Return to Sport After Two Sequential Iliac Artery Reconstructions in an Elite Cyclist: A Case Report
Infographic and supplementary materials
Plain language summary
Flow Limitations in the Iliac Arteries (FLIA) is a condition in which the main arteries to the legs become narrowed or kinked. It mostly affects high-level cyclists and causes leg pain and loss of power during hard efforts. This report follows a 19-year-old national-level cyclist who had surgery to repair the artery in his left leg after a year of symptoms. We implemented a return-to-sport (RTS) program for the athlete, however, while he was rebuilding before he could resume competition, the same symptoms appeared in his right leg. He had a second operation about six months later.
During both recoveries, performance tests on his own bike helped to monitor his progress and rule out any red flags. This included Ankle-brachial blood pressure index (ABI) after maximal effort, and wearable muscle oxygenation (near-infrared spectroscopy; NIRS) sensors that measure how quickly leg muscles recover oxygen after hard exercise. The results matched how his legs felt and performed, and helped clinical and coaching decision making when he could train harder.
The team learned valuable lessons from the first RTS process which helped to improve the second: clearer information about what the patient, coach, and clinical support team should expect; a more gradual build-up of training volume; flexible progression criteria instead of fixed ones; and scheduling surgery early rather than waiting to complete the season, to give more time to recover before returning to racing next season.
The athlete has since returned to racing and is satisfied with both operations. This case also shows that both legs should be assessed, because the more painful leg can hide a problem in the other leg.
Access the supplementary return-to-sport template below. A link to a code repository reproducing the manuscript Figure 2 is at the bottom.
Supplementary return-to-sport template
Code repository
github.com/jemarnold/sequential-return-to-sport-after-iliac-artery-surgeries