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• W2015495597 abstract "This review of external iliac artery pathology in cyclists illustrates the lack of evidence available to surgeons faced with such a patient requesting treatment. While investigations may reveal thickening of the artery wall and/or kinking in flexion, does this constitute grounds for treatment? Like all muscular arteries, the iliac artery dilates in response to increased blood flow. A lack of such dilatation rather than actual narrowing may be sufficient to cause symptoms in these athletes. They may, therefore, have genuine symptoms of vascular insufficiency, even in the presence of an apparently ‘normal’ calibre artery. Anyone who has spent time on a road bike knows that it places the body in a flexed position, which can put strain on the muscles around the pelvis and lower back. The authors correctly stress the need for a thorough review of both the bicycle set-up, and a search for back, hip or muscular problems. Only by eliminating other potential sources of lower limb pain and numbness can a diagnosis of vascular insufficiency be reached. Even then, an exhaustive search for alternative explanations using MRI and MRA is required before concluding that the external iliac artery is the source of symptoms. Physiological tests to confirm vascular insufficiency, whilst reproducing the situation causing the symptoms, are essential. The literature contains numerous case reports and one short series advocating a number of treatments. It also contains details of a fatal outcome following prosthetic bypass grafting in an elite cyclist. Endovascular interventions in narrowed arteries without evidence of kinking cannot be recommended. The damage that balloons inflict on the arterial wall may be beneficial in the presence of atheroma, but they are likely to exacerbate the situation in these athletes. Stenting must also be avoided because of the inevitable fractures that will occur. Arterial release and/or shortening to correct kinking is claimed to provide benefit in some, but these arteries always have some degree of wall thickening, even if they are not actually narrowed. It therefore makes empirical sense to widen the artery with a long vein patch at the same time, i.e. to release, shorten and widen. This is not a difficult operation to perform via a small muscle splitting incision and a retroperitoneal approach, but the vein patch must extend the entire length of the external iliac artery from the common iliac bifurcation to the inguinal ligament. Using the basilic vein from the inner aspect of the upper arm avoids an unsightly scar and avoids a scar on the medial thigh, which can cause irritation when cycling. The alternative to surgery is stopping competitive cycling. This option should be explored, although it is not an option that many professional or enthusiastic amateur cyclists will contemplate, even after the risks of surgery (and the risk of recurrence) have been fully explained. A cyclist who is turned down by one surgeon may choose to find another, often via the internet, which cannot always be trusted to give accurate or unbiased information. Whatever course of treatment is taken, those treating cyclists with such problems have a duty to follow up patients lifelong, and to submit cases to a registry to expand our knowledge of this difficult problem. Such a Registry can be found at www.jvrg.org.uk. This Registry was established by the Joint Vascular Research Group in the UK and we welcome submission of cases by all vascular surgeons. Iliac Artery Compression in Cyclists: Mechanisms, Diagnosis and TreatmentEuropean Journal of Vascular and Endovascular SurgeryVol. 38Issue 2PreviewTo review the mechanisms, diagnosis and treatment options for symptomatic iliac artery compression in cyclists. Full-Text PDF Open Archive" @default.
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• W2015495597 date "2009-08-01" @default.
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• W2015495597 title "Invited Commentary on Cyclists Paper" @default.
• W2015495597 doi "https://doi.org/10.1016/j.ejvs.2009.04.006" @default.
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