Iliac artery endofibrosis is an uncommon condition, which should be considered in young athletes with exertional lower limb symptoms. Imaging often appears normal at rest, and the diagnosis can be missed if clinical assessment is inadequate. We report a successful case of entirely minimally invasive surgical treatment for iliac artery endofibrosis in a 41-year-old cyclist. This novel technique offers superior potential for intraoperative assessment and aids enhancement in recovery after surgery. It is likely to be particularly appealing to elite athletes.