ObjectivesEndoluminal fibrosis is a rarely described cause of exertional claudication in athletes. It typically is located to the external iliac artery,but has been described in the femoral segment as well. Rare reports have described arterial changes as a nidus for microembolic disease.MethodsCase report.ResultsA 20-year-old male presented to the emergency department with 3 months of worsening right calf claudication. He reported a history of lupus anticoagulant, not currently being treated. He was a semi-professional soccer player and very physically active until symptom onset. The patient intermittently vaped. On physical exam, he had non-palpable pulses throughout the right leg with strongly palpable pulses throughout the left. Focal fixed petechiae were noted on the right toes. Duplex ultrasound showed focal high-grade stenosis of the right common femoral artery, and a subsequent CT angiogram demonstrated near-occlusion of a segment of the common femoral and a very small diameter (3 mm) right external iliac artery (Fig 1). All other lower extremity arteries were patent. Due to concern for a thromboembolic source, we performed a right iliofemoral endarterectomy with patch angioplasty. Intraoperatively, a dense, nearly occlusive rubbery mass at the external iliac-common femoral junction was identified (Fig 2). Pathology showed benign myxoid myofibroblastic proliferation, without signs of atherosclerosis. The intraoperative findings at this point suggested an endoluminal fibrosis with distal embolization. Palpable pedal pulses were restored. CTA was repeated 2 months postoperatively which demonstrated patency of the endarterectomy and normalization of the right external iliac diameter. The patient had been placed on warfarin and hydroxychloroquine with symptom resolution.ConclusionsFig 2Intraoperative appearance of iliofemoral fibrosis.View Large Image Figure ViewerDownload Hi-res image Download (PPT) ObjectivesEndoluminal fibrosis is a rarely described cause of exertional claudication in athletes. It typically is located to the external iliac artery,but has been described in the femoral segment as well. Rare reports have described arterial changes as a nidus for microembolic disease. Endoluminal fibrosis is a rarely described cause of exertional claudication in athletes. It typically is located to the external iliac artery,but has been described in the femoral segment as well. Rare reports have described arterial changes as a nidus for microembolic disease. MethodsCase report. Case report. ResultsA 20-year-old male presented to the emergency department with 3 months of worsening right calf claudication. He reported a history of lupus anticoagulant, not currently being treated. He was a semi-professional soccer player and very physically active until symptom onset. The patient intermittently vaped. On physical exam, he had non-palpable pulses throughout the right leg with strongly palpable pulses throughout the left. Focal fixed petechiae were noted on the right toes. Duplex ultrasound showed focal high-grade stenosis of the right common femoral artery, and a subsequent CT angiogram demonstrated near-occlusion of a segment of the common femoral and a very small diameter (3 mm) right external iliac artery (Fig 1). All other lower extremity arteries were patent. Due to concern for a thromboembolic source, we performed a right iliofemoral endarterectomy with patch angioplasty. Intraoperatively, a dense, nearly occlusive rubbery mass at the external iliac-common femoral junction was identified (Fig 2). Pathology showed benign myxoid myofibroblastic proliferation, without signs of atherosclerosis. The intraoperative findings at this point suggested an endoluminal fibrosis with distal embolization. Palpable pedal pulses were restored. CTA was repeated 2 months postoperatively which demonstrated patency of the endarterectomy and normalization of the right external iliac diameter. The patient had been placed on warfarin and hydroxychloroquine with symptom resolution. A 20-year-old male presented to the emergency department with 3 months of worsening right calf claudication. He reported a history of lupus anticoagulant, not currently being treated. He was a semi-professional soccer player and very physically active until symptom onset. The patient intermittently vaped. On physical exam, he had non-palpable pulses throughout the right leg with strongly palpable pulses throughout the left. Focal fixed petechiae were noted on the right toes. Duplex ultrasound showed focal high-grade stenosis of the right common femoral artery, and a subsequent CT angiogram demonstrated near-occlusion of a segment of the common femoral and a very small diameter (3 mm) right external iliac artery (Fig 1). All other lower extremity arteries were patent. Due to concern for a thromboembolic source, we performed a right iliofemoral endarterectomy with patch angioplasty. Intraoperatively, a dense, nearly occlusive rubbery mass at the external iliac-common femoral junction was identified (Fig 2). Pathology showed benign myxoid myofibroblastic proliferation, without signs of atherosclerosis. The intraoperative findings at this point suggested an endoluminal fibrosis with distal embolization. Palpable pedal pulses were restored. CTA was repeated 2 months postoperatively which demonstrated patency of the endarterectomy and normalization of the right external iliac diameter. The patient had been placed on warfarin and hydroxychloroquine with symptom resolution. Conclusions