PMID- 36334847 OWN - NLM STAT- MEDLINE DCOM- 20230124 LR - 20230202 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 77 IP - 2 DP - 2023 Feb TI - Surgical shortening of lengthened iliac arteries in endurance athletes: Short-term and long-term satisfaction. PG - 588-598.e3 LID - S0741-5214(22)02334-5 [pii] LID - 10.1016/j.jvs.2022.10.001 [doi] AB - OBJECTIVE: Endurance athletes are prone to develop flow limitations in iliac arteries (FLIA). Especially in cyclists and ice speed skaters, excessive hemodynamic loading coupled with hip hyperflexion may cause kinking in lengthened iliac arteries necessitating surgical correction. This study investigated the short-term (/=5 years) satisfaction of operative shortening of the iliac artery in endurance athletes. METHODS: All patients who were diagnosed and operated for FLIA owing to lengthened and kinked iliac arteries between 1997 and 2015 in one center were analyzed. Short-term follow-up consisted of an incremental maximal cycling test, ankle-brachial index with flexed hips, echo-Doppler examination with peak systolic velocity measurements and contrast-enhanced magnetic resonance angiography before and 6 to 18 months after surgery. Both short- and long-term satisfaction were assessed using questionnaires. RESULTS: A total of 83 patients (90 operated legs; 96.7% males; median age of 34 years at the time of surgery; interquartile range [IQR], 29-47) were analyzed. In the short-term, 87.5% reported symptom reduction with an 86.4% overall satisfaction rate. Symptom-free cycling improved from 272 +/- 84 W to 384 +/- 101 W (P < .001), whereas the maximal workload increased from 419 +/- 72 W to 428 +/- 67 W (P = .01). The ankle-brachial index with flexed hips increased from 0.55 (IQR, 0.45-0.65) to 0.62 (IQR, 0.52-0.74; P = .008), and the peak systolic velocity measured with hips flexed decreased from 2.50 m/s (IQR, 1.77-3.13 m/s) to 1.57 m/s (IQR, 1.20-2.04 m/s; P < .001). After a median of 12 years (IQR, 9.0-15.4 years), symptoms were still decreased in 84.1% of patients with an 81.2% overall satisfaction rate (79.5% response rate). Three patients needed a reintervention (recurrent FLIA, n = 2; failure, n = 1). CONCLUSIONS: Operative shortening of a lengthened and kinked iliac artery causing FLIA is successful both in the short- and long-term. CI - Copyright (c) 2022 The Authors. Published by Elsevier Inc. All rights reserved. FAU - van Hooff, Martijn AU - van Hooff M AD - Department of Sports and Exercise, Maxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands; Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, Maastricht University Maastricht, Maastricht, Limburg, The Netherlands. Electronic address: m.vanhooff@mmc.nl. FAU - Frenken, Deafvon AU - Frenken D AD - Department of Sports and Exercise, Maxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands. FAU - Bender, Mart AU - Bender M AD - Department of Vascular Surgery, Maxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands. FAU - Loos, Maarten AU - Loos M AD - Department of Vascular Surgery, Maxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands. FAU - Brini, Alberto AU - Brini A AD - Department of Mathematics and Computer Science, Faculty of Statistics, Eindhoven University of Technology, Eindhoven, Noord-Brabant, The Netherlands. FAU - Savelberg, Hans AU - Savelberg H AD - Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, Maastricht University Maastricht, Maastricht, Limburg, The Netherlands. FAU - Schep, Goof AU - Schep G AD - Department of Sports and Exercise, Maxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands. FAU - Scheltinga, Marc R AU - Scheltinga MR AD - Department of Vascular Surgery, Maxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands. LA - eng PT - Journal Article DEP - 20221109 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Male MH - Humans MH - Adult MH - Female MH - *Iliac Artery/diagnostic imaging/surgery/pathology MH - *Athletes MH - Magnetic Resonance Angiography MH - Leg/blood supply MH - Bicycling OTO - NOTNLM OT - Arterial shortening OT - Endurance athletes OT - FLIA OT - Iliac artery OT - Surgical technique EDAT- 2022/11/06 06:00 MHDA- 2023/01/25 06:00 CRDT- 2022/11/05 20:34 PHST- 2022/06/30 00:00 [received] PHST- 2022/09/30 00:00 [revised] PHST- 2022/10/03 00:00 [accepted] PHST- 2022/11/06 06:00 [pubmed] PHST- 2023/01/25 06:00 [medline] PHST- 2022/11/05 20:34 [entrez] AID - S0741-5214(22)02334-5 [pii] AID - 10.1016/j.jvs.2022.10.001 [doi] PST - ppublish SO - J Vasc Surg. 2023 Feb;77(2):588-598.e3. doi: 10.1016/j.jvs.2022.10.001. Epub 2022 Nov 9.