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hi eric,

an often overlooked/forgotten possibility is endofibrosis of iliac
arteries which tends to occur in female endurance athletes

here's a good reffrence article:

external iliac endofibrosis in endurance athletes: a novel case in an
endurance runner and a review of the literature.
S.J. Ford, A Rehman and A.W. Bradbury
Eur J Vasc Endovasc Surg 26, 629-634 (2003)

we use an extended treadmill protocol, carefull duplex imaging (for long
smooth sublte changes in EIAs) and post exersice waveform analysis to
identify these folks. we have a small series of 5-6 patients here who have
undergone patchgraft angioplasty with resolution of sxs. and normalization
of post exersice findings on f/u exams.

remeber Bernoulli does not lie! if you feel there was a good treadmill
exam and her pressures really did drop, then i bettcha there is a vascular
etiology!

hope that helps!
(:wats


On Tue, 2 Mar 2004, Eric Tyler wrote:

> Hi All,
>       I have a question relating to arterial treadmill testing.
> Today I completed an arterial study on a 38 y.o. female who complains of
> foot and calf pain with exercise.  I questioned whether her symptoms are
> vascular in nature as they were not consistent and she has no risk factors.
> Her resting ABI's were (R)1.28 and (L)1.22.   She exercised on the treadmill
> for 5 minutes, 10% grade at 2.5 MPH. She began to have calf pain at about 2
> 1/2 minutes into the study.  Her first post exercise ABI's were (R).89,
> (L).84.  They returned to resting pressures after about 5 minutes.  Her
> pressures were never even close to being poor, 123 mmHg was the lowest. She
> had the same test in 2000 with very similar results.   I have read that a
> pressure of 60 mmHg or less is usually required before arterial
> insufficiency is considered the root of the evil for causing pain.  The
> patient is also a staff member here.  The Dr's here are also fairly
> convinced her pain is not arterial related.  My question is for what reasons
> can the index drop post exercise other than PVD, aortic coarctation, and
> such.  Any ideas are greatly appreciated.  Thanks, Eric
>
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