title: A Case of Endofibrosis Presenting with Embolic Symptoms in a 43-Year-Old Cyclist.
abstract: BACKGROUND
  Endofibrosis is a rare clinical entity that usually manifests as claudication in cyclists and other endurance athletes. We report a case of a 43-year-old cyclist presenting with pain and cyanosis of his toes due to an embolism to his left anterior tibial artery. The source of the embolus was found to be an ulcerated, endofibrotic plaque in his left common femoral artery.
  
  
  METHODS
  We performed an extensive literature search using the PubMed database and identified 60 results on endofibrosis. Eight articles described thrombosis relating to endofibrosis. None of the articles described an embolic phenomenon relating to endofibrosis. The following search terms were used: endofibrosis, embolic, emboli, embolism, "distal occlusion," cyanosis, thrombosis, and thrombus.
  
  
  RESULTS
  The patient is a 43-year-old male cyclist who presented with pain and cyanosis of his second and third toes on his left foot for 1 week. The affected toes had a dark-purple discoloration involving the tissue overlying the distal phalanges. Computed tomography angiography showed an abrupt occlusion of the left anterior tibial artery in the mid-calf with a non-calcified plaque in the left common femoral artery. There were no other signs of arterial disease. He underwent left common femoral endofibrosectomy with patch angioplasty that revealed an ulcerated endofibrotic plaque with mural thrombus.
  
  
  CONCLUSIONS
  This case demonstrates an unusual presentation of a rare clinical entity. While there have been previous reports of thrombosis associated with endofibrosis, to our knowledge this is the first reported case of endofibrosis presenting with embolic symptoms.
authors.affiliation: Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: csdecarlo@partners.org.
authors.forename: Charles S
authors.initials: CS
authors.lastname: DeCarlo
authors.affiliation: Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Spangler
authors.affiliation: Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Stableford
mesh_terms: D000328:Adult; D017130:Angioplasty / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001642:Bicycling; D000072226:Computed Tomography Angiography; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005355:Fibrosis; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D010496:Pericardium / Q000637:transplantation; D012039:Regional Blood Flow; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D016896:Treatment Outcome