Exercise-induced iliac artery endofibrosis is a recently described abnormality of the
external iliac artery that typically affects younger, healthy endurance athletes.
Characteristic of the initially termed cyclist’s iliac syndrome is lower limb pain
during exercise with rapid recovery after exercise. This clinically complicated case
describes an older female long-distance runner in whom an incorrect diagnosis of
fibromuscular dysplasia was originally made when she presented with claudication
and thrombosis of the right external iliac artery. A thrombectomy and bilateral
balloon angioplasty were performed; however, her symptoms persisted. Four
months later, she unexpectedly complained of dual calf claudication, a diagnosis of
exercise-induced iliac artery endofibrosis was made, and a bilateral prosthetic graft
bypass procedure was performed, which resulted in a good outcome.