Endofibrosis of the external iliac artery is an unusual condition associated with competition cyclists. There seems to be a good prognosis after surgical therapy, consisting of endarterectomy and vein patching in combination with resection if the artery is lengthened. However, absence of well-documented long-term follow-up studies makes surgical treatment controversial. The authors describe four new patients with endofibrosis of the external iliac artery (EIA) with a review of relevant literature.