptoms and combine immediate post-exercise pressures with dynamic duplex ultrasonography; CTA or MRA defines anatomy. Activity and bike-fit changes may help mild cases. In selected athletes, endarterectomy with autologous patching or correction of kinking has the most consistent outcome data, whereas evidence for stenting remains limited. EIAE should be considered in endurance athletes with repeatable unilateral leg failure despite normal resting findings. Sport-specific exercise testing is central to timely diagnosis and appropriate treatment.
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Copyright (c) 2026 Joanna Brzoza, Monika Chlipała, Łukasz Dylewicz, Kinga Bylica, Jakub Rudzki, Wojciech Warmuz, Jakub Szczygieł, Kacper Solarz, Natalia Czołpińska, Zuzanna Kata
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