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External Iliac Artery Endofibrosis

External iliac artery endofibrosis is an unusual problem which occurs in patients who are marathon runners, cyclists, triathletes. Although the exact cause of the problem is unclear, the mechanism of arterial damage is thought to be related to the repetitive motion of hip flexion. These patients develop scarring or fibrosis in their external iliac artery, which is a large blood vessel in the pelvis which supplies flow to the leg. If the artery narrows enough, they will have muscle cramps, pain, or weakness in that leg when they exercise (claudication). Most of these patients are young. Balloon angioplasty and stenting is not the preferred treatment because it is not as durable as surgery. I like to access the external iliac artery through an extraperitoneal approach. I perform an endarterectomy and vein patch angioplasty. I believe this provides the best long term solution for these patients. These intraoperative pictures show a patient's left external iliac artery before and after treatment. The left ureter is retracted, the fibrotic lesion is removed by endarterectomy, and the arteriotomy is covered with a saphenous vein patch. This particular patient remains asymptomatic three years after surgery.

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