159-c : STENOSIS ARTERIA ILIACA: SYMPTOMS

Part 3: symptoms

Especially the group of Chevalier from Lyon has published over the years many updated publications about this disorder.  This deviation is most common in cyclists and skaters of high-level sports, at the top level for several years. The age at the onset of symptoms was on average between 25 and 30 years with peaks of 12 and 42 years. The riders often started intensive cycling at a young age (12-13 years) with  and at the time of onset of symptoms they cycled more than 50,000 to 60,000 km – often even exceeding 100,000 km. The condition, however, was also found in some cyclists who started cycling after their thirtieth year. Analysis of the 85 operated vessels in 72 athletes showed that the disease at the left twice as common as at the right and 13 times the disease was found, at the same time, at both sides. An explanation for the predominantly unilateral occurrence of the disorder is sought in an asymmetry when cycling. Cyclists generally have a stronger and a weaker leg, such as, inter alia, is deduced from differences in the size of both legs (5, 8). The location of the aorta is slightly left of the center and the position of left communis and the left externa are closer to the muscle psoas, so they are more likely to be involved. This could also explain the higher incidence of stenosis symptoms left over right. None of the patients was found to have an increased risk of vascular disease. This was reflected in blood pressure, smoking habits, serum cholesterol and family history.

(1)Steven Kruiswijk
(2) Bart Brentjens
(3) Reinier Honig
(4) Annemiek van Vleuten
All of them, sometimes more than once, operated upon for a pinched iliac artery.

SYMPTOMS

The complaints as a result of the narrowing of the iliac artery can be compared  with those of exertion ischemia or oxygen deficiency in the leg. The cyclist may feel like the cycling pants are too tight, as if they pinch. He may feel that he has a thick, heavy leg, a feeling that each rider is well familiar with, but that is certainly not always the result of the condition described herein. Maximum complaint consists of a crippling fatigue, starting in the thigh and expanding to the whole leg. The symptoms are often described as “my leg blocks, it will function no longer”.  The typical complaints, the crippling feeling, the heavy, thick leg, usually occur quite abruptly during intense, almost maximal efforts such as during a time trial and riding uphill.

For the cycling performance of the rider this means that he has no complaints in the peloton and can easily follow. But if suddenly a major effort is prompted, including a breakaway, a sprint or a steep climb, the complaints will come up  and the rider cannot stay in the peloton. On that basis, it makes sense that good performance or striking results can no longer be realized. During more constant heavy efforts like a time trial or riding in the lead, the performance will not be sustainable because of the crippling sensation in the leg. Once they ride slower the symptoms disappear again, which constitutes an important case history to make the diagnosis.

Moreover, the complaints are almost always one-sided at the same affected leg. The cyclist will compensate the stenosis  and / or burden them asymmetrically, which can cause a range of atypical symptoms: such as low back pain, pseudoradicular complaints or pelvic inclined position with consequent problems. These atypical symptoms may hinder the proper diagnosis because treatment of these complaints brings some relief which may lead to the conclusion that the underlying problem is a back problem instead of a stenosis of  the arteria iliaca.