Comparison between duplex scanning and angiographic findings in the evaluation of functional iliac obstruction in top endurance athletes.
OBJECTIVE
Review of a 10 year-experience, to evaluate the efficacy of pre-operative investigations in the detection of external iliac artery (EIA) endofibrosis in top endurance athletes.


METHODS
Retrospective study.


METHODS
From September 1995 to March 2004, 13 highly-trained athletes (all men, mean age 32.3 years) underwent surgery for disease involving 14 lower limbs (11 left, one right, one bilateral).


METHODS
We compared ultrasound scan (US) and digital subtraction angiography (DSA) data, at rest and at hip flexion with intra-operative findings for all 14 lower limbs. We analyzed the presence of stenosis in the external and common iliac arteries, the presence of psoas muscle arteries and the presence of excessive EIA length.


RESULTS
In the affected limbs, before treatment, the mean ankle brachial index (ABI) at rest was 0.98 compared with 0.56 after exercise, p=0.0001. The sensitivities of the US vs DSA examination in the detection of external and common iliac artery stenosis were, respectively, 84.6 and 53.8% vs 53.8 and 12.5%. The muscle psoas artery was detected by DSA with a sensitivity of 57.1 and 100% specificity. For the detection of excessive EIA length, the sensitivity of US was 85.7% with 57.1% specificity.


CONCLUSIONS
A fall of ABI after exercise proves the presence of a significant stenosis in symptomatic athletes. Color coded duplex ultrasonography is recommended for non-invasive imaging of suspected endofibrotic stenosis in young athletes, since it detects reliably both stenosis and elongation of iliacal arteries.
Department of Vascular Surgery, University Hôpital Nord, Chemin des Bourrelly, 13915 Marseilles Cedex 20, France. yalimi@ap-hm.fr
Y S
YS
Alimi
F
F
Accrocca
P
P
Barthèlemy
O
O
Hartung
M
M
Dubuc
M
M
Boufi
D000328:Adult; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000601:surgery; D005355:Fibrosis; D006801:Humans; D007083:Iliac Artery / Q000473:pathology* / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D013177:Sports; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014656:Vascular Surgical Procedures / Q000379:methods