External iliac artery endofibrosis is a rare disease affecting mainly highly trained cyclists. As the disease has only recently been described, the long term spontaneous evolution of external iliac artery endofibrosis is not known. We report a suspected case of forty-year spontaneous evolution of endofibrosis in a former competition cyclist. The results of this isolated original report suggest, as we intuitively presumed, that the lesions may stabilise when intensive training is stopped. Therefore, when no symptoms are noted on usual daily activity or submaximal exercise, surgery should not be performed. Surgery should only be considered, at the request of the subjects to allow them to continue competing.