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Sharifi M, Snyder R, Sharifi I, White E. Long-term outcome of percutaneous endovascular stenting in external iliac artery endofibrosis. Vasc Med 2024; 29:256-264. [PMID: 38469820 DOI: 10.1177/1358863x241227476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND External iliac artery endofibrosis (EIAE) is a rare vascular disease which has been traditionally seen in avid cyclists. The conventional approach has been surgery, although no high-quality evidence suggests superiority of surgery over percutaneous endovascular intervention. There are limited data on the efficacy of stenting in EIAE. METHODS Over a 14-year period, we treated 10 patients (13 limbs) with EIAE with stents. These patients had declined surgery. The mean follow up was 8.4 ± 3.3 years. There were eight women. Five patients were competitive runners, three were cyclists, and two were triathletes. The mean age was 40.7 ± 2.9 years and body mass index was 19.46 ± 1.6. Intravascular ultrasound (IVUS) was used in eight limbs. RESULTS Procedural success was achieved in all. The recurrence of symptoms occurred in three patients at a mean of 9.3 ± 2.1 months postindex intervention. The other seven patients remained symptom free. IVUS revealed a pathognomonic finding which we termed 'perfect circle appearance'. It results from symmetric or asymmetric hypertrophy of one or more layers of the arterial wall leading to negative remodeling, which creates a distinct echo dense structure contrasting itself from the luminal blood's echoluscent appearance. It is identical to IVUS images of diffuse venous stenosis with important implications in the treatment technique. CONCLUSIONS We conclude that stenting in EIAE is safe and effective with a good long-term outcome. It can be an alternative to surgery, particularly in those patients who refuse a surgical approach. The IVUS image is pathognomonic and 'sine qua non' of EIAE.
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Affiliation(s)
- Mohsen Sharifi
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA
- School of Osteopathic Medicine, A.T. Still University, Mesa, AZ, USA
| | - Robert Snyder
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA
| | - Iman Sharifi
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA
| | - Emily White
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA
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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.
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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.
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3
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Stone JR. Diseases of small and medium-sized blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Cai TY, Rajendran S, Robinson D. Functional magnetic resonance angiography in the diagnosis of iliac artery endofibrosis in an endurance runner. BMJ Case Rep 2019; 12:12/11/e232112. [PMID: 31780606 DOI: 10.1136/bcr-2019-232112] [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: 11/04/2022] Open
Abstract
A 45-year-old woman was presented with a 2-year history of left lower limb claudication symptoms occurring only during long-distance running. Multimodal imaging with exercise duplex ultrasonography and magnetic resonance angiogram confirmed the presence of flow-limiting stenoses in the left external iliac artery consistent with a diagnosis of left external iliac artery endofibrosis. She successfully underwent a left external iliac endarterectomy with vein patch repair and returned to full physical activity soon after. A year following full recovery from her original operation, she presented with similar symptoms on the right side and was managed in a similar manner. This report illustrates an unusual case of bilateral iliac artery endofibrosis occurring in an older endurance runner. We also present a novel diagnostic modality of pre-exercise and postexercise magnetic resonance angiography for iliac endofibrosis.
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Affiliation(s)
- Tommy Ye Cai
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia .,Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Saissan Rajendran
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - David Robinson
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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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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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.
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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
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Veraldi GF, Macrì M, Criscenti P, Scorsone L, Zingaretti CC, Gnoni M, Mezzetto L. Arterial endofibrosis in professional cyclists. G Chir 2016; 36:267-71. [PMID: 26888703 DOI: 10.11138/gchir/2015.36.6.267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
External Iliac Artery Endofibrosis (EIAE) is an uncommon disease usually affecting young, otherwise healthy, patients. It usually involves cyclists but cases have been reported in other groups of endurance athletes. The external iliac artery is the most affected anatomical site but other locations are described too. The precise pathophysiology and long-term evolution of the disease still remain unknown. The diagnosis may be challenging and delayed as the patients usually present symptoms only in extreme conditions and physical and instrumental examinations may be normal at rest. We present two cases of young professional cyclists who suffered of exercise-induced leg pain which led them to reduce running. Both patients were firstly treated with balloon angioplasty that rapidly failed to improve their symptoms. The successive open surgery with endofibrosectomy and autologous saphenous vein closure patch completely resolved physical limitations. EIAE is a rare disease that can induce arterial stenosis, thrombosis, dissection and secondary atheroma. After-exercise ankle-brachial index represents a useful diagnostic criterion. Careful observation of angio-CT may strengthen the suspect. Knowledge of the these features allows a better pre-operative assessment and an early effective treatment. Surgical revascularization remains the gold standard approach.
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8
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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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Abstract
Atherosclerotic peripheral artery disease is the most common cause of intermittent claudication. Nonatherosclerotic peripheral artery disease is a heterogeneous collection of diseases affecting the extracoronary arteries which is not due to atherosclerosis. These diseases include, but are not limited to, popliteal artery entrapment syndrome, cystic adventitial disease, external iliac endofibrosis, and thromboangiitis obliterans. Due to its relatively low prevalence, nonatherosclerotic peripheral artery disease may be misdiagnosed leading to the mismanagement of potentially treatable conditions. The proper and timely diagnosis of these conditions is paramount to the prevention of adverse outcomes as treatments widely vary. The diagnostic approach to patients presenting with intermittent claudication must take into account both atherosclerotic as well as nonatherosclerotic causes of peripheral artery disease making the differential vital to clinical practice.
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Affiliation(s)
- Ari J Mintz
- Internal Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA,
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11
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Lindner D, Agar G, Domb BG, Beer Y, Shub I, Mann G. An unusual case of leg pain in a competitive cyclist: a case report and review of the literature. Sports Health 2014; 6:492-6. [PMID: 25364481 PMCID: PMC4212352 DOI: 10.1177/1941738114524160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cycling has become a popular recreational and competitive sport. The number of people participating in the sport is gradually increasing. Despite being a noncontact, low-impact sport, as many as 85% of athletes engaged in the sport will suffer from an overuse injury, with the lower limbs comprising the majority of these injuries. Up to 20% of all lower extremity overuse injuries in competitive cyclists are of a vascular source. A 39-year-old competitive cyclist had a 5-year history of thigh pain during cycling, preventing him from competing. The patient was eventually diagnosed with external iliac artery endofibrosis. After conservative treatment failed, the patient underwent corrective vascular surgery with complete resolution of his symptoms and return to competitive cycling by 1 year. Since its first description in 1985, there have been more than 60 articles addressing external iliac artery endofibrosis pathology.
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Affiliation(s)
| | - Gabriel Agar
- Department of Orthopaedics, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Benjamin Gilbert Domb
- American Hip Institute, Westmont, Illinois ; Hinsdale Orthopaedics, Hinsdale, Illinois ; Loyola University of Chicago, Chicago, Illinois
| | - Yiftah Beer
- Department of Orthopaedics, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Idit Shub
- Meir Medical Center, Kfar Saba, Israel
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12
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Rouvière O, Feugier P, Gutiérrez JP, Chevalier JM. Arterial Endofibrosis in Endurance Athletes: Angiographic Features and Classification. Radiology 2014; 273:294-303. [DOI: 10.1148/radiol.14130882] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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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.
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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.
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Green BL, Bailey MA, Bridge KI, Scott DJA. Images in vascular medicine. External iliac artery endofibrosis in an amateur runner. Vasc Med 2014; 19:419-20. [PMID: 25080463 DOI: 10.1177/1358863x14544401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ben L Green
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Marc A Bailey
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK The Leeds Vascular Institute at The Leeds General Infirmary, Leeds, UK
| | - Katherine I Bridge
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK The Leeds Vascular Institute at The Leeds General Infirmary, Leeds, UK
| | - D Julian A Scott
- Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK The Leeds Vascular Institute at The Leeds General Infirmary, Leeds, UK
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Clifft JK, Coleman FA, Malone CB. Vascular disorder in a competitive cyclist: a case report. Physiother Theory Pract 2014; 30:517-20. [PMID: 24620853 DOI: 10.3109/09593985.2014.898351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this case report was to alert the physical therapist (PT) to the possibility of vascular disorders in endurance athletes with apparent musculoskeletal symptoms. A 33-year-old female injured her knee in a fall and described a history of progressive unilateral lower extremity (LE) pain and weakness, especially with running and cycling. She received LE stretching and strengthening but her symptoms persisted, so she stopped all activity. When she became symptomatic with minimal exertion, she went to a neurologist, but electromyographic (EMG)/nerve conduction velocity (NCV) studies were normal. Eventually, she was referred for vascular studies, which confirmed a diagnosis of external iliac artery endofibrosis. The patient underwent a right common iliac to common femoral artery bypass graft approximately 3 years after onset of initial symptoms. She ran a 5K race 3 weeks after surgery and returned to cycling after 4 weeks. Endofibrosis of the external iliac artery is an uncommon disorder but is most frequently diagnosed in high-performance athletes, especially cyclists. Physical therapists who practice in orthopedic settings should be aware of vascular conditions that mimic musculoskeletal disorders in endurance athletes. Vascular consult or referral may be necessary if PT interventions are ineffective in treating athletes with exercise-induced LE pain and weakness.
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Affiliation(s)
- Judy K Clifft
- Department of Physical Therapy, University of Tennessee Center for the Health Sciences , Memphis, TN , USA
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Howard AQ, Sinha S, Peach G, Hinchliffe RJ. Minimally invasive surgical repair of iliac artery endofibrosis. J Vasc Surg 2013; 58:1657-60. [DOI: 10.1016/j.jvs.2013.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 11/25/2022]
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External Iliac Artery Fibrosis in Endurance Athletes Successfully Treated with Bypass Grafting. Ann Vasc Surg 2013; 27:1183.e1-4. [DOI: 10.1016/j.avsg.2013.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 01/03/2013] [Accepted: 01/04/2013] [Indexed: 11/23/2022]
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Rajasekaran S, Kvinlaug K, Finnoff JT. Exertional Leg Pain in the Athlete. PM R 2012; 4:985-1000. [DOI: 10.1016/j.pmrj.2012.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 10/03/2012] [Accepted: 10/05/2012] [Indexed: 01/27/2023]
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Politano AD, Tracci MC, Gupta N, Hagspiel KD, Angle JF, Cherry KJ. Results of external iliac artery reconstruction in avid cyclists. J Vasc Surg 2012; 55:1338-44; discussion 1344-5. [DOI: 10.1016/j.jvs.2011.11.106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 10/28/2011] [Accepted: 11/16/2011] [Indexed: 10/28/2022]
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20
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Endofibrosis and Kinking of the Iliac Arteries in Athletes: A Systematic Review. Eur J Vasc Endovasc Surg 2012; 43:208-17. [DOI: 10.1016/j.ejvs.2011.11.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 11/28/2011] [Indexed: 11/19/2022]
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Abstract
Athletes rarely present with symptoms or clinical findings suggestive of vascular disease. However, vascular etiologies should be considered when an athlete complains of persistent symptoms which are refractory to conservative therapies commonly used for presumed musculoskeletal injuries. A comprehensive history should be performed, with special consideration to the postures the athlete assumes repeatedly during their chosen sport. Musculoskeletal anatomy surrounding the vascular bed of interest should be thoroughly reviewed. Physical examination should include provocative maneuvers specific to the suspected vascular disorder. The proper use of noninvasive diagnostic studies, including duplex ultrasonography, computerized tomography (CT), and magnetic resonance imaging (MRI), along with catheter-based angiography, when indicated, can ensure prompt diagnosis. Appropriate, multifaceted treatment of an athlete affected by a vascular disorder can facilitate an expeditious return to previous levels of activity.
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Affiliation(s)
- Alice A Perlowski
- Section of Vascular Medicine, Division of Cardiovascular Medicine, Massachusetts General Hospital, Boston, MA, USA
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22
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Abstract
OBJECTIVE Ankle-to-brachial index (ABI) can be easily performed by all physicians. The Ruffier-Dickson (RD) test is an easy procedure to attain moderate exercise at the bedside for physicians who do not have an ergometer. DESIGN Retrospective analysis. SETTING Tertiary care, institutional practice. PATIENTS Fifty-three asymptomatic athletes and 22 patients suffering from unilateral pain due to histologically proven exercise-induced arterial endofibrosis (EIAE). INTERVENTION Brachial and ankle systolic blood pressures were measured in the supine position on the suspected leg in EIAE or left leg in controls, at rest (rest) and at the first minute of the recovery from incremental maximal cycle ergometer exercise (maxCE) and Ruffier-Dickson (RD) exercise tests. MAIN OUTCOME MEASURES Comparison of ABI(rest), ABI(maxCE), and ABI(RD) in discriminating patients from normal subjects, using receiver operating characteristics (ROC) curves. RESULTS Area (+/-SE of area) of ROC curve was 0.76 +/- 0.06 for ABI(rest), 0.83 +/- 0.05 for ABI(RD) (nonsignificant from rest), and 0.99 +/- 0.01 for ABI(maxCE) (P < 0.01 from ABI(RD) and P < 0.001 from ABI(rest)). An ABI(maxCE) below 0.48 was 100% specific and 80% sensitive for EIAE. For the RD test, a 100% negative predictive value was only attained for postexercise ABI values higher than 0.92. CONCLUSION ABI after maximal cycle ergometer exercise is more accurate than ABI after an RD test to search for unilateral EIAE in athletes.
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Unusual causes of intermittent claudication: Popliteal artery entrapment syndrome, cystic adventitial disease, fibromuscular dysplasia, and endofibrosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2009; 11:156-66. [DOI: 10.1007/s11936-009-0016-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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