Vascular disorder in a competitive cyclist: a case report

Area of Science:

• Sports Medicine
• Vascular Surgery

Background:

• Endurance athletes can present with exercise-induced lower extremity (LE) pain and weakness that may mimic musculoskeletal disorders.
• Vascular conditions, such as external iliac artery endofibrosis, are uncommon but should be considered in athletes with persistent, activity-limiting LE symptoms.

Observation:

• A 33-year-old female endurance athlete experienced progressive unilateral LE pain and weakness, unresponsive to physical therapy (PT) for apparent musculoskeletal issues.
• Neurological examinations and electrodiagnostic studies (electromyography/nerve conduction velocity) were normal, delaying diagnosis.
• Vascular studies ultimately revealed external iliac artery endofibrosis, a condition often seen in high-performance cyclists.

Findings:

• The patient underwent successful bypass graft surgery for external iliac artery endofibrosis.
• Post-surgery, she rapidly returned to high-level athletic activities, including running and cycling.
• This case highlights the diagnostic challenge of vascular disorders presenting as musculoskeletal complaints.

Implications:

• Physical therapists in orthopedic settings must maintain a high index of suspicion for vascular pathologies in endurance athletes with unexplained LE symptoms.
• Failure of standard PT interventions for exercise-induced LE pain and weakness warrants consideration of vascular consultation.
• Recognizing and diagnosing conditions like external iliac artery endofibrosis can prevent prolonged disability and enable timely, effective treatment for athletes.