Research Paper on External Iliac Artery Endofibrosis

Introduction

External Iliac artery Endofibrosis (EIAE) is a rare disease that affects youthful patients. It is common among athletes, especially cyclists (Lim et al., 2009). The disease attacks the external iliac artery and may sometimes spread to other parts of the human anatomy. The disease was initially described by Chevalier in 1986 in cyclists, and the number of cases of EIAE has increased over time (Venstermans et al., 2009). However, the disease is also common in other athletes such as runners, rowers, and rugby players. Very little is known about the pathophysiology of EIAE and its evolution (Nakamura et al., 2011). However, it is believed that this disease is exercise related, but its relationship with atherosclerosis is still unknown. The paper describes that symptoms associated with EIAE, its diagnosis, and its treatments.

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Most patients suffering from External Iliac Arterial endofibrosis begin by experiencing muscle cramps while they are cycling or training at high intensity. Some extreme cases have indicated their initial symptoms to be stomach cramps, which delayed their initial diagnosis since this is a rare symptom of the disease. The cramps are usually consistent during the intense exercise and usually worsen with time if the diagnosis is not done earlier. The muscle cramping is followed by swelling and pain that occurs in the thighs and buttock of the diseased side. The patient may experience loss of power on the affected leg during exercise.

The diagnosis of the disease may be hard and delayed since the symptoms appear very late near-maximal exercise. There are numerous techniques to the diagnosis of the disease, and they include Ultrasounds, Magnetic resonance imaging, and computed tomography. The use of ultrasounds in the diagnosis is quite hard since wavelengths are usually normal unless the patients have engaged in the intensive physical activity or subjecting them to hip movement a before the ultrasound is done. The presence of arterial kinking is an indicator that the patient is suffering from the disease. Computed tomography has been found to be the most effective method of diagnosing the condition since it can assess the luminal narrowing, clearly indicate kinking, and show abnormal elongation, if any.

There are two main treatment options available for the disease. These include conservative and surgical therapy, but the exact outcome of these treatments plans is yet to be determined (Venstermans et al., 2011). Conservative therapy comprises a change in the athletes' lifestyle, with the patient being forced to adjust their cycling or training plans for other athletes such as players (Ford et al., 2003). The cycling adjustment involves a change in the cyclists' posture, reduction of intensive workouts, or an end to cycling (Takach et al., 2006). Additionally, the athlete is supposed to reduce risks associated with excessive cardiovascular strain through avoidance of smoking and hyperhomocysteinemia examination (Giannoukas et al., 2006). The patient could also be introduced to medicine that lowers the cholesterol and antiplatelet levels in the body. Conservative therapy is a safer option compared to surgery which is invasive (Flors et al., 2012). However, most of the patients are competent professionals who may not be willing to end their careers after they get diagnosed with the disease.

There are several surgical therapists available for the treatment of External Iliac Arterial Endofibrosis. They are arterial release. Vessel shortening, endofibrosectomy, and interposition grafting (Bruneau et al., 2009).Pathological cause of the flow limitation determines the choice of the surgical operation to be carried out on a patient. These flow limitations include the presence of a long artery, external compression of the artery, and the presence of endofibrosis (Bucci et al., 2011). The most popular surgical therapy is the arterial release, which has been proven to be safe and poses no future complications after surgery. Endofibrosectomy is another form of surgical therapy which is non-invasive and has a quicker recovery chance and causes minimal harm to the muscle (Chir,2015). However, it is highly likely that it has short term effects and may lead to the reoccurrence of the disease in the future. Vessel shortening is an option in case the patient has an extremely elongated artery. Vessel shortening should be carried out with endofibrosectomy as a necessity (Politano et al., 2012). Additionally, another form of surgery that can be applied in the treatment of the disease if interposition grating. Interposition grafting is carried out when the vessel is of reasonable length, but there are substantial endofibrotic arteries (Willson et al., 2010). However, the use of prosthetic material in the grafts should be avoided unless there is no option available. Finally, even though surgical treatment has been described as the most effective method in the treatment of the disease, the long-term consequence of this treatment plan is yet to be determined.

Conclusion

In conclusion, EIAE is an uncommon condition that mostly occurs among older people that have smoked cigarettes for several years. However, since the 1980s, the disease has been reported among young people who are majorly cyclists. It is characterized symptoms such as muscle cramping which is the most common symptom. Rare cases have reported their initial symptom as stomach cramps. Diagnosis of the disease is difficult because the symptoms manifest themselves when the patient is under intense exercise. Ultrasound, MRI scans, and Computed tomography have been significant in the diagnosis of the diseases. Treatment of the disease is done through conservative therapy or surgery. Conservative surgery isinvasive, but it is never a good choice for elite athletes interested in professional competition. These athletes mostly opt for surgery which is done in four ways. Arterial release, vessel shortening, endofibrosectomy, and interposition grafting are some of the effective surgery options available for patients. However, the long-term efficacy of surgery is yet to be determined.

References

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