Short- and long-term outcomes after endarterectomy with autologous patching in endurance athletes with iliac artery endofibrosis

Objective: Endurance athletes such as cyclists may develop intermittent claudication owing to iliac artery endofibrosis after long-lasting extreme hemodynamic challenges. This study investigated short-term (<1.5 years) and long-term (>5 years) satisfaction and safety after a surgical endarterectomy and autologous patching. Methods: Data of endurance athletes who underwent an endarterectomy for flow limitation of the iliac artery owing to endofibrosis between 1997 and 2015 in one center were studied. Maximal cycling exercise tests, ankle-brachial index with flexed hips, echo-Doppler examination (peak systolic velocity), and contrast-enhanced magnetic resonance angiography were performed before and 6 to 18 months after surgery. Short-term and long-term satisfaction were evaluated using questionnaires. Potential patch dilatation was assessed using echo-Doppler. Results: Analysis of 68 patients (79 legs; 55.7% males, median age at the time of surgery, 34 years; interquartile range, 2641 years) demonstrated that cycling workload at symptom onset improved from 226 +/- 97 to 333 +/- 101 (P <.001) Watts. Peak workload increased from 326 +/- 111 to 352 +/- 93 Watts (P <.001). Ankle-brachial index with flexed hips increased from 0.34 (interquartile range [IQR], 0.00-0.47) to 0.59 (IQR, 0.51-0.69; P <.001). Peak systolic velocity with extended and flexed hip decreased from 2.04 m.sec(-1) (IQR, 1.52-2.56 m.3sec(-1)) to 1.25 m.sec(-1) (IQR, 0.92-1.62 m.sec(-1); P <.001) and 2.40 m.sec(-1) (IQR, 1.81-2.81 m.sec(-1)) to 1.15 m.sec(-1) (IQR, 0.97-1.60 m.sec(-1); P <.001), respectively. Thirty-day major complication rate was 5.1% (hematoma requiring evacuation n(Legs) = 2, septic bleeding from deep infection n(Legs) = 1, and iliac occlusion requiring thrombectomy n(Legs) = 1). In the short term, 91.2% of patients reported symptom reduction with a 93.7% overall satisfaction rate. After a median of 11.1 years (IQR, 7.8-17.6 years), the overall satisfaction was 91.7%; 94.5% of patients reported persistent symptomreduction. Patch dilatation of >20 mm was observed in two patients. Linear mixed model analysis revealed no alarming patch dilatation in the long term. Conclusions: Endarterectomy with an autologous patch for intermittent claudication owing to iliac artery endofibrosis in endurance athletes shows high rates of patient satisfaction and symptomreduction in both the short and long term. The risk of surgical complications or patch dilatation is mild. A surgical intervention for flow limitation of the iliac artery owing to endofibrosis is safe and successful.