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Thigh Claudication related to Occlusion of the Profunda Femoris Artery in a Competitive Cyclist
Mohyee Ayouty, Raghav Gupta, Ali Azizzadeh, NavYash Gupta
Cedars-Sinai Medical Center, Los Angeles, CA
Background: Lower extremity claudication in competitive cyclists due to iliac artery endofibrosis secondary to repeated compression is a relatively rare, but well described phenomenon. However, only two case reports of isolated occlusion of the profunda femoral artery (PFA) have been reported in these athletes and both treated conservatively. We report one such case including the surgical treatment and findings. A high level of suspicion for this etiology in symptomatic patients should be considered when the external iliac artery is found to be normal.
Methods: A 37-year-old avid cyclist presented with a five month history of right thigh claudication with thigh muscle weakness that he first noted after a bike race. Symptoms did not resolve with physical therapy. He was a non-smoker with no history of thrombotic or embolic disease and peripheral pulses were normal. The patient underwent arterial Doppler studies that included the patient bringing his bike trainer to the office which did replicate the symptoms. Ankle-brachial indices (ABIs) were normal bilaterally including with exercise, but the proximal PFA was noted to be occluded with distal reconstitution. CT angiography confirmed occlusion of the PFA with a normal appearing external iliac artery with no evidence of plaque. Transthoracic echocardiogram was normal. The patient underwent a right profunda femoral endarterectomy with bovine pericardial patch angioplasty. The thrombotic material in the artery appeared organized and chronic and there was no evidence of dissection of the blood vessel. Following surgery and recovery the patient had complete resolution of the right thigh symptoms and returned to cycling and other intense physical activities and remains symptom free over two years post operatively.
Results: Thigh claudication in avid cyclists has been described secondary to iliac artery endofibrosis due to repetitive trauma from a persistently flexed position during exercise, but there are only two case reports of isolated PFA occlusion in competitive cyclists with the etiology presumed to be a dissection or subtle plaque and both patients were treated conservatively. To our knowledge, this is the first such case that was treated operatively and intra-operative finding were not consistent with a dissection raising the possibility of in-situ thrombosis or endofibrosis from repetitive trauma. A high level of suspicion for this pathology is warranted in symptomatic competitive cyclists when the external iliac artery is found to be normal.
Conclusion: We present a case report of a competitive cyclist presenting with thigh claudication found to have isolated occlusion of the PFA who underwent endarterectomy with patch angioplasty with return to activity.
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