Iliac artery endofibrosis #2b - diagnosis part 2

Find yourself a specialist

“I will have plenty of time to write” – two weeks have passed and not a single word posted. What can I say? I’m a busy man. 😉 Sorry about that. But hey, it’s the things you do that count, right? Not the things you don’t. So here I am, writing.

Last time, I left off at how to self-diagnose signs of iliac artery endofibrosis. That’s a great starting point for picking up early clues. However, to get a proper diagnosis, you’ll need to go to a hospital for specialized imaging. And I want to emphasize specialized. Iliac artery endofibrosis is a strange animal – it’s not a typical arterial disease. The symptoms often only appear under specific conditions: certain positions, high load and effort. That means you need to find a clinic with experience diagnosing cyclists, one that tailors its approach to your use case (you, the cyclist.)

MRI and Doppler

In both the Netherlands and Belgium, there are several hospitals with expertise in diagnosing iliac artery endofibrosis. Without diving into a review of each one – this isn’t meant to be a healthcare rating blog– I’ll just share my own experience: I was treated at the Flevoziekenhuis in Almere. Their diagnostic process included Doppler imaging and an MRI scan. In some clinics, they also incorporate exercise tests combined with blood pressure measurements. This approach is actually quite similar to the self-assessment I did earlier – just a bit more ‘sophisticated,’ of course.

Doppler imaging

During Doppler imaging, ultrasound is used to visualize blood flow in your arteries. The setup is quite similar to a prenatal ultrasound. However, instead of checking whether the baby has her nose or his nose, they’re looking for restricted blood flow. I highly suggest you bring your partner (if you have one). If you weren’t worried about your arterial health, it would almost be a romantic moment.

The imaging process involves checking your arteries in different positions: with your legs straight, at a 90-degree angle, and after some physical effort (in my case, 1–2 minutes of squats). The goal is to recreate the conditions under which you would experience symptoms while cycling. With your legs straight, blood flow is smooth and steady. At a 90-degree angle, a kink in the artery may cause turbulence. After exercise, this effect becomes more noticeable. They scan both the left and right sides and know exactly what flow patterns are normal and what patterns raise red flags.

MRI

Doppler ultrasound is usually the first step and often gives a strong indication if something is wrong. However, to pinpoint the exact location of a narrowing or kink in the artery, I underwent an MRI scan. During the MRI, they inject contrast fluid into your veins. This helps to clearly show your arteries and blood flow. They perform the scan both in a straight position and a fetal position. The fetal position mimics a cycling posture, which is when the kink or narrowing often becomes visible. In a straight position, everything might look normal.

That’s exactly why you need to see a specialist. Standard imaging can easily miss the issue if not done in the correct posture or with the right technique.

Going into MRI in fetal position feels a bit awkward.

The confirmation you were looking for

After the imaging is done, your doctor or surgeon will go over the results with you. In my case, I was shown the imaging of the kink in my artery, which is pretty cool actually. You see a visualization of your blood squeezing its way through the kinked section. This visual also left me with no doubt. Even with zero medical training, I could clearly see something was wrong. It looked like someone had twisted a garden hose. Poor leg.

The MRI doesn’t just confirm the issue. It also helps to pinpoint the exact location of the kink and helps to make a plan for surgery, which I’ll cover in the next post of this series.

Thanks for reading again, kisses from Watopia.💋😘 I’ve already done my first spins back on the bike, and it feels amazing to move again.