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
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.
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.
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