van Hooff M, Hegge MMJM, Bender MHM, Loos MJA, Brini A, Savelberg HHHCM, Scheltinga MRM, Schep G. Short- and Long-Term Results of Operative Iliac Artery Release in Endurance Athletes.
J Vasc Surg 2022;
75:1993-2001.e3. [PMID:
35085748 DOI:
10.1016/j.jvs.2021.12.082]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE
Endurance athletes may develop intermittent claudication due to sport-related flow-limitations of the iliac artery (FLIA) caused by arterial kinking. This study investigated short- and long-term efficacy of an operative release for iliac artery kinking.
METHODS
Between 1996 and 2015, all patients diagnosed and operated with FLIA due to iliac artery kinking without significant arterial stenosis (<15%) or excessive arterial length (vessel length to straight ratio <1.25) were included. Short-term follow up consisted of cycling tests including ankle-brachial index with flexed hip (ABIflexed) and echo-Doppler examinations (peak systolic velocity, PSV) before and 6-18 months after surgery. Additionally, short-term and long-term efficacy were evaluated using questionnaires.
RESULTS
A total of 142 endurance athletes (155 legs, 88.4% male, median age 26, (22-31; interquartile range)) were available for analysis. In the short-term, symptoms were reduced in 83.9% of the patients with an overall 80.3% satisfaction rate. Power during a maximal cycling test improved from 420 (384-465) to 440 (400-485) Watt (P<.05). Symptom free workload increased from 300 (235-352) to 400 (332-460) Watt (P<.001). Post-exercise ABIflexed increased from 0.53 (0.39-0.62) to 0.57 (0.47-0.64) (P<.05) and PSV with flexed hip decreased from 1.98 (1.58-2.51) to 1.60 (1.20-2.15) m/s (P<.001). Postoperative imaging revealed (minor) kinking in 37%, mostly a-symptomatic. Long-term results were evaluated after a median 15.2 (10.9-19.5) years. The athletes cycled an additional 125.500 (72.00-227.500) kilometres. This is approximately equal to the 131.000 (98.250-220.000) cycled kilometres before the diagnosis of FLIA. On the long-term, a total of 63.9% reported persistent reduction of complaints with an overall 59.1% satisfaction rate. Eight patients needed a reintervention of which six were considered failures and two were considered as newly developed FLIA.
CONCLUSION
An operative iliac artery release for sport-related functional kinking in the absence of stenosis of excessive vessel length is short-term and long-term effective in most athletes.
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