External iliac artery endofibrosis in females: Case reports and review of the literature

In the past four decades, reports of an unusual vascular disease affecting young and otherwise healthy endurance athletes have begun to emerge. This rare entity has been coined as external iliac artery endofibrosis (EIAE). It has been primarily described in high-level competitive cyclists, suggesting a biomechanical etiology given the repetitive flexion and extension of the hip joint associated with cycling.^1,2 Patients present with symptoms of claudication at peak levels of exertion, levels not usually achievable by the untrained individual. Lesions are predominantly isolated to the external iliac artery (EIA), and histologic examination reveals endothelial thickening and fibrosis without evidence of atherosclerosis.^1–5 Cases of EIAE have been overwhelmingly described in male athletes, with a paucity of reports in females.^2,3 We herein describe two cases of elite female athletes afflicted by EIAE and review the current literature pertaining to this entity in females. Both patients consented to publication of their case details and images.