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Tresson P, Hublet A, Holdner A, Bordet M, Millon A, Papillard M, Rouviere O. Common Femoral Artery Curvature During Hip Flexion. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03479-x. [PMID: 37311843 DOI: 10.1007/s00270-023-03479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/24/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE To assess the conformational changes of the common femoral artery (CFA) during hip joint flexion in patients without atherosclerosis. METHODS Patients who underwent digital subtraction angiography for suspicion of arterial endofibrosis between 2007 and 2011 were retrospectively searched. Angiographic images were analyzed by two independent readers. The CFA was divided into four segments of equal length, and the segment containing the folding point was noted. Segments 1 and 2 were located in the proximal half of the CFA and segments 3 and 4 in the distal half. Readers assessed the CFA angulation, located the arterial folding point, and classified the CFA curvature as harmonious, or as a moderate or severe plication. RESULTS Forty patients were included. The Lin concordance correlation coefficients, used to evaluate inter-observer variability, were 0.90 (95% CI [0.83; 0.96]), 0.96 (95% CI [0.93; 0.98]) and 0.96 (95% CI [0.94; 0.98]) for the measures of the CFA angle during flexion, of the length between the superficial circumflex iliac artery and the folding point, and of the length between the folding point and the femoral bifurcation, respectively. The CFA curvature was described as harmonious in 12 patients, moderate plication in 14 patients, and severe plication in 14 patients. The CFA folding point was located on segment 1, 2 and 3 in 6, 26 and 8 patients, respectively; no folding point was located on segment 4. CONCLUSION In these patients with non-atheromatous disease, hip flexion yielded most frequently a harmonious curvature or a moderate plication of the CFA.
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Affiliation(s)
- Philippe Tresson
- Department of Vascular and Endovascular Surgery, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Bron Cedex, France.
| | - Alexandre Hublet
- Department of Vascular and Endovascular Surgery, Centre Hospitalier InterRegional Edith Cavell CHIREC, Hopital Delta, Brussels, Belgium
| | - Alexandre Holdner
- Service de Biostatistique et Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003, Lyon, France
- Université Claude Bernard Lyon 1 (Univ Lyon), 69621, Villeurbanne, France
| | - Marine Bordet
- Department of Vascular and Endovascular Surgery, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Bron Cedex, France
- Service de Biostatistique et Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003, Lyon, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Bron Cedex, France
- Université Claude Bernard Lyon 1 (Univ Lyon), 69621, Villeurbanne, France
| | - Matthieu Papillard
- Department of Urinary and Vascular Radiology and Department of Vascular Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003, Lyon, France
| | - Olivier Rouviere
- Université Claude Bernard Lyon 1 (Univ Lyon), 69621, Villeurbanne, France
- Department of Urinary and Vascular Radiology and Department of Vascular Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003, Lyon, France
- LabTau, Inserm, U1032, Lyon, France
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Thaker S, Rowbotham E, Banerjee A, Robinson P. Dorsalis pedis artery thrombosis in an elite rugby player: an unusual cause of pedal claudication in a high-risk ankle. Skeletal Radiol 2022; 51:2059-2063. [PMID: 35254494 DOI: 10.1007/s00256-022-04025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/13/2022] [Accepted: 02/27/2022] [Indexed: 02/02/2023]
Abstract
Vascular thrombosis in young elite athletes is uncommon, usually affecting calf veins and arteries beyond the knee joint. Arterial thrombosis, especially in the dorsalis pedis artery, is very rare without premature atherosclerosis or trauma. Its clinical presentation with progressive claudication of insidious onset is nonspecific and overlaps with the symptoms of deep peroneal nerve compression as a part of anterior ankle impingement, a more common entity in athletes. Ultrasound can evaluate pedal claudication in athletes differentiating vascular and neural causes expediting diagnosis, management and, in turn, return to play. Furthermore, imaging-Doppler ultrasound and MR angiography in particular-plays a vital role in the evaluation of potential aetiology and evolution (i.e., collateral development and recanalization) of the occluded vessel. We present a case of dorsalis pedis artery thrombosis with both MRI and ultrasound findings in a professional rugby player who had no systemic comorbidity, but numerous previous surgical interventions around the ankle joint in both the remote and recent past, putting the adjacent DPA at increased risk for developing thrombosis. In this high-risk ankle, the dorsalis pedis thrombosis may be iatrogenic or due to sports-related, arterial wall injury with superimposed thrombosis.
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Affiliation(s)
- Siddharth Thaker
- Radiology Department, Chapel Allerton Hospital, Leeds, LS7 4SA, UK
| | - Emma Rowbotham
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - Philip Robinson
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Verma M, Pandey NN, Kumar S. External iliac artery Endofibrosis in a professional cyclist. Indian J Thorac Cardiovasc Surg 2022; 38:556-558. [PMID: 36050975 PMCID: PMC9424394 DOI: 10.1007/s12055-022-01349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
We present a case of a 30-year-old female professional cyclist who presented with right thigh claudication while performing high-intensity efforts. Based on the typical clinical history and the presence of a smooth long segment diffuse narrowing in the right external iliac artery on non-contrast magnetic resonance angiography, a diagnosis of external iliac artery endofibrosis or "cyclist's iliac syndrome" was made. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-022-01349-8.
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Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029 India
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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.
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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
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5
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Cyclist Endofibrosis (Exercise-Induced Arterial Endofibrosis) Treated by Drug-Coated Balloon Angioplasty. Case Rep Vasc Med 2020; 2020:4290271. [PMID: 32724699 PMCID: PMC7366215 DOI: 10.1155/2020/4290271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 06/24/2020] [Indexed: 11/17/2022] Open
Abstract
Exercise-induced arterial endofibrosis is an uncommon entity that is most frequently identified in high-performance athletes, especially cyclists. We present this disease in a male professional cyclist of 22 years of age. The course of his condition, clinical manifestations, modalities of investigation, and a nonprecedent treatment plan are demonstrated.
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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.
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Affiliation(s)
- Christopher J François
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA.
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Perrier L, Feugier P, Goutain-Majorel C, Girouin N, Boutier R, Papillard M, Bedel M, Rabilloud M, Rouvière O. Arterial endofibrosis in endurance athletes: Prospective comparison of the diagnostic accuracy of intra-arterial digital subtraction angiography and computed tomography angiography. Diagn Interv Imaging 2020; 101:463-471. [PMID: 32245721 DOI: 10.1016/j.diii.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To prospectively compare the diagnostic capabilities of computed tomography angiography (CTA) to those of digital subtraction angiography (DSA) in endurance athletes with suspicion of arterial endofibrosis. MATERIALS AND METHODS Forty-five athletes (39 men, 6 women; median age: 30 years, interquartile range: 23-42 years) prospectively underwent DSA and CTA without (n=5) or with (n=40) electrocardiogram gating. DSA was interpreted by a single expert (experience of 15 years). CTA was independently interpreted by three other readers (experience of 5-8 years). Readers assessed the presence and degree of stenoses on iliac and femoral arteries and the overall diagnosis (negative, uncertain, positive) of endofibrosis at the limb level. Sensitivities and specificities of DSA and CTA were estimated at the limb level using histological findings and long-term follow-up as reference, and compared using the McNemar test. RESULTS For diagnosing and quantifying stenoses, concordance between DSA and CTA was moderate-to-good for common and external iliac arteries, moderate for lateral circumflex arteries and poor-to-moderate for the other branches of the deep femoral artery. It was good for all readers for the overall diagnosis of endofibrosis. After long-term follow-up (median, 95 months; interquartile range: 7-109 months), DSA sensitivity and specificity were respectively 88.6% (39/44; 95% confidence interval [CI]: 76-95%) and 75% (24/32; 95% CI: 57.9-86.7%); CTA sensitivity and specificity were respectively 88.6% (39/44; 95% CI: 76-95%; P>0.99) and 84.4% (27/32; 95% CI: 68.2-93.1%; P=0.51), 86.3% (38/44; 95% CI: 73.3-93.6%; P>0.99) and 75% (24/32; 95% CI: 57.9-86.7%; P>0.99), and 84.1% (37/44; 95% CI: 70.6-92.1%; P=0.68) and 75% (24/32; 95% CI: 57.9-86.7%; P>0.99) for the three readers. CONCLUSION CTA shows performances similar to those of DSA in predicting the long-term diagnosis of endofibrosis in endurance athletes with suggestive symptoms.
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Affiliation(s)
- L Perrier
- Service de radiologie urinaire et vasculaire, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Pavillon B, 5, place d'Arsonval, 69437 Lyon cedex 03, France; Faculté de médecine Lyon Est, Université de Lyon, Université Lyon 1, 69003 Lyon, France
| | - P Feugier
- Service de chirurgie vasculaire, Centre hospitalier Lyon Sud, Hospices civils de Lyon, 69495 Pierre-Bénite, France
| | - C Goutain-Majorel
- Service de physique médicale et radioprotection, centre hospitalier Lyon Sud, Hospices civils de Lyon, 69495 Pierre-Bénite, France
| | - N Girouin
- Norimagerie, 69300 Caluire et Cuire, France
| | - R Boutier
- Norimagerie, 69300 Caluire et Cuire, France
| | - M Papillard
- Service de radiologie, Centre hospitalier de Mâcon, 71018 Mâcon, France
| | - M Bedel
- Service de biostatistique-bioinformatique, Pôle santé publique, Hospices Civils de Lyon, 69003 Lyon, France
| | - M Rabilloud
- Faculté de médecine Lyon Est, Université de Lyon, Université Lyon 1, 69003 Lyon, France; Service de biostatistique-bioinformatique, Pôle santé publique, Hospices Civils de Lyon, 69003 Lyon, France; CNRS, UMR 5558, équipe biostatistiques santé, laboratoire de biométrie et biologie évolutive, 69100 Villeurbanne, France
| | - O Rouvière
- Service de radiologie urinaire et vasculaire, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Pavillon B, 5, place d'Arsonval, 69437 Lyon cedex 03, France; Faculté de médecine Lyon Est, Université de Lyon, Université Lyon 1, 69003 Lyon, France.
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8
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Henrard C, Belge H, Fastré S, Di Monaco S, Revencu N, Hammer F, Pasquet A, Persu A. Cervical artery dissection: fibromuscular dysplasia versus vascular Ehlers-Danlos syndrome. Blood Press 2019; 28:139-143. [PMID: 30623691 DOI: 10.1080/08037051.2018.1557507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the case of a 42-year-old patient referred for suspicion of fibromuscular dysplasia in the context of a carotid artery dissection occurring after a minor trauma. Initial complaints included left hemicrania, lateral diplopia with left 6th cranial nerve palsy and pulsatile tinnitus. The work-up disclosed a large left carotid-cavernous fistula, as well as more proximal carotid lesions compatible with multifocal fibromuscular dysplasia. Personal history included colonic and uterine perforation. Family history disclosed a fatal hemorrhage due to rupture of a splenic artery aneurysm in the father and an iliac dissection in the sister. Genetic screening revealed a mutation in exon 6 of the COL3A1 gene in the index patient and her sister, confirming the diagnosis of vascular Ehlers-Danlos syndrome (vEDS). This case report shows that images suggestive of fibromuscular dysplasia may be found in patients with demonstrated vEDS. Furthermore, it reminds that in case of cervical artery dissection occurring in a young patient, all efforts should be made to diagnose the underlying condition. In particular, the existence of a family history of arterial dissection, the occurrence of a carotid-cavernous fistula and coexistence with other complications suggestive of a connective tissue disease should prompt physicians to consider the diagnosis of vEDS.
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Affiliation(s)
- Caroline Henrard
- a Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Hendrica Belge
- b The Institute of Pathology and Genetics, Clinical Genetics , Gosselies , Belgium
| | - Sophie Fastré
- c Division of Neurology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Silvia Di Monaco
- a Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.,d Department of Medical Sciences, Internal Medicine and Hypertension Division , AOU Città della Salute e della Scienza, University of Turin , Turin , Italy
| | - Nicole Revencu
- e Center for Human Genetics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Frank Hammer
- f Department of Radiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Agnès Pasquet
- a Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.,g Pole of Cardiovascular Research , Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain , Brussels , Belgium
| | - Alexandre Persu
- a Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.,g Pole of Cardiovascular Research , Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain , Brussels , Belgium
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9
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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.
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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
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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.
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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
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Peake LK, D'Abate F, Farrah J, Morgan M, Hinchliffe RJ. The Investigation and Management of Iliac Artery Endofibrosis: Lessons Learned from a Case Series. Eur J Vasc Endovasc Surg 2018; 55:577-583. [PMID: 29548540 DOI: 10.1016/j.ejvs.2018.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/20/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE/BACKGROUND The objective was to summarise the lessons learned, and evolution in local practice over the last 7 years, in the investigation and surgical management of iliac artery endofibrosis. METHODS This was a retrospective case series. A case note review of consecutive patients investigated for suspected iliac artery endofibrosis by a single surgeon, over a 7 year period, was undertaken. Included were cases of first presentation and those who had previously undergone intervention. RESULTS Some 63 patients were referred with suspected endofibrosis in the period 2011-17, four of whom had previously undergone surgery for the condition. After investigation of both limbs, 50 symptomatic limbs in 46 patients had a confirmed diagnosis; amongst those 46 patients, iliac artery endofibrosis was found in a further six asymptomatic, contralateral limbs. Individuals were diagnosed at a median age of 36 years (range 18-52 years) and typically presented with thigh claudication, foot numbness, and limb weakness on exercise. The median delay to diagnosis was 3 years (range 0-14 years). Complete external iliac artery occlusion was a feature in three cases. Overall, 27 limbs in 25 patients underwent operative repair; a further five limbs in four patients underwent operative repair at other centres internationally. There were three post-operative superficial wound infections (11%) and one below knee deep vein thrombosis (4%). Symptoms resolved in 23 cases (85%) with a median follow up of 2.1 years (range 65 days-5.7 years). Of the four limbs developing recurrent symptoms, two had undergone surgery for an occluded external iliac artery. CONCLUSION Surgical repair in the medium term appears effective in resolving symptoms in most patients. Further investigation is needed to establish the durability of surgery and to delineate the natural history of the disease.
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Affiliation(s)
- Lewis K Peake
- Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Fabrizio D'Abate
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - John Farrah
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Robert J Hinchliffe
- Centre for Surgical Research, University of Bristol, Bristol, UK; North Bristol NHS Trust, Bristol, UK.
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12
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DeCarlo CS, Spangler EL, Stableford JA. A Case of Endofibrosis Presenting with Embolic Symptoms in a 43-Year-Old Cyclist. Ann Vasc Surg 2016; 36:292.e5-292.e8. [PMID: 27423721 DOI: 10.1016/j.avsg.2016.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/26/2016] [Accepted: 03/11/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endofibrosis is a rare clinical entity that usually manifests as claudication in cyclists and other endurance athletes. We report a case of a 43-year-old cyclist presenting with pain and cyanosis of his toes due to an embolism to his left anterior tibial artery. The source of the embolus was found to be an ulcerated, endofibrotic plaque in his left common femoral artery. METHODS We performed an extensive literature search using the PubMed database and identified 60 results on endofibrosis. Eight articles described thrombosis relating to endofibrosis. None of the articles described an embolic phenomenon relating to endofibrosis. The following search terms were used: endofibrosis, embolic, emboli, embolism, "distal occlusion," cyanosis, thrombosis, and thrombus. RESULTS The patient is a 43-year-old male cyclist who presented with pain and cyanosis of his second and third toes on his left foot for 1 week. The affected toes had a dark-purple discoloration involving the tissue overlying the distal phalanges. Computed tomography angiography showed an abrupt occlusion of the left anterior tibial artery in the mid-calf with a non-calcified plaque in the left common femoral artery. There were no other signs of arterial disease. He underwent left common femoral endofibrosectomy with patch angioplasty that revealed an ulcerated endofibrotic plaque with mural thrombus. CONCLUSIONS This case demonstrates an unusual presentation of a rare clinical entity. While there have been previous reports of thrombosis associated with endofibrosis, to our knowledge this is the first reported case of endofibrosis presenting with embolic symptoms.
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Affiliation(s)
- Charles S DeCarlo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
| | - Emily L Spangler
- Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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13
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D'Abate F, Paraskevas KI, Oates C, Palfreeman R, Hinchliffe RJ. Color Doppler Ultrasound Imaging in the Assessment of Iliac Endofibrosis. Angiology 2016; 68:225-232. [PMID: 27178720 DOI: 10.1177/0003319716649113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endofibrosis (EF) of the iliac arteries is a flow-limiting condition typically seen in highly trained endurance athletes. Thirty-seven athletes (74 limbs) were referred to our department with suspected EF. All patients had a pre- and postexercise color Doppler ultrasound (CDU) of the iliac arteries. Doppler waveform and peak systolic velocity (PSV) and end-diastolic velocity (EDV) were assessed pre- and postexercise. Endofibrosis was diagnosed with CDU in 24 athletes (29 limbs). Arterial wall and course abnormalities were detected at rest in 20 (67%) symptomatic limbs of athletes with and 4 (22%) symptomatic limbs of athletes without EF. Postexercise abnormal waveforms of the stenotic/damped type were seen in the iliac arteries in all 29 limbs of athletes diagnosed with EF. These waveform changes were accompanied by high PSV (>350 cm/s) and EDV (>150 cm/s), with (n = 10; 34%) or without (n = 19; 66%) the evidence of reduced arterial lumen caliber. Color Doppler ultrasound can be used to detect EF.
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Affiliation(s)
- Fabrizio D'Abate
- 1 St George's Vascular Institute, St George's Healthcare NHS Trust, London, United Kingdom
| | - Kosmas I Paraskevas
- 2 Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Crispian Oates
- 3 Department of Medical Physics, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Roger Palfreeman
- 1 St George's Vascular Institute, St George's Healthcare NHS Trust, London, United Kingdom
| | - Robert J Hinchliffe
- 1 St George's Vascular Institute, St George's Healthcare NHS Trust, London, United Kingdom
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14
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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]
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15
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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.
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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
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16
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Regus S, Söder S, Lang W. Dissecting aneurysm of common iliac artery in a long-distance runner. J Vasc Surg Cases 2016; 2:4-6. [PMID: 31724633 PMCID: PMC6849994 DOI: 10.1016/j.jvsc.2015.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/20/2015] [Indexed: 11/28/2022] Open
Abstract
We present an unusual case of a long-distance runner suffering from acute dissection of a common iliac artery (CIA) aneurysm with endofibrotic lesions. He suffered from acute pelvic and abdominal pain after exercise. Computed tomography angiography confirmed the dissecting aneurysm of the left CIA without signs of rupture. After cutdown, resection of the CIA and iliac bifurcation as well as bypass grafting was performed. Histologic examination confirmed endofibrotic lesions without calcifications. Complicated iliac artery aneurysm could be the result of endofibrotic lesions. Clinicians should keep this in mind, even if physical examination findings and the ankle-brachial index are normal at rest and after exercise.
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Affiliation(s)
- Susanne Regus
- Department of Vascular Surgery, University Hospital, Erlangen, Germany
| | - Stephan Söder
- Department of Pathology, University Hospital, Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital, Erlangen, Germany
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