Background: There is increasing recognition that high-performance athletes can develop symptomatic arterial flow restriction in one or both (15%) legs due to kinking and/or endofibrosis of their iliac arteries.

Methods: Case report and review based on a Medline search of the literature.

Results: A 51-year-old female, 24-hour endurance runner presented with a six-month history of rapidly progressing intermittent claudication affecting her right thigh and calf in the absence of classical risk factors for atherosclerosis. On the basis of invasive and non-invasive investigations, a provisional diagnosis of endofibrosis was made and she was treated successfully with angioplasty.

Conclusions: The epidemiology, optimal investigation and treatment of iliac endofibrosis in endurance athletes is poorly described. Each individual unit's experience is likely to be very small. A European register of such cases would increase our understanding of the condition and improve patient outcomes.