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Medical History

Pt is a 41 yo female avid athlete who enjoys long distance running and cycling. C/o 7 month h/o right lower extremity claudication after 60-90 minutes of intense cycling or running. Reports right leg numbness and coolness. No symptoms at rest. Medical History. Left foot surgery 2006

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Medical History

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  1. Pt is a 41 yo female avid athlete who enjoys long distance running and cycling. C/o 7 month h/o right lower extremity claudication after 60-90 minutes of intense cycling or running. Reports right leg numbness and coolness. No symptoms at rest.

  2. Medical History Left foot surgery 2006 Bicuspid aortic valve

  3. Imaging • Duplex: Exercise ABI • Right 1.15 to 0.27 • Left 1.3 to 0.88 • CT angiogram: Narrowed Right external iliac artery

  4. Operation: • Right external iliac artery endarterectomy with vein patch angioplasty

  5. Exercise Associated lower extremity arteriopathy in avid cyclists: Early longitudinal results K Cherry et al, SVS abstract 2008 • Retrospective analysis of 8 avid cyclists with lower extremity claudication • 6 males, 2 females (mean age 35) • c/o thigh and calf claudication with maximal exertion • Avg time to onset 11 years and 342 miles/week • Normal resting ABI and drop in exercise ABI <0.8 • Treatment ( dacron patch angioplasty, 3 inguinal ligament release, 2 iliofemoral bypass, partial resection and patch angioplasty) • All with inguinal ligament release • Of the 11 arterial reconstruction, 8 (73%) was patent, 23% stenosis

  6. Obstructive external iliac arteriopathy in avid bicyclists: New and variable histopathologic features in four women K Cherry et al, JVS 2002; 36: 565-70 • Retrospective analysis of 4 competitive cyclists undergoing resection and graft placement for segmental external iliac artery disease at Mayo Clinic from 1991-2001 • 4 females (mean age 36, range 24-37), onset 10-13 yrs • c/o lower extremity claudication with maximal exertion, significant drop in ABI with exercise, bruits (60%) • Preoperative angiography showed stenotic disease (40-85%) • Gross examination: wall thickening (smooth cell hyperplasia) and luminal narrowing without aneurysm formation • Adventitial thickening • Hypothesis of injury: high blood flow and mechanical stress of the cycling position

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