You are only as strong as your weakest leg

About my iliac artery endofibrosis surgery

Live life update: recovering on the couch after some plumbing work on my left leg. Read: I had surgery to fix iliac artery endofibrosis in my left leg. In normal wording – my left iliac artery was kinked and narrowed. This caused reduced blood flow in my left leg. It is a relatively common condition in cyclists. Many (pro)-cyclists have dealt with it. Some recent examples you might have heard of are Marianne Vos and Fabio Jakobsen. You can develop it due to a combination of (unlucky) anatomy and repetitive hip flexion that comes with high volume training in cycling.

No tutti frutti Fanta cheering me up last week.

But you were going pretty well?

It might seem like yes, but no. First, rule #1: as an athlete you don’t talk about your doubts and weaknesses. Everyone is always bothered by something, whether it is a blister or something more serious. You don’t talk about it so as not to make the competition any wiser – but more importantly, to not talk yourself down. Focusing on the negative will not help your training and only drives you crazy. I am sure you can talk yourself into an injury without actually physically suffering from one.

Second, indeed I was pretty fit. I was training well and my fitness was on a good level. But only relatively speaking. I noticed I was stagnating. I had not progressed over the past half year and started to perform inconsistently during racing and training. But more importantly: I was not feeling well on the bike. Every session felt like ‘working’ to get the power out.

WTF is going on?!

This feeling of inconsistency – the good days, the bad days, with the bad days slowly becoming more dominant – started to make me doubt. WTF is going on?! I am ticking all the boxes, but I only started to feel worse every week. To closer friends and family, I sometimes briefly mentioned the strange feelings in my left leg that started to become apparent, still not really willing to admit it to myself. I made up my own excuses to downplay it, some of the best:

• My fan is on my left side on the indoor trainer, the cold air might affect the blood flow in my left leg

• I switched saddle last year, I will switch back to my old saddle

• I crashed in December 2024, that hurt my leg, it might still bother me

Self-diagnosis to the rescue

Frequent readers of this blog probably know I like nerding around. No different here. I am familiar with iliac artery endofibrosis and also have cycling friends who have had it. However, my problems, especially in the earlier stages were not prominent enough – at least that is what I told myself – to chase a doctor and get a scan. I was displaying ostrich behavior (see excuses above).

DIY blood pressure testing.

Early May I could no longer ignore the sensations in my leg and I started to have a serious suspicion of iliac artery endofibrosis. I started to do more research on how you can diagnose it. Turns out, a simple blood pressure test on your arm/ankle (ABI index) pre- and post-exercise is a good method to detect the presence of endofibrosis. So, I ordered a 30EUR blood pressure device and did the test. The results: no bueno. My blood pressure dropped significantly on my left-leg post exercise – a clear indication of restricted blood flow in the artery. This ‘self-testing’ experiment that was supposed to ease my mind now got my seriously worried.

You are only as strong as you weakest leg

Obviously, next steps were to start finding a doctor. I started asking around and ended up with Jelle Posthuma, a surgeon specialized in treating this condition in cyclists. I explained my situation, symptoms and the results from blood pressure tests. Jelle got me over for a Doppler ultrasound + MRI and the results confirmed what I already feared. My left iliac artery was kinked and narrowed.

Fast forward two weeks, and here I am post-surgery. The past few days were pretty rough, but I am feeling better by the day and will be sure to come back soon. Many thanks already to Jelle and the hospital for helping me so quickly. In the end, you are only as strong as your weakest leg.

I will have quite some time on my hands the coming days and plan to write more on this topic. Iliac artery endofibrosis is relatively common, yet not well understood. Many cyclists waste months/years before they get the right diagnosis. I plan to do a little mini-series to tell you more about my symptoms, diagnosis, recovery, etc. Interested? Hit the subscribe button👇

In the meantime, let me know if you have any questions on this topic!