Vascular handlebar syndrome in a triathlete: a case report

Handlebar syndrome has a low incidence and its presentation can be quite different making the diagnosis sometimes challenging.

We present a rare case of the handlebar syndrome in which the handlebar of a bike injures the common femoral artery with an atypical clinical presentation. A written informed consent was obtained from the patient, and the study was approved by the Ethics Committee Research UZ/KU Leuven with the corresponding reference number S70224.

The case is a unique late presentation of the handlebar syndrome with only mild symptoms during high-intensity exercise, with normal arterial pulsations and a murmur in the groin. The patient was initially conservatively treated. Although symptoms decreased, there was still a loss of power during maximal intense efforts, and the ankle-brachial index dropped on the bike with a duplex showing low-grade stenosis in the common femoral artery. We performed femoral endarterectomy using a bovine patch. Postoperatively, the patient was symptom-free during intense exercise.

Diagnosis could be missed in the absence of early symptoms, posing a risk in children with respect to limb growth and length. Treatment is patient- and lesion-tailored, and mostly performed by open surgery, although conservative management has also been described.