Progressive stenosis of the iliac artery, known as iliac artery endofibrosis, is poorly recognized by primary care physicians. It is mainly found in male endurance cyclists who are younger than 40 years of age.^1,2 Because vascular disease is unexpected in these athletes, an arterial insufficiency syndrome is often missed; instead, lower limb and sometimes buttocks pain is attributed to musculoskeletal or neurologic causes. Nonatheromatous functional “kinking” along with stenosis or endofibrosis is the main culprit for claudication.^3–7

The condition is almost certainly underdiagnosed in Canada owing to a lack of recognition and no clear unified strategy for the assessment and management of these patients. The delay in diagnosis is profound, averaging between 12 and 41 months, and diagnosis usually occurs only after many months of failed physiotherapy.¹ The failure to diagnose and treat iliac artery endofibrosis in young athletes has career and social implications that could be markedly reduced with better awareness of the condition among family doctors. According to our literature review completed in February 2015, there are no Canadian data published on this high-yield condition.