Iliac artery syndrome has been described in competition cyclists or other endurance athletes who present with claudication during intense activity. It may be difficult to diagnose, as the patient's pulses and ankle brachial pressure index (ABPI) are often normal at rest. We report a case of external iliac artery stenosis in a 30-year-old male competition cyclist. Exploration revealed a markedly hypertrophied psoas muscle with a thickened external iliac artery. The course of the EIA was markedly angulated down into the pelvis and then up over the prominent psoas muscle. It was treated successfully by iliac endarterectomy and vein patch angioplasty.