Case Report

By Dr. Sarwan Kumar , Dr. Deepak Gupta , Dr. Shiva S Rau
Corresponding Author Dr. Sarwan Kumar
Wayne State University, Internal Medicine, - United States of America
Submitting Author Dr. Deepak Gupta
Other Authors Dr. Deepak Gupta
Anesthesiology, Detroit Medical Center/Wayne State University, Box No 162, 3990 John R - United States of America 48201

Dr. Shiva S Rau
Wayne State University, Internal Medicine, - United States of America


Vascular Insufficiency, Cyclists

Kumar S, Gupta D, Rau SS. Calcific Arterial Changes in an Avid Cyclist: An Evolving Vascular Insufficiency. WebmedCentral SPORTS MEDICINE 2011;2(3):WMC001816
doi: 10.9754/journal.wmc.2011.001816
Submitted on: 31 Mar 2011 12:53:05 AM GMT
Published on: 31 Mar 2011 06:51:49 PM GMT

Case Report(s)

A 72-year-old Caucasian male presented to the emergency room with a laceration to his left thigh after falling on a piece of glass. The bleeding was partially controlled by local pressure and the patient did not report any muscle weakness or loss of sensation in the left lower extremity. The patient never saw any primary care physician. There was no past medical or surgical history. There was no tobacco, alcohol or recreational drug abuse. The patient lived independently and was an avid cyclist who was used to biking 10 miles per day for decades. On examination, a 3 inch laceration was noted on his left lateral thigh that was apparently deep. However, he had good peripheral pulses, motor power and intact sensation in his left lower extremity. His left femur skiagrams were reviewed for any foreign bodies. Incidentally, the skiagrams revealed arterial calcifications in the left thigh and popliteal fossa. There was a left testicular arterial calcification seen in the scrotal area. Based on these incidental findings, the patient’s history was reviewed again and the patient was more forthcoming with the complaints of intermittent claudication in the lower extremities after strenuous bicycling that used to resolve after rest. It was explained to the patient the need to follow up with a primary care team upon discharge from the emergency room for the workup and management of this evolving pathological endovascular process in his lower extremities secondary to the exposure of the iliac artery to recurrent compressive trauma by the fibrous tissue and hypertrophied muscles in the cyclists.


Recent reviews of literature by Lim et al [1] and Willson et al [2] summarized the patho-physiology and management of the iliac artery compression seen in cyclists. The iliac artery is exposed to recurrent compressive trauma by the fibrous tissue and hypertrophied muscles in the cyclists. The patient may be asymptomatic except during maximal exercise while cycling. The diagnosis can be confirmed with color duplex and angiography (non-invasive and invasive). The condition can be conservatively managed with posture and bicycle setup adjustments. There is limited evidence for surgical and endovascular treatment; and the use of the endovascular prosthetic devices should be avoided [1]. Because of the rarity of disease, international registry like ‘Iliac Artery Compression Syndrome Registry’ [3] can be a useful tool for research purposes in this subset of patients.


In summary, iliac artery compression can be an incidental finding in an avid cyclist who like any other endurance athlete may not have the ongoing atherosclerotic pathological processes in the body but recurrent mechanical trauma to the lower extremities may present with symptoms of occlusive vascular disease.


1.Lim CS, Gohel MS, Shepherd AC, Davies AH. Iliac artery compression in cyclists: mechanisms, diagnosis and treatment. Eur J Vasc Endovasc Surg. 2009 Aug;38(2):180-6.
2.Willson TD, Revesz E, Podbielski FJ, Blecha MJ. External iliac artery dissection secondary to endofibrosis in a cyclist. J Vasc Surg. 2010 Jul;52(1):219-21. 
3. Joint Vascular Research Group UK,

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Competing Interests



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