Disclosures: Marianne A. Mousigian, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 33-year-old female distance runner presented with right exertional leg symptoms while running due to right external iliac artery endofibrosis.

Case Description: A 33-year-old distance runner presented with a 4-month history of right calf and hamstring fatigue associated with foot paresthesias while running. Physical exam was notable for absent dorsalis pedis pulses bilaterally, mild calf circumference asymmetry (1.0cm difference), and decreased right medial hamstring and Achilles reflexes (1+ on right, 2+ on left). While she had 5/5 strength on manual muscle testing, her right lower extremity had trace weakness compared to her contralateral side.

Setting: Ambulatory careAssessment/

Results: Resting ankle brachial indices (ABI) were obtained and were 0.79 and 1.25 on the right and left, respectively. Following a one-mile treadmill run, right ABI dropped to 0.24 while the left ABI was 1.24. CT aorta with contrast revealed a 7.3-cm-long complete occlusion of the right external iliac artery with distal reconstitution via collateral vessels. The patient underwent right common iliac to right femoral artery bypass using an autologous venous graft. Postoperatively, resting ABIs normalized at four weeks, and the patient returned to running at six weeks with near full resolution of symptoms.

Discussion: External iliac artery endofibrosis is characterized by progressive thickening of the vessel intima, causing luminal stenosis and resultant ischemia. It is a rare, poorly recognized condition afflicting endurance athletes.

Conclusion: External iliac artery endofibrosis is a rare condition most commonly seen in competitive cyclists, though also reported in distance runners. Many patients often have exertional leg symptoms for months to years before being diagnosed. This highlights the need to consider vascular etiologies in an otherwise young and healthy population without vascular risk factors. Furthermore, the exertional nature of the condition in some patients highlights the importance of utilizing the appropriate diagnostics to capture the condition by reproducing the provocative positions or activities that elicit symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/external-iliac-artery-endofibrosis-in-a-distance-runner-a-case-report/