Flow restrictions in leg arteries of endurance athletes are commonly caused by kinking and could be easily resolved by a straightforward surgical procedure, conclude authors of a study in this week’s issue of THE LANCET.
Endurance athletes—especially cyclists and speed skaters—often have restrictions in blood flow in their iliac arteries (the arteries supplying blood to the lower limbs) during exercise; these restrictions have previously been ascribed to intravascular lesions, with implications for invasive interventions such as iliac-artery-bypass surgery. Goof Schep and colleagues from St Joseph Hospital, Veldhoven, Netherlands, proposed that blood flow could also be restricted by kinking in the arteries, and that surgical release of these kinks might be an effective treatment.
The investigators prospectively studied 80 endurance athletes who had complaints suggestive of flow restriction in the iliac arteries of one (74 athletes) or both (6 athletes) legs. All athletes were either endurance cyclists or other athletes who used endurance cycling as part of their training schedule. Using vascular diagnostic tools, blood-flow restrictions were assessed by measurement of systolic pressure in the ankle after exercise; kinks in the iliac arteries were detected with echo-doppler and magnetic-resonance angiography. Surgery was offered to athletes diagnosed with arterial kinking as part of the study.
Kinks in the iliac arteries were diagnosed as the most important cause for flow limitation in 69% (40 of 58) of the legs with blood-flow restriction. 23 legs were operated on to remove the kinks; all athletes who had surgery reported subjective improvements which were confirmed by ankle blood-pressure measurements and improved performance on an exercise bicycle. 20 (87%) athletes were able to successfully return to their desired high level of competition.
Goof Schep comments: “Our sports-specific protocol is effective in detecting kinking of the iliac arteries as a cause for flow restriction. This cause for flow limitation had not been acknowledged in the past. Surgical treatment directed at the kinking is less invasive and therefore a better alternative to vascular reconstruction in the major subgroup of athletes that appear to have only minor intravascular abnormalities. The incidence of these abnormalities in top athletes is high, since 5 of the 25 Dutch athletes that were selected for the olympic games (Sydney 2000) in cycling and triathlon needed surgery to correct blood-flow restrictions.”
Contact: Dr Goof Schep, Sint Joseph Hospital, Department of Sports Medicine, PO Box 7777, 5500 MB, Veldhoven, Netherlands; T) +31 40 258 8000; F) +31 40 258 9495; E) gschep@sjz.nl or g.schep@wxs.nl
Journal
The Lancet