Elite rider Michelle Geoghegan was looking forward to a strong 2011 with her UCI ranked Dutch Moving Ladies squad. But after a mystery loss of performance in her left leg and months of protracted medical treatment, a narrowed external iliac artery was the diagnosis for the elite Kerry rider.
Common in cyclists, it has hit pro riders such as Stuart O’Grady, Theo Bos and former double Ras winner and Olympian Ciaran Power.
In this informative article, Geoghegan explains the symptoms and diagnosis methods, before outlining the corrective surgery and her road to recovery.
She will race next year with her new Belgian Steeds-Vooraan squad and hopes telling her story will help others.
Looking back I can see the beginnings of the injury that destroyed my season in the early winter of 2010. It was just some background noise that I was more than willing to ignore.
Advertisement
As the season progressed so did the injury. In the flat races I just felt like I had no power. That meant I was sitting near the back a lot and subsequently crashing a lot.
I had an intense lactic burn in my quad and a loss of sensation in the lower leg. It was completely isolated from the left leg and worst when climbing. My left leg would be screaming at me when the rest of me wasn't really under any huge pressure.
If I raced a few days in a row my form would steadily decline which just wasn't right – I usually got better day on day. For days following a race I would have residual soreness in the muscles in my left leg.
My physio seemed to think that the problem was a weakness in my lower back so I headed back to Holland armed with exercises to strengthen my back.
At the bottom of the aptly named Dead Man's Climb
Things didn't improve though. I remember a hilly UCI race in Belgium where I actually had to come to a complete stop on a short cobbled climb. Usually I loved any race with a few hills thrown in. I thought I just didn't have the capacity to suffer any more – I was soft.
I decided to go and see Scott McDonald of Winning Solutions in Dublin. I told him I had heard of a problem that some of the elite women's peloton had suffered from - a narrowed external iliac artery.
A few days later Scott called me to say that he had done some investigating and there was actually a very simple test that you could carry out to diagnose the problem. The test involved taking your blood pressure at the ankle and elbows right and left before and after intense exercise.
The ratio of the pressures from the elbow to the ankle should range from 1.1 to 1.3 and shouldn't drop after exercise. Scott carried out the initial measurements and I then hopped on the watt bike where I was to exercise until I could feel the pain starting.
When I had warmed down and showered Scott talked me through the results. My pressures had dropped by 60% after exercise. What this effectively means is that I had a 60% reduction in blood flow to my left leg. I had pretty much been anaerobic for the entire season.
Related News
Having finally gotten to the root of the problem I was faced with the next big obstacle – finding a vascular consultant in Ireland.
Ciaran Power had been diagnosed with the same problem a number of years ago so I gave him a ring. It turned out that he had traveled to France for his surgery as he couldn't find anybody with the expertise here.
The condition is quite commonly seen in older people, usually ex-smokers with unhealthy lifestyles, not healthy young adults. It is however quite common with cyclists and there are a list of top pros including the likes of Stuart O'Grady, Travis Meyer, Theo Bos, to name a few who have suffered from it.
Duplex scan imaging shows the wavey walls of my iliac artery
The iliac artery is the main artery into the leg and runs down into the hip. The problem among cyclists is thought to be the result of a combination of the over development of the muscles in the hip, the repetitive nature of the pedaling action and the position on the bike.
The problem with diagnosing it is simply that it doesn't present in the same way in a high level athlete and a 60-year-old smoker. On an MR angiogram my stenosis barely registered but the rates of flow following exercise were highly turbulent and indicative of a significant stenosis.
The corrective surgery itself – performed by Dr Sean O'Neill, vascular surgeon at St James’ Hospital - involved taking a vein from my ankle, dissecting the artery and using the vein as a patch; effectively widening the artery.
I was in hospital for a week before heading home to Kerry for complete rest and the Mammy's dinners. Over the weeks I was able to go on short walks, followed by walk runs.
At six weeks I returned to the vascular lab at St James’ to repeat the tests and happily my pressures were 1.3 before and after exercise – no drop. Day 45 and I was on the bike for a whopping 20km. Day 60 and I was on to a week of sixty km after which I was good to go with whatever I could handle.
So at ten weeks post op and after a difficult couple of months, I am happy to be back with my awesome training buddies, pedaling with two legs and looking forward to some good training doled out by Scott McDonald and next season with my new team. I am very thankful to Sean and his team in the vascular lab at St James Hospital and to everyone who helped me through the ups and downs.
I really hope that this article can be a source for any athlete looking for information on iliac artery endofibrosis. Being able to speak to Ciaran Power was really helpful for me and that was the reasoning behind writing this now.
Cheers
Michelle
