External Iliac Artery Endofibrosis: A Rare Condition With Distinct Presentations

Backgroung: External iliac artery (EIA) endofibrosis is a rare, non-atherosclerotic condition affecting endurance athletes, commonly presenting as exercise-induced claudication. It is typically underdiagnosed and misattributed to musculoskeletal or neurological causes. Case Summary: We present our management of 3 cases of EIA endofibrosis in endurance athletes. The first patient, a 55-year-old male cyclist, underwent surgical revascularization for right EIA stenosis. The second case involved a 43-year-old female physical education teacher, who was treated with a prosthetic bypass graft for a loop configuration of the EIA. The third case, an amateur triathlete, presented with acute ischemia and underwent urgent revascularization using an interposition graft. All patients experienced complete resolution of symptoms and successfully resumed their athletic activities. Conclusion: EIA endofibrosis is an important consideration in athletes with exertional leg symptoms. Surgical treatment, including venous or prosthetic bypass grafts, is effective in relieving symptoms and ensuring long-term recovery. Early diagnosis is crucial to avoid complications, particularly in cases involving acute ischemia.