Prior reports have documented excellent early results after surgery for external iliac endofibrosis in cyclists. We sought to evaluate our long-term functional outcomes in this select cohort of patients.

Patients undergoing reconstruction for symptomatic iliac artery endofibrosis at a single institution from 2000 to 2015 were reviewed. With Institutional Review Board approval, data were collected from medical record review and follow-up telephone interviews.

Eighteen patients (mean age, 44 years; range, 26-57 years; 8 men and 10 women) underwent operative intervention for iliac endofibrosis or kinking. All were high-performance endurance athletes (cyclists, triathletes, marathon runners). Four patients had undergone previous operative repair at other institutions. Four patients were found to have external iliac artery occlusion at the time of presentation. Median drop in exercise ankle-brachial index noted while cycling in the vascular laboratory was 0.72 (range, 0.34-1.0) in the affected limb and 0.37 (range, 0.13-0.52) in the contralateral side. Flexed positioning computed tomography angiography was used to confirm diagnosis in 11 patients. Surgical intervention included iliofemoral bypass (n = 5), patch angioplasty (n = 9), and an arterial shortening procedure (n = 4). Concomitant inguinal ligament release was performed in 72% of patients. Primary patency was 93% at 1 year and 82% at latest follow-up (mean follow-up, 66 months; range, 4-198 months). Whereas 82% of patients were able to return to their prior level of physical endurance, in a long-term follow-up survey, 50% of these patients experienced some recurrence of symptoms.

External iliac artery endofibrosis is a rare disease seen primarily in high-performance cyclists or triathletes. Cycling exercise ankle-brachial indices and flexed positioning arteriography can be useful tools for confirming the diagnosis. Surgery remains a viable treatment option with acceptable patency rates and early short-term success; however, longer term follow-up indicates relatively high symptom recurrence rates, which should be discussed during preoperative consultation.