Diagnostic Approach and Management of Iliac Artery Endofibrosis in Athletes: A Scoping Review

Iliac artery endofibrosis (IAE) is a rare vascular condition with an estimated global prevalence of 0.01%. It primarily affects endurance athletes, especially cyclists, and often presents with exercise-induced leg discomfort or reduced performance. This scoping review provides a comprehensive overview of IAE in athletes, with a focus on the current understanding of IAE, diagnostic approaches, and treatment strategies. A total of 43 studies published between 1997 and 2023 were analyzed, including 443 athletes diagnosed with IAE. Most participants were male endurance cyclists, with a predominance of left-sided lesions. The diagnostic tools primarily included ankle-brachial index measurement (used in approximately 84% of studies), Doppler ultrasonography, and angiography. Balloon angioplasty and stenting were associated with a higher likelihood of symptom relapse and often required secondary interventions. In contrast, endarterectomy with patch angioplasty remains the preferred treatment for athletes who continue to participate in competitive sports because of its high success rate, long-term durability, and sustained symptom relief.