LOWER-EXTREMITY ARTERIAL-DISEASE IN SPORTS

The recent description of exercise-induced intimal fibrosis affecting mainly the iliac artery (and therefore usually described as external i liac artery endofibrosis) has dramatically changed the diagnostic appr oach of unexplained recurrent lower limb exercise pain, especially in cyclists. Because arterial disease is often associated with the aftere ffect of various concomitant musculotendinous lesions, several months may pass before an arterial origin is suspected. The arterial origin o f the pain must not be eliminated on normal ankle-to-arm index or norm al Doppler velocity profiles at rest. Ultrasound examinations taken at rest may show the lesions in 80% of endofibrotic patients and allow f or the diagnosis of popliteal entrapment syndrome during dorsiflexion of the foot. However, the hemodynamic consequences of a stenosis on th e aortoiliofemoral axis can only be proved by measurement of the ankle -to-arm index after exercise. A cutoff of this index <0.5 provides an 85% sensitivity in the detection of endofibrosis. Invasive investigati ons (arteriography or angioscopy) will confirm the diagnosis before su rgery is discussed. Although long-term results in endofibrosis are unk nown, most of the surgically treated patients return to competition.