Circulation. 1999;100:e38
(Circulation. 1999;100:e38.)
© 1999 American Heart Association, Inc.
Circulation Electronic Pages |
External Iliac Artery Endofibrosis in a Young Cyclist
P. Abraham, MD;
J. M. Chevalier, MD;
R. Loire, MD;
J. L. Saumet, MD
From Laboratoire d'Explorations Vasculaires, Centre Hospitalier
Universitaire, Angers (P.A., J.L.S.); Departement de Chirurgie Vasculaire,
Hopital Edouard Herriot, Lyon (J.M.C.); and Laboratoire d'Anatomie et
Cytologie Pathologique, Hopital Louis Pradel, Bron (R.L.), France.
Correspondence to Pr Jean-Louis Saumet, Laboratoire d'Explorations Vasculaires, Centre Hospitalier Universitaire, 49033 Angers cedex 01, France. E-mail explovasc{at}chu-angers.fr
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Introduction
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 Top
 Introduction
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An 18-year-old
cyclist was referred to the laboratory for unexplained
pain in his left
lower limb during exercise. He had started
competition at 14 years of
age and had cycled
10 000 km/y in
the preceding 5 years.
He had complained
for 18 months of a
subjective sensation of a painful and swollen left
thigh at
maximal exercise. Different physiotherapies and treatments
proved
unsuccessful. Clinical investigation and ankle-to-brachial
indices
at rest were normal (1.10 on the left side and 1.15 on the
right
side). An incremental (50 W/3 min) bicycle exercise test was
stopped
at 330 W because of pain. Ankle-to-brachial pressure
measurements
showed a fall of left-side values <0.5. Ultrasound
imaging
showed typical lesions of endofibrosis, consisting of a
mildly
echoic thickening of the left myointimal border (normally
0.3
mm) in an axial view of the iliac arteries (Figure 1
). On arteriography
(Figure 2
), the stenosis was evident only
when the arterial
diameter of the proximal left iliac
artery was compared with
the contralateral iliac artery or the femoral
segment. Surgery
consisted of shortening the artery, resection of the
fibrotic
lesions, and enlargement of the artery with a saphenous vein
patch.
Figure 3
shows the
histological findings of severe stenosis
(
75%
of the vessel lumen) on cross section of the artery. Three
years
after surgery, the patient is asymptomatic during
exercise.
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Footnotes
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister,
Jr, MD, Chief, Department of Pathology, St Luke's Episcopal
Hospital and Texas Heart Institute, and Clinical Professor of
Pathology, University of Texas Medical School and Baylor College
of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
