1
|
Okamoto Y, Funasaki H, Tanaka K, Ohki T, Saito M. Exertional Lower Extremity Pain in a Triathlete Caused by External Iliac Artery Endofibrosis: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00009. [PMID: 38608127 DOI: 10.2106/jbjs.cc.23.00685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
CASE This report describes a 25-year-old female professional triathlete with right external iliac artery endofibrosis (EIAE) that was definitively diagnosed on contrast-enhanced magnetic resonance images obtained immediately after treadmill running. The EIAE was treated by percutaneous transluminal angioplasty. By 8 weeks after surgery, she had no symptoms of claudication or pain in the right thigh after a 1-hour running session. There has been no recurrence in 1 year postoperatively. CONCLUSION EIAE is a rare condition and difficult to diagnose in a timely manner because symptoms and radiographic imaging features appear only during intense exercise. Our patient was successfully treated with percutaneous transluminal angioplasty.
Collapse
Affiliation(s)
- Yasufumi Okamoto
- Department of Sports and Wellness Clinic, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Funasaki
- Department of Sports and Wellness Clinic, The Jikei University School of Medicine, Tokyo, Japan
| | - Kota Tanaka
- Department of Sports and Wellness Clinic, The Jikei University School of Medicine, Tokyo, Japan
| | - Takao Ohki
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Sports and Wellness Clinic, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Regus S, Schoeffl I, Knetsch J, Schoeffl V, Haase K. [Iliac endofibrosis in high-performance sports: an interdisciplinary diagnostic challenge]. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2023; 37:171-181. [PMID: 38048810 DOI: 10.1055/a-2133-9702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
OBJECTIVES Iliac endofibrosis (IE) is a rare arterial disease in endurance athletes, especially cyclists and triathletes. The diagnosis is considered challenging and the latency from the onset of initial symptoms to diagnosis is often several years. Diagnostic options include determination of the ankle brachial index (ABI) after maximal exercise as a non-invasive procedure, as well as duplex sonography, CT or MRI angiography, and invasive angiography. The aim of this paper is to analyse in more detail this time lag to correct diagnosis from the first description in 1985 to the year 2021, as well as to identify the most important diagnostic tools for practice. MATERIALS AND METHODS Literature research according to PRISMA criteria in PubMed, Web of Science, Cochrane databases, supplemented by a search in Google Scholar up to 10/18/2021. RESULTS We identified a total of 133 publications that dealt thematically with IE in endurance athletes. In 42 publications (40 case reports and 2 clinical trials), the diagnosis was confirmed intraoperatively, and in 32 (32/42; 74.4%), statements were made about the duration from the onset of the first symptoms to the final diagnosis (mean 45, median 36 months). This latency was constant over the entire observation period from 1985 to 2021, with no trend toward shortening. Twenty-four papers (24/42; 56%) reported detailed results of ABI determination as well as further diagnostic testing. In all cases, the ABI value decreased to less than 0.66 (in 5 case reports, this decrease was measured at rest; in 19 case reports, it occurred after stress), whereas further diagnostic testing by duplex sonography, DSA, MRA, or CTA revealed no abnormal findings in 3 cases (3/24; 12.5%) and showed no more than minor stenosis in 14 cases (14/24; 58.3%). CONCLUSIONS A drop in ABI after exercise is the most reliable method to diagnose iliac endofibrosis. This non-invasive and easy-to-perform examination should be integrated into the performance diagnostics of highly ambitious endurance athletes at risk. This may ideally prevent irreversible vessel wall damage by early diagnosis as well as a reduction of the presumed high number of undetected cases.
Collapse
|
3
|
Fisher AT, Tran K, Dossabhoy SS, Sorondo S, Fereydooni A, Lee JT. Anatomic factors contributing to external iliac artery endofibrosis in high performance athletes. Ann Vasc Surg 2022; 87:181-187. [PMID: 35654289 DOI: 10.1016/j.avsg.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION External iliac artery endofibrosis (EIAE) classically presents in cyclists with intimal thickening of the affected arteries. We investigated possible anatomical predisposing factors including psoas muscle hypertrophy, arterial tortuosity, inguinal ligament compression, and arterial kinking via case-control comparison of symptomatic and contralateral limbs. METHODS All patients with unilateral EIAE treated surgically at our institution were reviewed. Each patient's symptomatic side was compared with their contralateral side using paired t-tests. Psoas hypertrophy was quantified by transverse cross-sectional area (CSA) at L4, L5, and S1 vertebral levels, and inguinal ligament compression was measured as anterior-posterior distance between inguinal ligament and underlying bone. Tortuosity index for diseased segments and arterial kinking were measured on TeraRecon. RESULTS Of 33 patients operated on for EIAE from 2004-2021, 27 with available imaging presented with unilateral disease, more commonly left-sided (63%). Most (96%) had external iliac involvement and 26% had ≥2 segments affected: 19% common iliac artery, 15% common femoral artery. The symptomatic limb had greater mean L5 psoas CSA (1450 mm2 vs. 1396 mm2, mean difference 54 mm2, P=0.039). There were no significant differences in L4 or S1 psoas hypertrophy, tortuosity, inguinal ligament compression, or arterial kinking. 63% underwent patch angioplasty and 85% underwent additional inguinal ligament release. 84% reported postoperative satisfaction, which was associated with greater difference in psoas hypertrophy at L4 (p=0.022). CONCLUSIONS Psoas muscle hypertrophy is most pronounced at L5 and is associated with symptomatic EIAE. Preferential hypertrophy of the affected side correlates with improved outcomes, suggesting psoas muscle hypertrophy as a marker of disease severity.
Collapse
Affiliation(s)
- Andrea T Fisher
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
| | - Kenneth Tran
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
| | - Shernaz S Dossabhoy
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
| | - Sabina Sorondo
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
| | - Arash Fereydooni
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
| | - Jason T Lee
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
| |
Collapse
|
4
|
Hatz HJ, Strissel NL, Bower TC, Macedo T. Exercise-induced iliac artery vasospasm. J Vasc Surg 2022; 75:1439. [PMID: 35314043 DOI: 10.1016/j.jvs.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 10/18/2022]
|
5
|
Martinez A, Wells BJ. Vascular Disease Patient Information Page: External iliac artery endofibrosis. Vasc Med 2022; 27:207-210. [PMID: 35168434 DOI: 10.1177/1358863x221076565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Bryan J Wells
- Emory University School of Medicine, Atlanta, GA, USA.,Department of Medicine, Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
6
|
Tran K, Dossabhoy SS, Sorondo S, Lee JT. Bicycle exercise ankle brachial index recovery time as a novel metric for evaluating the hemodynamic significance of external iliac endofibrosis in competitive cyclists. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:681-685. [PMID: 34746530 PMCID: PMC8556481 DOI: 10.1016/j.jvscit.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022]
Abstract
Subtle radiographic findings can increase the challenge of diagnosing external iliac artery endofibrosis. We evaluated a new metric, the bicycle exercise ankle brachial index recovery time (BART), in a cohort of cyclists with symptomatic external iliac artery endofibrosis. BART was defined as the time required in minutes for the ankle brachial index to return to 0.9 after a period of exercise. Surgical correction resulted in an improvement in BART postoperatively (4.5 ± 4.1 vs 9.1 ± 4.3 minutes; P < .001), with improved values correlating with better patient satisfaction. Documentation of the BARTs before and after surgical treatment provides an additional measure of postoperative hemodynamic improvement.
Collapse
Affiliation(s)
- Kenneth Tran
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif.,Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif
| | - Shernaz S Dossabhoy
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Sabina Sorondo
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif.,Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif
| |
Collapse
|
7
|
Francois CJ, Skulborstad EP, Kalva SP, Majdalany BS, Collins JD, Eldrup-Jorgensen J, Ferencik M, Ganguli S, Kendi AT, Khaja MS, Obara P, Ptak T, Reis SP, Sutphin PD, Dill KE. ACR Appropriateness Criteria ® Nonatherosclerotic Peripheral Arterial Disease. J Am Coll Radiol 2020; 16:S174-S183. [PMID: 31054743 DOI: 10.1016/j.jacr.2019.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
| | | | | | | | - Bill S Majdalany
- Panel Vice Chair, University of Michigan Health System, Ann Arbor, Michigan
| | | | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | | | | | | | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | - Thomas Ptak
- University of Maryland Medical Center, Baltimore, Maryland
| | | | | | - Karin E Dill
- Specialty Chair, UMass Memorial Medical Center, Worcester, Massachusetts
| |
Collapse
|
8
|
Abstract
A variety of nonatherosclerotic diseases affect the arteries of the pelvis and lower extremities. Chronic repetitive traumatic conditions, such as popliteal entrapment and external iliac artery fibroelastosis, vasculitis and connective tissue diseases, and noninflammatory vascular diseases, are a few of the more commonly encountered nonatherosclerotic peripheral vascular diseases. Ultrasound, computed tomography angiography, and magnetic resonance angiography are essential in the initial assessment and management of patients with peripheral vascular disease.
Collapse
Affiliation(s)
- Christopher J François
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA.
| |
Collapse
|
9
|
Lindo FA, Lee JT, Morta J, Ross E, Shub Y, Wilson C. Diagnosis and management of external iliac endofibrosis: A case report. JOURNAL OF VASCULAR NURSING 2019; 37:86-90. [PMID: 31155167 DOI: 10.1016/j.jvn.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
External iliac artery endofibrosis is an uncommon, nonatherosclerotic disease seen in endurance cyclists. It is poorly identified by providers. These otherwise healthy patients usually present with symptoms of arterial insufficiency, such as thigh or buttock pain, loss of power, or weakness occurring during strenuous exercises. These symptoms subside rapidly with rest. As these patients lack traditional risk factors of peripheral artery disease, their symptoms are often overlooked or are attributed to other etiologies, resulting in mismanagement and delayed treatment. In this case study, we report our experience with the successful management of a 48-year-old male who is a longstanding, avid cyclist. He self-referred to our institution after extensive research of providers familiar with his problem and at the recommendation of other cyclists with similar experiences. The patient underwent a successful left external iliac to common femoral artery endarterectomy and patch angioplasty. Three months after operation, he returned to cycling and, for the most part, has remained without symptoms.
Collapse
Affiliation(s)
- Fae A Lindo
- Stanford Health Care, Heart and Vascular Clinics, 300 Pasteur Dr. Boswell Bldg. A32, Stanford, CA 94305, USA.
| | - Jason T Lee
- Stanford Health Care, Heart and Vascular Clinics, 300 Pasteur Dr. Boswell Bldg. A32, Stanford, CA 94305, USA
| | - Jocelyn Morta
- Stanford Health Care, Heart and Vascular Clinics, 300 Pasteur Dr. Boswell Bldg. A32, Stanford, CA 94305, USA
| | - Elsie Ross
- Stanford Health Care, Heart and Vascular Clinics, 300 Pasteur Dr. Boswell Bldg. A32, Stanford, CA 94305, USA
| | - Yelena Shub
- Stanford Health Care, Heart and Vascular Clinics, 300 Pasteur Dr. Boswell Bldg. A32, Stanford, CA 94305, USA
| | - Christina Wilson
- Stanford Health Care, Heart and Vascular Clinics, 300 Pasteur Dr. Boswell Bldg. A32, Stanford, CA 94305, USA
| |
Collapse
|
10
|
Wuarin L, Verdon G, Pollorsi G, Huber C, Murith N, Mugnai D. External Iliac Artery Endofibrosis in a Female Cyclist: A Case Report. Ann Vasc Surg 2018; 55:310.e1-310.e4. [PMID: 30287298 DOI: 10.1016/j.avsg.2018.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/18/2018] [Accepted: 07/07/2018] [Indexed: 11/27/2022]
Abstract
External iliac artery endofibrosis is a rare disease described mainly in male endurance athletes. It presents as claudication of the lower limb during near-maximum effort. The patients lack the usual risk factors for atherosclerosis, which makes diagnosis challenging. We present a case of external iliac artery endofibrosis in a female competitive cyclist. The initial surgical management was complicated by early recurrence due to intimal hyperplasia. After secondary drug-eluting balloon angioplasty, the patient was able to resume competition. As such, it is important to maintain a high index of suspicion when evaluating a patient presenting with claudication symptoms in this setting. Primary treatment is surgical, and in cases of early recurrence angioplasty may be indicated. Most patients can return to full activity after healing is complete.
Collapse
Affiliation(s)
- Lydia Wuarin
- Département de Chirurgie, Service de Chirurgie Cardio-Vasculaire, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
| | - Gabriel Verdon
- Département de Chirurgie, Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Gaia Pollorsi
- Département de Chirurgie, Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Christoph Huber
- Département de Chirurgie, Service de Chirurgie Cardio-Vasculaire, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Nicolas Murith
- Département de Chirurgie, Service de Chirurgie Cardio-Vasculaire, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Damiano Mugnai
- Département de Chirurgie, Service de Chirurgie Cardio-Vasculaire, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| |
Collapse
|
11
|
Regus S, Almási-Sperling V, Janka R, Rother U, Lell M, Meyer A, Lang W. MRI to investigate iliac artery wall thickness in triathletes. PHYSICIAN SPORTSMED 2018. [PMID: 29522363 DOI: 10.1080/00913847.2018.1450060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Endofibrosis was first described in endurance athletes. This rare disease is characterized by intimal hyperplasia of iliac arteries. Due to non-specific symptoms diagnosing could be very challenging and delayed. This represents a serious problem not only for affected athletes but also for consulting physicians. The aim of this study was to analyze intimal thickness of iliac arteries using non-contrast magnetic resonance imaging (MRI) in competitive triathletes suffering from exercise induced leg pain consistent with symptoms caused by endofibrosis. METHODS 18 highly trained triathletes (16 triathletes, 12 male) with a mean age of 45.4 ± 10.2 years were investigated by non-contrast MRI. We divided subjects into two groups: 10 complaint about exercise- induced leg pain and 7 were free of any symptoms. In all 10 symptomatic athletes consulting physicians excluded musculoskeletal or neurological disorders before and we suspected endofibrosis. One patient was excluded from statistical analysis due to a known recurrent external iliac artery (EIA) occlusion after surgical repair 6 month ago. RESULTS Mean wall thickness (T) of all 17 subjects was 1.34 ± 0.11mm for the common iliac artery (CIA) and 1.74 ± 0.18mm for the EIA. We found no significant differences by comparing T of symptomatic (s) and asymptomatic (a) legs. There were no significant differences in mean ratio of patent artery to whole artery between the symptomatic and asymptomatic legs for the CIA (0.81 vs 0.82, p = 0.87) and for the EIA (0.71 vs 0.72, p = 0.78). MRI shows a thickening of the left EIA (4.41mm) in the patient who suffered from recurrent occlusion of the left EIA and after surgical repair and histological examination confirmed an endofibrotic lesion. CONCLUSION Non-contrast MRI seems to be an appropriate diagnostic tool to exclude endofibrosis in triathletes, but it cannot be recommended as initial screening modality for athletes suffering from exercise-induced leg pain.
Collapse
Affiliation(s)
- Susanne Regus
- a Department of Vascular Surgery , University Hospital , Erlangen , Germany
| | | | - Rolf Janka
- b Institute of Radiology , University Hospital , Erlangen , Germany
| | - Ulrich Rother
- a Department of Vascular Surgery , University Hospital , Erlangen , Germany
| | - Michael Lell
- b Institute of Radiology , University Hospital , Erlangen , Germany
| | - Alexander Meyer
- a Department of Vascular Surgery , University Hospital , Erlangen , Germany
| | - Werner Lang
- a Department of Vascular Surgery , University Hospital , Erlangen , Germany
| |
Collapse
|
12
|
A Rare Case of Intermittent Claudication Associated with Impaired Arterial Vasodilation. Case Rep Vasc Med 2018; 2017:4868123. [PMID: 29435381 PMCID: PMC5757101 DOI: 10.1155/2017/4868123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/14/2017] [Accepted: 11/29/2017] [Indexed: 11/18/2022] Open
Abstract
Exercise-related intermittent claudication is marked by reduced blood flow to extremities caused by either stenosis or impaired vascular function. Although intermittent claudication is common in the elderly, it rarely occurs in the young and middle-aged individuals. Here, we report a case of exercise-related claudication in a 41-year-old woman, in the absence of overt vascular pathology. Using a series of imaging and functional tests, we established that her complaints were due to impaired arterial vasodilation, possibly due to a defect in nitrous oxide-mediated dilation. The symptoms were reversible upon administration of a calcium antagonist, showing reversibility of the vascular impairment. Identification of reversible vascular “stiffness” merits consideration in young and otherwise healthy subjects with claudication of unknown origin.
Collapse
|
13
|
Peripheral Non-atherosclerotic Arterial Disorders: What Radiologists Need to Know. Acad Radiol 2017; 24:497-505. [PMID: 27940229 DOI: 10.1016/j.acra.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 12/24/2022]
Abstract
Peripheral non-atherosclerotic arterial disorders (NAADs) are a heterogeneous group of rather uncommon conditions that tend to manifest in subjects without atherosclerosis. Each of these conditions has distinctive pathophysiology; however, there are some common clinical and radiological characteristics and in some cases a common treatment approach that unifies these conditions to a specific group, hence the NAADs. Clinicians and radiologists often fail to recognize NAADs, and there might be a delay in the management of such patients; this may result in seriously adverse outcomes that could otherwise have been avoided or minimized. Knowledge of these conditions and of their radiological appearances is therefore important to help establish a correct diagnosis to allow the prompt initiation of treatment. The purpose of this pictorial review is to present a selection of NAADs cases and to discuss the radiological characteristics and the most common lines of therapeutic approaches.
Collapse
|
14
|
Abstract
A 33-year-old elite female runner presented to a tertiary care sports medicine clinic with a 2-year history of progressive anterior thigh and circumferential leg pain with associated foot paresthesias brought on by high-intensity running. She had both external iliac artery vasospasm and chronic exertional compartment syndrome. External iliac artery vasospasm is a rare cause of exertional leg pain, particularly in the running population. This case highlights the unique features of this condition, addresses the multidisciplinary approach that led to the accurate diagnoses, and demonstrates that more than 1 etiology for exertional leg pain can coexist in an athlete.
Collapse
Affiliation(s)
- Kristin L Garlanger
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Elena J Jelsing
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| |
Collapse
|
15
|
Hinchliffe R, D'Abate F, Abraham P, Alimi Y, Beard J, Bender M, Björck M, Edmundson C, Fernandez Garcia B, Cherry K, Álvarez Fernández L, Feugier P, Lee J, Palfreeman R, Passfield L, Peach G, Ricco JB, Rimpler H, Roake J, Rouviere O, Schep G, Spark I, Schumacher Y, Zierler R. Diagnosis and Management of Iliac Artery Endofibrosis: Results of a Delphi Consensus Study. Eur J Vasc Endovasc Surg 2016; 52:90-8. [DOI: 10.1016/j.ejvs.2016.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/06/2016] [Indexed: 11/25/2022]
|
16
|
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; 35:203.e11-5. [PMID: 27263822 DOI: 10.1016/j.avsg.2016.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 02/06/2016] [Accepted: 02/08/2016] [Indexed: 10/21/2022]
Abstract
External iliac artery endofibrosis is a rare medical condition typically encountered in young endurance athletes, mainly cyclists. Iliac endofibrosis usually develops in the external iliac artery and is rarely seen in the common iliac or in common femoral arteries. We describe a unique case of a patient who was not a professional or high-endurance cyclist. The lesions in our case appeared to be bilateral in the common iliac arteries and were not limited to the external iliac artery as most commonly described. We present an overview of the literature regarding this medical condition.
Collapse
Affiliation(s)
- Arie Franco
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA.
| | - David A Rigberg
- Department of Vascular Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Stefan G Ruehm
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
17
|
Apigian AK, Landry GJ. Basic data underlying decision making in nonatherosclerotic causes of intermittent claudication. Ann Vasc Surg 2014; 29:138-53. [PMID: 25277047 DOI: 10.1016/j.avsg.2014.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 01/13/2023]
Abstract
Although most cases of vasculogenic intermittent claudication are caused by atherosclerosis, there is an important minority of cases that are due to nonatherosclerotic causes. Because of their rarity and younger population affected, often without traditional atherosclerotic risk factors, there is frequently a significant delay in diagnosis of nonatherosclerotic peripheral arterial diseases by several months to years in some cases. Here, we review the literature on nonatherosclerotic causes of lower extremity claudication, symptoms, management including surgical and endovascular interventions, and outcomes. Conditions included are popliteal artery entrapment syndrome, cystic adventitial disease, pseudoxanthoma elasticum, persistent sciatic artery, fibromuscular disease, giant cell arteritis, iliac endofibrosis, neurogenic claudication, and chronic exertional compartment syndrome.
Collapse
Affiliation(s)
- Aimie K Apigian
- Knight Cardiovascular Institute, Oregon Health & Science University, Sam Jackson Park Road, Portland, OR
| | - Gregory J Landry
- Knight Cardiovascular Institute, Oregon Health & Science University, Sam Jackson Park Road, Portland, OR.
| |
Collapse
|
18
|
Abstract
MR angiography is a powerful tool in evaluating anatomy and pathology when applied to the male pelvis. MR angiography produces high-quality images of the arterial system approaching the resolution of CT angiography, without ionizing radiation. Additional advantages include the ability to obtain angiographic images in the absence of contrast material with non-contrast-enhanced MR angiographic techniques. Blood pool contrast agents, such as gadofosveset, have significantly improved the quality of venous system imaging. Steady state imaging with blood pool contrast agents allows for acquisition of superior-quality high-resolution images and other time-intensive techniques.
Collapse
Affiliation(s)
- Patrick D Sutphin
- Division of Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8834, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8834, USA.
| |
Collapse
|