There was a time in the early 90s or so when pretty much every single doctor in France, who was a cardiologist, or something related and who was seeing cyclists on a regular basis, would be telling guys that roughly after 200,000km to 300,000km you would bet EIAE and would need surgery. It was a certainty. You can find a lot of stuff on that. Of course, it's not a certainty anymore.

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Heath Dotson
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I´m sorry to hear your story. I got a little worried when I read what you said about time trialling. Because since having surgery, I´m ok running, my oxygen uptake seems better than ever, but I´m not satisfied with my speed on the bike. I run just as fast as I did before experiencing my first symptoms, but I´m nowhere as fast on the bike. Riding at paces close to aerobic threshold seems ok, but I have a hard time pushing myself above anaerobic threshold before my legs give in. Of course, I don´t weigh much and even less now than before, so I thought that might be the reason. My comfort in this would be that since I specialize on half and full distance, it probably won´t bother me during races. But I obviously don´t want it to get worse.
Anyway, regarding the surgery. I had almost no pain. I was up walking the next day, and two days after the surgery I took a one hour walk. On day three I walked for three hours with a heart rate monitor. After two weeks I started riding in an upright position, after four weeks I started jogging, and after six weeks I was training all out. I do mean all out, I went right away and did a stair workout just to test my leg, raising my HR to 190. I´m not saying it was the correct approach, but what I want to say is that it doesn´t necessarily take long to recover.
Of course, my surgeon told me that because I´m so skinny, they could do a cross-incision (or whatever the correct term is) along the psoas muscle fibres, which makes the cut in the muscle a whole lot smaller. Then they did a enderarterectomy with a vein patch - and moved the iliac artery a bit to the left so it wouldn´t be on top of the psoas muscles.
It´s also a correct observation that the external iliac artery feeds the quadriceps. When I was at my worst, I could still do some very easy cycling and jogging if I focused on using only my gluts and hamstrings in my left leg, turning off my quads. It felt easier sitting upright, but I do think that the foremost reason for that is just that you use your gluts and hamstrings more in that position. Before it got worse, I could also run at an aerobic level more comfortably if I leaned backwards a bit.
Running feels ok now. But I first felt my symptoms running, during a 10K run. I was really pushing myself up a hill and then suddenly I lost all power in my left leg.
I just went to the surgeon today. He scanned my pulse with ultra sound and said that the left and right leg pulse waves were symmetrical. He didn´t think I would need new surgery, but only time will tell. I´m just enjoying one day at a time, doing my best. As long as I can train, race, make progress and achieve results which satisfy me I guess I will have to accept that the condition may limit my maximum performance.

Bumping this because I've been having some issues in my right hip. My chiro palpated a painful lump on top of my R femoral artery while doing some ART - she doesn't think it is muscle or tendon related. I've been having pain while running only (walking, cycling, hip flexion, aqua jogging) and no loss of power as cited above.

This injury came on rather quickly about 8 weeks ago and has improved a bit but I haven't really been able to run since. I have been cleared of stress fractures.

I'm curious if anyone here has experience with these symptoms. Before you say it, yes I will be continuing to seek a professional diagnoses but this is Canada - public health care takes a while!!

Thanks, Ian

Nope. That´s not endofibrosis. There´s no single painful spot, no swollen bumb or anything. The ischemic pain and cramping is universal in the leg, but depending on wether it´s the internal or the external iliac artery that is affected (or both) it concentrates either on the posterior or anterior thigh and calves.

This is an issue I might possibly have, but I have put off investigating it further as I have other things I want to do with my money.

I have also been suffering quite bad from cramp in just about every big race since ironman nz 2006. Every big race since then I have cramped at some point, sometimes extremely badly, so I'm not sure if there is any relation there, but just putting it out there. Cramps have occurred most often in adductors.

The last time I did a big bike race (200km and very hilly) I had more electrolytes than ever and yet cramped earlier than ever before. Around 2 months later during a ride I had so much pain I had to pretty much do half a 3 hour ride one legged. It's in my left leg too. Same thing happened in another ride 2 weeks later so decided to flag cyclin for a while and just swim (it band issues had also presented themselves some 10 months earlier, as well as knee issues - these were preventing me from running).

I've gone to see a sports med specialist and he thought this might be an issue. So he sent me off to get ultrasound. Ultrasound came back 'clean'. Didn't seem to be any kinks or dents from an interpretation of the data. I had been getting numbness and loss of strength in my left leg on and off earlier in year, including whilst lightly kicking during swimming! I've now started cycling again (up to 3 hours) and my left leg does feel quite a bit weaker than my right still, but the pain hasn't come back to any great degree again. I'm running over an hour now as well...

So for the moment, I'm just going to see how things go. Loss of power in my left leg has always been an issue for me in races. I guess it may be that if I don't want to spend the money to investigate it further and have it fixed, that I just have to accept my performance is going to be compromised.

If it gets back to the stage at which it was towards the end of last year, I may just have to look into getting it looked at again as I'd like to be able to keep doing this sport!

I can´t do any diagnosis based on your description, but I can tell it´s well worth checking it out, because an eventual kinking would seriously inhibit your performance. I just don´t know, though. Endofibrosis usually causes symptoms at maximal effort, and probably doing intense work with your hip flexors. It´s always like on and off, you go hard out and it starts cramping, but when you back off the symptoms disappear leaving no pain. It causes no problem even during prolonged training sessions at low intensity, but it can be more bothersome starting off before your blood gets flowing through alternate routes, only too ease when you´ve warmed up. And it can get worse when dehydrated and/or tired.

hi Heath, i read your article on the problem you had with external iliac artery endofibrosis. have you had an operation yet?

i am an elite triathlete and road cyclist and the same problem started 6 years ago. i was misdiagnosed all this time and couldnt find a solution. finally, last week, i saw a vascular surgeon and he picked up the problem straight away as he had operated on other cyclists with the same condition.

i am amazed it has been found and now am on the right track. the pain is immense when i cycle and run at medium to high intensities in the quadriceps and also a huge lack of power and go into red zone long before anyone else. it is so painful and so frustrating.

the surgeon said he will operate. i am in the process of organising for that.

just thought i would share my story with you and get some support over the internet and learn a bit more about the condition from other athletes.

i dont want to give up the bike, its my life and my passion. so i will go for the op.

regards, Greer

While I have very mild endofibrosis on my right side, a more recent CT scan showed significant kinking when I bend my legs. I was the first one they ever put into the CT in the legs bent position. It's really quite amazing how clearly defined the kinks were on the CT. The ABI on the left was about 0.62, while the right was about 0.9. So 8 weeks ago, I had surgery on my left side. The doctor shortened both my femoral and external illiac arteries. I've been able to hike and jog for a few weeks and I get back on the bike this week, so we'll soon see how well it worked. In the meanwhile, I did an ABI test on a treadmill. Both left and right ABI's were over 1.1, so we know that running doesn't cause a loss of blood flow for me. I'll try to remember to post the results of my next on-bike ABI test. Fingers crossed for a more normal ABI on the left!