Abraham P, Chevalier J M, Leftheriotis G, Saumet J L
Laboratoire d'explorations vasculaires et de medecine du sport, Centre hospitalo-universitaire, Angers, France.
Am J Sports Med. 1997 Jul-Aug;25(4):581-4. doi: 10.1177/036354659702500424.
The recent description of exercise-induced intimal fibrosis affecting mainly the iliac artery (and therefore usually described as external iliac artery endofibrosis) has dramatically changed the diagnostic approach of unexplained recurrent lower limb exercise pain, especially in cyclists. Because arterial disease is often associated with the aftereffect of various concomitant musculotendinous lesions, several months may pass before an arterial origin is suspected. The arterial origin of the pain must not be eliminated on normal ankle-to-arm index or normal Doppler velocity profiles at rest. Ultrasound examinations taken at rest may show the lesions in 80% of endofibrotic patients and allow for the diagnosis of popliteal entrapment syndrome during dorsiflexion of the foot. However, the hemodynamic consequences of a stenosis on the aortoiliofemoral axis can only be proved by measurement of the ankle-to-arm index after exercise. A cutoff of this index <0.5 provides an 85% sensitivity in the detection of endofibrosis. Invasive investigations (arteriography or angioscopy) will confirm the diagnosis before surgery is discussed. Although long-term results in endofibrosis are unknown, most of the surgically treated patients return to competition.
近期对主要影响髂动脉（因此通常称为髂外动脉内膜纤维化）的运动诱发内膜纤维化的描述，极大地改变了不明原因复发性下肢运动疼痛的诊断方法，尤其是在骑自行车的人群中。由于动脉疾病常与各种伴随的肌腱病变的后遗症相关，在怀疑动脉起源之前可能会经过数月时间。不能因静息时踝臂指数正常或多普勒速度曲线正常而排除疼痛的动脉起源。静息时的超声检查在80%的内膜纤维化患者中可显示病变，并能在足部背屈时诊断腘动脉压迫综合征。然而，主动脉-髂股轴上狭窄的血流动力学后果只能通过运动后踝臂指数的测量来证实。该指数低于0.5对内膜纤维化检测的敏感性为85%。在讨论手术之前，侵入性检查（动脉造影或血管内镜检查）将确诊。尽管内膜纤维化的长期结果尚不清楚，但大多数接受手术治疗的患者可恢复运动。
