Monckeberg's Medial Sclerosis in Athletes: Report of Two Cases and Possible Pathophysiological Mechanisms

Background and Clinical Significance: Monckeberg's medial sclerosis (MMS) is characterized by the calcification of the tunica media within the arterial wall, resulting in increased arterial stiffness. MMS typically affects the arteries of the lower limbs with elevated ankle-brachial index (ABI) values and preserved peripheral perfusion. Commonly associated conditions are diabetes mellitus and chronic kidney disease (CKD). Case Presentation: We report two cases of MMS in middle-aged male individuals without these risk factors, both of whom had a history of long-standing professional athletic activity. In both cases, radiographs demonstrated characteristic "railroad track" medial calcifications, ABI values were elevated, and Doppler ultrasound showed calcifications but preserved triphasic flow without evidence of peripheral artery stenosis or occlusion. Conclusions: Given the absence of diabetes, CKD, or smoking history, we hypothesized that repeated strenuous exercise may have triggered the development of arterial calcifications in these two cases. Further research is needed to understand the underlying pathophysiological mechanisms and to determine the clinical and prognostic significance of medial arterial calcifications in athletes.