- Title: MRI to investigate iliac artery wall thickness in triathletes
- Open Access: Nee
- Language: English
- Year: 2018
- DOI/URL: https://doi.org/10.1080/00913847.2018.1450060
- Publication Date: 01-09-2018
- Journal: Taylor & Francis - The Physician and Sportsmedicine
- Pubmed ID: 29522363
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.
- Title: Color Doppler Ultrasound Imaging in the Assessment of Iliac Endofibrosis
- Open Access: Nee
- Language: English
- Year: 2016
- DOI/URL: https://doi.org/10.1177/0003319716649113
- Publication Date: 13-05-2016
- Journal: Sagepub - Angiology
- Pubmed ID: 27178720
Endofibrosis (EF) of the iliac arteries is a flow-limiting condition typically seen in highly trained endurance athletes. Thirty-seven athletes (74 limbs) were referred to our department with suspected EF. All patients had a pre- and postexercise color Doppler ultrasound (CDU) of the iliac arteries. Doppler waveform and peak systolic velocity (PSV) and end-diastolic velocity (EDV) were assessed pre- and postexercise. Endofibrosis was diagnosed with CDU in 24 athletes (29 limbs). Arterial wall and course abnormalities were detected at rest in 20 (67%) symptomatic limbs of athletes with and 4 (22%) symptomatic limbs of athletes without EF. Postexercise abnormal waveforms of the stenotic/damped type were seen in the iliac arteries in all 29 limbs of athletes diagnosed with EF. These waveform changes were accompanied by high PSV (>350 cm/s) and EDV (>150 cm/s), with (n = 10; 34%) or without (n = 19; 66%) the evidence of reduced arterial lumen caliber. Color Doppler ultrasound can be used to detect EF.
- Title: Angiographic evaluation of high performance athletes with endofibrosis
- Open Access: Ja
- Language: English
- Year: 2014
- DOI/URL: https://doi.org/10.1016/j.jvir.2013.12.511
- Publication Date: 01-03-2014
- Journal: Elsevier - Journal of Vascular and Interventional Radiology
Background
Arterial endofibrosis is a non-atherosclerotic lesion affecting the external iliac, as well as the common iliac and common femoral arteries. This lesion is most often seen in competitive cyclists and is thought to arise from repetitive damage to the vessel wall due to hemodynamic and mechanical stress (1). The typical patient presentation involves lower extremity pain, cramping, and decrease in power during high intensity effort (1). Ankle to brachial pressure index after maximal exercise and MR angiography are typically used in the initial diagnosis. DSA is typically reserved for patients considering surgical treatment. DSA provides important diagnostic information via provocative maneuvers (hip flexion) and measurement of pressure gradients across the lesion.
Clinical Findings/Procedure Details
A few examples will be presented of high performance athletes who underwent conventional angiography for the evaluation and preoperative workup for iliac artery endofibrosis. Intra-procedural images will be used to demonstrate the technique and associated provocative maneuvers. CTAand MRA images will also be employed to demonstrate the preoperative and postoperative findings.
Conclusion and/or Teaching Points
Angiography is a valuable technique in the evaluation of high performance athletes with flow limiting iliac artery endofibrosis.
- Title: Arterial endofibrosis in endurance athletes: angiographic features and classification
- Open Access: Nee
- Language: English
- Year: 2014
- DOI/URL: https://doi.org/10.1148/radiol.14130882
- Publication Date: 01-10-2014
- Journal: RSNA - Radiology
- Pubmed ID: 24955926
Purpose: To describe the spectrum of angiographic features of arterial endofibrosis and to assess the patterns of associated lesions.
Materials and methods: This retrospective study was compliant with the declaration of Helsinki principles. Files of patients who underwent surgery between January 1998 and December 2009 were retrospectively searched for histologic analysis-proven arterial endofibrosis. Preoperative angiograms were read in consensus by two radiologists. Abnormalities of the common iliac (CIA), external iliac (EIA), and femoral arteries were classified into five types, known as the CEF classification.
Results: This study assessed 180 patients (161 men, 19 women) with 195 symptomatic limbs (136 left-side limbs; P < .001). Angiography depicted 28 abnormalities in the CIA (27 stenoses, one dissection), 185 in the EIA (17 thromboses, 167 stenoses, one dissection), one in the common femoral artery (dissection), and 14 in the deep femoral artery (one thrombosis, 13 stenoses). CIA and EIA stenoses predominantly involved the distal and proximal third of the artery respectively. They were mild (CIA and EIA mean severity, 19% ± 7 and 26% ± 11, respectively) and long (45% ± 26 and 51% ± 26 of the artery, respectively). EIA stenoses were significantly longer in women (P < .003). Upon hip flexion, 23 CIA and 116 EIA stenoses showed kinking (mean amplitude, 76° ± 23 and 76° ± 30, respectively). All deep femoral artery stenoses were diaphragm-like and involved the lateral circumflex femoral artery. CIA, EIA, and femoral lesions were not randomly associated (P < .001). ConCLUSION: Arterial endofibrosis mainly affects the central part of the iliac artery and the lateral circumflex femoral artery. The CIA, EIA, and femoral lesion classification may help to distinguish patterns of associated lesions.
- Title: Endofibrose de l’artère iliaque externe diagnostiquée par écho-doppler post-effort
- Open Access: Ja
- Language: French
- Year: 2012
- DOI/URL: https://doi.org/10.1016/j.jmv.2012.03.002
- Publication Date: 01-06-2012
- Journal: Elsevier - Journal des Maladies Vasculaires
Résumé
L’endofibrose artérielle est une pathologie de découverte récente qui touche le sportif de haut niveau, avec une prédominance chez les cyclistes. La localisation préférentielle est l’artère iliaque externe. La symptomatologie est hétérogène (crampe, fatigue, œdème, paresthésies, paralysie), toujours liée à un effort. Le diagnostic peut être retardé du fait de l’atypie des symptômes chez des sujets sportifs. Les examens complémentaires sont la mesure de l’index de pression systolique après l’effort, l’écho-doppler, l’angioscanner, l’angio-IRM et l’artériographie. Nous rapportons ici un cas d’endofibrose dont le diagnostic a été porté tardivement grâce à la réalisation d’un écho-doppler post-effort, alors que l’angioscanner et l’artériographie n’avaient pas décelé d’anomalies caractéristiques.
Summary
Arterial endofibrosis is a disease of recent discovery which concerns high-performance athletes, predominantly competitive cyclists. The preferential location is the external iliac artery. The symptoms are diverse (pain, edema, paresthesia), always linked to an effort. The diagnosis may be delayed due to atypical symptoms in athletes. Complementary tests are measure of the systolic pressure index after exercise, duplex ultrasound, CT angiography, MR angiography and arteriography. We report a case of endofibrosis where late diagnosis was established with postexercise duplex ultrasound, while CT angiography and arteriography failed to reveal characteristic abnormalities.
- Endofibrosis in athletes: is a simple bedside exercise helpful or sufficient for the diagnosis?
- Simultaneous arterial pressure recordings improve the detection of endofibrosis
- Comparison Between Duplex Scanning and Angiographic Findings in the Evaluation of Functional Iliac Obstruction in Top Endurance Athletes
- Recognising vascular causes of leg complaints in endurance athletes. Part 1: validation of a decision algorithm