Athlete's iliac artery syndrome, first described in 1984, is a condition in which the iliac arteries, typically the external iliac, develop endofibrosis, leading to arterial stenosis and blood flow disruption during exercise. The syndrome can cause artery elongation, kinking, and, if untreated, total occlusion. Athletes involved in sports requiring frequent hip flexion, like running and cycling, are at increased risk.

Patients presenting with leg pain associated with sporting activities involving frequent hip flexion and in whom a diagnosis of athlete's iliac artery syndrome was made on the basis of duplex Doppler evaluation were prospectively followed up in this study. Outcomes measured were age, type of athlete and activity, symptoms, risk factors for peripheral arterial disease, special investigations, treatment strategies, response to treatment, and return to activity. Analysis of catheter-directed angiography in hip flexion was compared with a control group, and histology specimens were also studied in patients undergoing open repair.

A study of 32 patients with 45 limbs found 13 with bilateral disease and 19 with unilateral symptoms. The median age was 36 years, with 19 female patients, 14 professional athletes, and 9 elite amateurs. Conservative management outcome: Two patients with mild to moderate endofibrosis improved symptoms by altering saddle positions and converting to mountain biking. Surgery outcome with inguinal ligament release: A total of 13 limbs treated with an open external iliac vein patch and simultaneous inguinal ligament release showed no recurrence after a mean follow-up of 5.4 years. Surgery outcome without inguinal ligament release: Two limbs treated with a vein patch without inguinal ligament release experienced recurrence within 2 years, requiring further surgery. Inguinal release outcome: Of 14 limbs treated with inguinal release, 11 remained disease free with a mean follow-up of 3.3 years. Iliac stenting outcome: Iliac stenting, although initially relieving symptoms, resulted in recurrence in all seven limbs, necessitating more extensive procedures. Advanced disease outcome: Iliofemoral Dacron grafting with inguinal release for advanced disease showed mixed results, with one graft occluding and requiring reintervention, while others remained patent and allowed for continued exercise.

After surgery, athletes may return to peak performance within 3 to 6 months, though recurrences can occur. Some cases of recurrence have been successfully managed by addressing inguinal ligament compression. Further research is needed to clarify optimal treatment strategies and to better understand the condition's etiology.