- Title: A Case of Endofibrosis Presenting with Embolic Symptoms in a 43-Year-Old Cyclist
- Open Access: Nee
- Language: English
- Year: 2016
- DOI/URL: https://doi.org/10.1016/j.avsg.2016.03.019
- Publication Date: 2016-10-01
- Journal: Elsevier - Annals of Vascular Surgery
- Pubmed ID: 27423721
Background: Endofibrosis is a rare clinical entity that usually manifests as claudication in cyclists and other endurance athletes. We report a case of a 43-year-old cyclist presenting with pain and cyanosis of his toes due to an embolism to his left anterior tibial artery. The source of the embolus was found to be an ulcerated, endofibrotic plaque in his left common femoral artery.
Methods: We performed an extensive literature search using the PubMed database and identified 60 results on endofibrosis. Eight articles described thrombosis relating to endofibrosis. None of the articles described an embolic phenomenon relating to endofibrosis. The following search terms were used: endofibrosis, embolic, emboli, embolism, "distal occlusion," cyanosis, thrombosis, and thrombus.
Results: The patient is a 43-year-old male cyclist who presented with pain and cyanosis of his second and third toes on his left foot for 1 week. The affected toes had a dark-purple discoloration involving the tissue overlying the distal phalanges. Computed tomography angiography showed an abrupt occlusion of the left anterior tibial artery in the mid-calf with a non-calcified plaque in the left common femoral artery. There were no other signs of arterial disease. He underwent left common femoral endofibrosectomy with patch angioplasty that revealed an ulcerated endofibrotic plaque with mural thrombus.
Conclusions: This case demonstrates an unusual presentation of a rare clinical entity. While there have been previous reports of thrombosis associated with endofibrosis, to our knowledge this is the first reported case of endofibrosis presenting with embolic symptoms.
- Title: Bilateral Common Iliac Artery Endofibrosis in a Recreational Cyclist: Case Report and Review of the Literature
- Open Access: Nee
- Language: English
- Year: 2016
- DOI/URL: https://doi.org/10.1016/j.avsg.2016.02.016
- Publication Date: 2016-08-01
- Journal: Elsevier - Annals of Vascular Surgery
- Pubmed ID: 27263822
External iliac artery endofibrosis is a rare medical condition typically encountered in young endurance athletes, mainly cyclists. Iliac endofibrosis usually develops in the external iliac artery and is rarely seen in the common iliac or in common femoral arteries. We describe a unique case of a patient who was not a professional or high-endurance cyclist. The lesions in our case appeared to be bilateral in the common iliac arteries and were not limited to the external iliac artery as most commonly described. We present an overview of the literature regarding this medical condition.
- Title: Iliac artery endofibrosis Case study of an elite triathlete
- Open Access: Ja
- Language: English
- Year: 2016
- Publication Date: 2016-04-01
- Journal: CFPC - Canadian Family Physician
- Pubmed ID: 27076542
Progressive stenosis of the iliac artery, known as iliac artery endofibrosis, is poorly recognized by primary care physicians. It is mainly found in male endurance cyclists who are younger than 40 years of age.1,2 Because vascular disease is unexpected in these athletes, an arterial insufficiency syndrome is often missed; instead, lower limb and sometimes buttocks pain is attributed to musculoskeletal or neurologic causes. Nonatheromatous functional “kinking” along with stenosis or endofibrosis is the main culprit for claudication.3–7
The condition is almost certainly underdiagnosed in Canada owing to a lack of recognition and no clear unified strategy for the assessment and management of these patients. The delay in diagnosis is profound, averaging between 12 and 41 months, and diagnosis usually occurs only after many months of failed physiotherapy.1 The failure to diagnose and treat iliac artery endofibrosis in young athletes has career and social implications that could be markedly reduced with better awareness of the condition among family doctors. According to our literature review completed in February 2015, there are no Canadian data published on this high-yield condition.
- Title: Intravascular ultrasound imaging as a novel tool for the diagnosis of endofibrosis
- Open Access: Ja
- Language: English
- Year: 2016
- DOI/URL: https://doi.org/10.1016/j.jvsc.2016.03.007
- Publication Date: 2016-05-01
- Journal: Elsevier - Journal of Vascular Surgery Cases Innovations and Techniques
- Pubmed ID: 31193347
Endofibrosis is a rare cause of lower extremity claudication in a healthy young adult.1 Given the increase in the number of high-intensity athletes during the past decade, the prevalence of endofibrosis is steadily increasing, making this disease relevant to the practice of the modern vascular surgeon. The pathology involves hypertrophy of the intimal layer of the iliac vessels, seen usually in runners or cyclists, and results in intimal thickening that leads to stenosis and decreased blood flow during heavy exercise.2 Symptoms occur only at maximal exertion.
Diagnosis has previously been described by provocative duplex examinations and angiography, sometimes with pressure gradients obtained across the proposed lesion with vasodilators to mimic the exercise state.3 Angiographic findings are generally subtle, and often, pharmacologically stimulating the high level of exercise needed to induce symptoms in these patients may not be possible. The patient consented to the publication of this report in which we found the use of intravascular ultrasound (IVUS) imaging as a diagnostic tool to aid in the diagnosis of endofibrosis. We believe that IVUS imaging is superior to the other traditional modalities used for the diagnosis of this disease. In this report, we introduce the use of IVUS to definitively diagnose intimal thickening and endofibrosis, which leads to appropriate operative planning and surgical treatment.
- Title: Endofibrosis: an unusual cause of leg pain in an athlete
- Open Access: Nee
- Language: English
- Year: 2016
- DOI/URL: https://www.minervamedica.it/en/journals/sports-med-physical-fitness/article.php?cod=R40Y2016N01A0157
- Publication Date: 2016-02-01
- Journal: Minerva Medica - The Journal of Sports Medicine and Physical Fitness
- Pubmed ID: 26140352
Endofibrosis of the external iliac artery can occur as a rare complication of high endurance physical activities, particularly cycling, running, and rowing. Symptoms mimic claudication and typically occur with vigorous exercise and improve with rest. Patients can experience thigh pain, swelling and paresthesias in the affected extremity. The diagnosis of endofibrosis is often delayed given the patient's overall normal appearance and lack of significant medical history. This report outlines the presentation and evaluation of a case of endofibrosis of the external iliac artery in an otherwise healthy 42-year-old healthy woman. Her diagnosis was delayed for two years before appropriate diagnostic testing and subsequent surgical intervention allowed for return to a normal, active lifestyle.