Elite cyclists may develop an iliac syndrome due to stenosis of the external iliac artery caused by an intimal thickening that is distinct from atherosclerosis and intimal fibrodysplasia.


Clinical features:

(1) The typical patient is an elite cyclist with years of intense training.

(2) The cyclist experiences pain in the thigh and buttock, followed by numbness in the limb.

(3) The ischemia starts during periods of violent physical effort (sprinting, hill climbing, etc) and improves when the level of exertion decreases.

(4) Symptoms are usually unilateral.

(5) Physical findings are normal at rest but a during exercise there may be a drop in the ankle systolic blood pressure, a bruit over the pelvis, and/or decrease in distal pulse intensity.

(6) Arteriography shows narrowing in the mid-portion of the external iliac artery on the affected side. The artery also shows a sinuous lengthening.


Potential complications:

(1) thrombosis

(2) dissection

(3) physical disability (need to discontinue competitive cycling)


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