External Iliac Artery Endofibrosis
Patients who present with symptoms of thigh pain with loss of power and cramping in the buttock and thigh can have a diagnosis of external iliac artery endofibrosis. This is a condition in which the patient who is usually a cyclist or runner finds that when they push themselves to peak exercise their leg starts to fail.
The diagnosis is made by dynamic duplex ultrasound scanning and pressure studies which show a vasoconstriction of the external iliac artery with a reduction in ankle pressures associated with this at peak exercise. The patient often has to present for diagnostic testing at Melbourne Vascular Diagnostics with their bicycle and wind trainer to be able to mimic their usual condition that produces these symptoms. Once the diagnosis is made then the options for management are usually surgical.
The operation involves an open operation exposing the eternal iliac artery and distal common iliac artery and sometimes the common femoral artery in the groin. Once the arteries are controlled and clamped the external iliac artery is opened along its length and a foamy plaque removed. A segment of the great saphenous vein which is harvested from the thighs and is used to perform a patch angioplasty of the entire length of the external iliac artery making sure to cover the origin of the internal iliac proximally, and to extend to the end of the disease distally, sometimes even continuing the patch into the common femoral artery.
Postoperatively the patient is required to avoid any intense exercise while healing takes place and then they can gradually get back into their training schedule.
Some patients will have elongated external iliac arteries which need to be shortened as there is some kinking involved but the majority of patients will have what appears to be a failure of endothelial function which usually causes vasodilatation associated with exercise. The opening of the artery breaks the circle of smooth muscle fibres that contract to cause vasoconstriction and the introduction of a vein patch increases the cross sectional area of the external iliac artery allowing for a dramatic boost in flow to the leg.