Arterial endofibrosis in endurance athletes: angiographic features and classification

To describe the spectrum of angiographic features of arterial endofibrosis and to assess the patterns of associated lesions.

This retrospective study was compliant with the declaration of Helsinki principles. Files of patients who underwent surgery between January 1998 and December 2009 were retrospectively searched for histologic analysis-proven arterial endofibrosis. Preoperative angiograms were read in consensus by two radiologists. Abnormalities of the common iliac (CIA), external iliac (EIA), and femoral arteries were classified into five types, known as the CEF classification.

This study assessed 180 patients (161 men, 19 women) with 195 symptomatic limbs (136 left-side limbs; P < .001). Angiography depicted 28 abnormalities in the CIA (27 stenoses, one dissection), 185 in the EIA (17 thromboses, 167 stenoses, one dissection), one in the common femoral artery (dissection), and 14 in the deep femoral artery (one thrombosis, 13 stenoses). CIA and EIA stenoses predominantly involved the distal and proximal third of the artery respectively. They were mild (CIA and EIA mean severity, 19% ± 7 and 26% ± 11, respectively) and long (45% ± 26 and 51% ± 26 of the artery, respectively). EIA stenoses were significantly longer in women (P < .003). Upon hip flexion, 23 CIA and 116 EIA stenoses showed kinking (mean amplitude, 76° ± 23 and 76° ± 30, respectively). All deep femoral artery stenoses were diaphragm-like and involved the lateral circumflex femoral artery. CIA, EIA, and femoral lesions were not randomly associated (P < .001). ConCLUSION: Arterial endofibrosis mainly affects the central part of the iliac artery and the lateral circumflex femoral artery. The CIA, EIA, and femoral lesion classification may help to distinguish patterns of associated lesions.