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Home > Vascular Annual Meeting > gupta_exercise_associated

Exercise Associated Lower Extremity Arteriopathy in Avid Cyclists: Early Longitudinal Results

Naren Gupta, Allen D. Rubin, Klaus D. Hagspiel, Alan H. Matsumoto, Kenneth J. Cherry.
University of Virginia Health System, Charlottesville, Va.
 
OBJECTIVES: To review the clinical features, diagnosis, surgical treatment and outcomes of exercise associated lower extremity claudication in a group of avid cyclists.

METHODS: Eight competitive cyclists were treated for lower extremity symptoms. Clinical presentation, diagnostic studies, anatomic lesions, type of therapy and outcomes were retrospectively analyzed.

RESULTS: We treated 8 patients (6 males and 2 females, mean age 35.1 years; range, 23 - 54) with complaints in one (n=2) or both (n=6) lower extremities. Seven patients presented with thigh and one with lower leg pain on maximal exertion. Average time and average distance cycled prior to onset of symptoms was 11.6 years (range, 3-30) and 342 miles/week (range, 80-500). Average time elapsed between symptoms and operation was 3.3 years (range, 2 mos - 8 years). All patients had normal resting ABIs, with a drop in ABI after cycling to less than 0.8 in symptomatic extremities. Angiography was performed in standard as well as hyper-flexed positions. Intravascular ultrasound and pressure gradients were obtained in select cases. Angiographic abnormalities ranged from subtle irregularities to significant stenosis of the external iliac artery and extrinsic narrowing of the common or proximal superficial femoral artery with hyperflexion. Eight extremities were treated by external iliac artery polyester patch angioplasty, 3 by inguinal ligament release alone, 2 by iliofemoral bypass, and 1 by partial resection of a redundant external iliac artery and patch angioplasty. All patients had inguinal ligament releases. Follow-up ranged from 2-24 months. Of the 11 arterial reconstructions, 8 (72.7%) were widely patent. Three (27%, 2 in one patient) were stenotic and required repeat operations. One of those patients also had severe atherosclerosis. Four patients reported complete or near complete return to peak performance; one has since won a national title. The two most recent patients report ongoing improvement.

CONCLUSIONS: There is little longitudinal data concerning the management of external iliac arteriopathy in high-performance cyclists. Operative intervention varies with disease extent. The majority of patients with exercise-induced decreases in the ABI and objective angiographic findings may expect to benefit from surgical intervention in the short term.

AUTHOR DISCLOSURES: N. Gupta, None; A.D. Rubin, None; K.D. Hagspiel, None; A.H. Matsumoto, None; K.J. Cherry, None.