Illiac Artery Endofibrosis?

Anyone here suffer from Illiac Artery Endofibrosis? Seems to be one of the most rare, yet dangerous over use injuries for cyclist. I am 30 years old and seem healthy plus I average 8 hours a week in the saddle years round so my chances seem slim. Most people who end up with it seem to average many more hours in the saddle or running. Just curious to know more about it and anyone who is/has dealt with it.

The below thread from Slow Twitch has some great info and stories:

https://forum.slowtwitch.com/forum/Slowtwitch_Forums_C1/Triathlon_Forum_F1/Illiac_Artery_Endofibrosis_-_I’ve_got_it._P4499854/

It sounds exceedingly rare based on some case studies that I’ve read.
The interesting part is that it sounds like it doesn’t have a huge effect on blood flow at rest, so in general we measure leg blood flow with something called Ankle Brachial Index, which essentially is a ratio of leg to arm blood pressure. In athletes with endofibrosis they tend to have normal ABI at rest but it will be reduced after exercise. Essentially means that the evaluating physician needs to be looking for endofibrosis specifically to test for it.

Pauline Ferrand Prevot had surgery for it last winter and then raced the second part of the UCI MTB XCO world cup season and killed it. Unfortunately she just announced that she has another lesion in one of her legs so she is having another surgery. I don’t know much about it other than that though.

yep, same leg, different spot

hopefully she can come back in time for the Olympics!

I just had my L iliac artery repaired in October for what turned out to be quite extensive endofibrosis. 20cm (!!) of artery was repaired with patch angioplasty. I’m back on the bike now with no limitations. Just gradually rebuilding my fitness.

It’s not as uncommon as once was thought. Screening & diagnosis for the condition is becoming more consistent and suspicion is as many as 20% of professional cyclists may develop it to some extent (references linked below). Diagnosis in amateur athletes is less common and typically there would be other structural/biomechanical factors that would contribute to the condition developing.

I had previous musculoskeletal injuries that we strongly think contributed to adding mechanical stress to the artery in aero position. It’s probably not a condition anyone will get just from cycling a lot… Some predisposing factors probably exist in those who develop it.

Some interesting recent developments on screening for blood flow limitation with power and with NIRS (muscle O2, eg. Moxy or Humon) may make the initial screening process more accessible, which may actually increase the number of diagnoses made both in amateur & professional athletes. This is something I’m researching as well.

It’s not something that you should be concerned about unless you have had specific symptoms for a while. This is not medical advice, but my suggestion as a random-person-on-the-internet is the presence of a combination of the following symptoms may be worth following up with a sports med Doc, or Physio to assess for other more likely causes (biomechanical, muscular asymmetry, previous injuries, etc.) and in the absence of any other contributing factor begin the screening process for a vascular cause.

  1. pain, weakness, tightness, burning, parasthesia (pins & needles) in the quad or possibly calf or glute on one side
  2. L/R power imbalance of ~55/45 or more, that worsens at higher intensities
  3. Symptoms that persist after onset during exertion, but resolve within 5min of rest
  4. NO symptoms at rest
  5. Symptoms have persisted or worsened over 1+ year of exercise

Initial screening is fairly simple and non-invasive with an ankle-brachial index blood pressure test after a stress test on the bike. But this should be done by a Doc who is familiar with the condition. I was lucky and got referred directly to a vascular surgeon by my sports med Doc when we started to suspect vascular involvement.

I wrote a bit of what it felt like and how the condition influenced my training philosophy when I first confirmed the diagnosis, after progressive symptoms for 4+ yrs. https://sparecycles.blog/2018/07/24/left-leg-burns/ I was able to perform some very extensive self-experimentation before, and now after my surgery which will be written up as a case study.

just had surgery for it yesterday.
would it count as Blood Flow Restricted training (BFR)? :thinking:

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