Surgical shortening of lengthened iliac arteries in endurance athletes: Short-term and long-term satisfaction

OBJECTIVE: Endurance athletes are prone to develop flow limitations in iliac arteries (FLIA). Especially in cyclists and ice speed skaters, excessive hemodynamic loading coupled with hip hyperflexion may cause kinking in lengthened iliac arteries necessitating surgical correction. This study investigated the short-term (≤1.5 years) and long-term (≥5 years) satisfaction of operative shortening of the iliac artery in endurance athletes.

METHODS: All patients that were diagnosed and operated for FLIA due to lengthened and kinked iliac arteries between 1997 and 2015 in one center were analyzed. Short-term follow up consisted of an incremental maximal cycling test, ankle-brachial index with flexed hips (ABIFlexed), echo-Doppler examination with peak systolic velocity (PSV) measurements and CE-MRA before and 6-18 months after surgery. Both short- and long-term satisfaction were assessed using questionnaires.

RESULTS: A total of 83 patients (90 operated legs; 96.7% males; median age 34 years at the time of surgery, interquartile range 29-47) were analyzed. In the short-term, 87.5% reported symptom reduction with an 86.4% overall satisfaction rate. Symptom-free cycling improved from 272±84 (mean±SD) Watt to 384±101 Watt (p<.001) whereas the maximal workload increased from 419±72 Watt to 428±67 Watt (p=.01). ABIFlexed increased from 0.55 (0.45-0.65) to 0.62 (0.52-0.74, p=.008), whereas PSV measured with hips flexed dropped from 2.50 (1.77-3.13) to 1.57 (1.20-2.04) m/s, p<.001). After a median of 12 (9.0-15.4) years, symptoms were still reduced in 84.1% of patients with an 81.2% overall satisfaction rate (79.5% response rate). Three patients needed a reintervention (recurrent FLIA, n=2; failure, n=1).

CONCLUSION: Operative shortening of a lengthened and kinked iliac artery causing FLIA is successful both in the short- and long-term.