Arterial endofibrosis is a non-atherosclerotic lesion affecting the external iliac, as well as the common iliac and common femoral arteries. This lesion is most often seen in competitive cyclists and is thought to arise from repetitive damage to the vessel wall due to hemodynamic and mechanical stress (1). The typical patient presentation involves lower extremity pain, cramping, and decrease in power during high intensity effort (1). Ankle to brachial pressure index after maximal exercise and MR angiography are typically used in the initial diagnosis. DSA is typically reserved for patients considering surgical treatment. DSA provides important diagnostic information via provocative maneuvers (hip flexion) and measurement of pressure gradients across the lesion.

A few examples will be presented of high performance athletes who underwent conventional angiography for the evaluation and preoperative workup for iliac artery endofibrosis. Intra-procedural images will be used to demonstrate the technique and associated provocative maneuvers. CTAand MRA images will also be employed to demonstrate the preoperative and postoperative findings.

Angiography is a valuable technique in the evaluation of high performance athletes with flow limiting iliac artery endofibrosis.