Flow limitations in the iliac arteries of endurance athletes during
exercise were previously ascribed solely to intravascular lesions. We postulate
that functional kinking of the arteries can also result in flow limitations.
However, the diagnostic tools in routine practice are not effective in
diagnosing such flow limitations in a substantial proportion of athletes,
mainly because these diagnostic tools do not measure in the provocative
situations. Ninety-two symptomatic legs in 80 endurance athletes were examined
with newly developed, sports-specific vascular tests. Thirty-five asymptomatic
cyclists matched for working capacity served as the control subjects. Legs were
classified as vascular or non-vascular following a decision algorithm, based
upon the results of these diagnostic tests, excluding orthopaedic causes by the
effects of specific treatment. Independently of this clinical classification,
an alternative method was applied to find stable characteristics in the total
patient group using factor analysis. This characterisation was based on scores
on 14 test variables deriving from diagnostic tests that were not used in the
decision algorithm, thus avoiding dependency between the clinical
categorisation and the statistical categorisation. The hypothesis was that
these characteristics were sufficiently sensitive to classify patients with
vascular and non-vascular complaints. If so, these characteristics should
correspond with the one derived from the decision algorithm. Following the
decision algorithm, 58 legs (63 %) were classified as vascular,
29 (32 %) as non-vascular and 5 (5 %) as
inconclusive. The latter were considered non-vascular. In a substantial
proportion of the vascular patients, kinking of the iliac arteries was
identified as the major cause of flow limitation. The characteristics derived
from factor analysis proved to classify 87 % in agreement with
the decision algorithm (kappa 0.56). The agreement is sufficient for validation
of the clinical classification. The algorithm can therefore be applied in
clinical situations to diagnose endurance athletes with flow limitations due to
both intravascular lesions and kinking of the arteries.
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