Pt is a 41 yo female avid athlete who enjoys long distance running and cycling.  C/o 7 month h/o rig...
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Pt is a 41 yo female avid athlete who enjoys long distance running and cycling. C/o 7 month h/o right lower extremity claudication after 60-90 minutes of intense cycling or running. Reports right leg numbness and coolness. No symptoms at rest. Medical History. Left foot surgery 2006

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Medical History

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Medical history

Pt is a 41 yo female avid athlete who enjoys long distance running and cycling. C/o 7 month h/o right lower extremity claudication after 60-90 minutes of intense cycling or running. Reports right leg numbness and coolness. No symptoms at rest.


Medical history

Medical History

Left foot surgery 2006

Bicuspid aortic valve


Imaging

Imaging

  • Duplex: Exercise ABI

    • Right 1.15 to 0.27

    • Left 1.3 to 0.88

  • CT angiogram: Narrowed Right external iliac artery


Operation

Operation:

  • Right external iliac artery endarterectomy with vein patch angioplasty


Exercise associated lower extremity arteriopathy in avid cyclists early longitudinal results

Exercise Associated lower extremity arteriopathy in avid cyclists: Early longitudinal results

K Cherry et al, SVS abstract 2008

  • Retrospective analysis of 8 avid cyclists with lower extremity claudication

  • 6 males, 2 females (mean age 35)

  • c/o thigh and calf claudication with maximal exertion

  • Avg time to onset 11 years and 342 miles/week

  • Normal resting ABI and drop in exercise ABI <0.8

  • Treatment ( dacron patch angioplasty, 3 inguinal ligament release, 2 iliofemoral bypass, partial resection and patch angioplasty)

  • All with inguinal ligament release

  • Of the 11 arterial reconstruction, 8 (73%) was patent, 23% stenosis


Medical history

Obstructive external iliac arteriopathy in avid bicyclists: New and variable histopathologic features in four women

K Cherry et al, JVS 2002; 36: 565-70

  • Retrospective analysis of 4 competitive cyclists undergoing resection and graft placement for segmental external iliac artery disease at Mayo Clinic from 1991-2001

  • 4 females (mean age 36, range 24-37), onset 10-13 yrs

  • c/o lower extremity claudication with maximal exertion, significant drop in ABI with exercise, bruits (60%)

  • Preoperative angiography showed stenotic disease (40-85%)

  • Gross examination: wall thickening (smooth cell hyperplasia) and luminal narrowing without aneurysm formation

  • Adventitial thickening

  • Hypothesis of injury: high blood flow and mechanical stress of the cycling position


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