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External Iliac Artery Endofibrosis: A Rare Condition With Distinct Presentations.

Safa Riahi1, Yassine Khadhar1, Bilel Derbel1

  • 1Department of Cardiovascular Surgery, La Rabta University Hospital, Faculty of Medicine of Tunis, Tunisia.

Vascular and Endovascular Surgery
|April 13, 2026
PubMed
Summary

External iliac artery (EIA) endofibrosis, a rare condition in athletes, causes leg pain during exercise. Surgical repair effectively resolves symptoms, allowing athletes to return to sport.

Keywords:
case seriesclaudicationendofibrosisendurance athletesexternal iliac arterysurgical bypass

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Area of Science:

  • Vascular Surgery
  • Sports Medicine
  • Athletic Performance

Background:

  • External iliac artery (EIA) endofibrosis is a rare, non-atherosclerotic condition causing exercise-induced claudication in endurance athletes.
  • Often underdiagnosed and misattributed to other causes, leading to delayed treatment.
  • Affects athletes' ability to perform and may lead to acute ischemia if untreated.

Purpose of the Study:

  • To present the management of three cases of EIA endofibrosis in endurance athletes.
  • To highlight the effectiveness of surgical interventions for EIA endofibrosis.
  • To emphasize the importance of early diagnosis and treatment in athletes with exertional leg symptoms.

Main Methods:

  • Case series detailing the surgical revascularization of three endurance athletes with EIA endofibrosis.
  • Treatments included surgical revascularization for stenosis, prosthetic bypass graft for loop configuration, and interposition graft for acute ischemia.
  • All patients were monitored for symptom resolution and return to athletic activity.

Main Results:

  • All three patients experienced complete resolution of exercise-induced claudication and other symptoms.
  • Successful return to previous levels of athletic activity post-surgery.
  • No major complications reported following surgical interventions.

Conclusions:

  • EIA endofibrosis should be considered in endurance athletes presenting with exertional leg symptoms.
  • Surgical treatment, including bypass grafts, offers effective symptom relief and long-term recovery.
  • Timely diagnosis and intervention are crucial to prevent complications, especially acute ischemia.