Stybar declared a few days ago that he had undergone thesurgical intervention to resolve the pathology of iliac artery endofibrosisAn operation that, like the pawns in "Guess Who," involves the group's athletes. In recent years, it has involved, remaining in Italy, Erica Magnaldi, Nicola Conci, Luca Chirico, Eugenio Alafaci, Fabio Aru and Alessandro MonacoGiven its nature, mostly tied to sport, to the ignorant eyes of those who observe it is seen as a last resort.
Guardascione responds
None of this. Carlo Guardascione, doctor of the Team Jayco-AlUla, he explained to us what leads to the diagnosis but above all who and why decides to operate on this part of the body that is unknown to most. And perhaps we shouldn't talk about nightmares...
«I must point out two things first – Guardascione clarifies – because they are fundamental. There is an anatomical predisposition, because not everyone has the iliac artery that makes a loop, that makes a sort of curve or knee at the groin level. The second Intensive cycling activity is a predisposing factor. So it concerns cyclists, amateurs, professionals and anyone else who has been practicing endurance sports for several years."
What pathology is it?
The pathology is called endofibrosis of the iliac arteryAnd it is a vascular pathology obviously due to the thickening and narrowing of some areas of the iliac artery, which however are already anatomically abnormal. In the sense that the arterial wall in the groin area thickens in subjects who have been doing this type of endurance sport for several years (In young people, except for a few exceptional cases, it is not visible.) So they have an artery that makes a sort of loop, a sort of curve, physiologically. So by thickening the wall under stress, there is a narrowing of the blood flowDuring physical effort, blood flow to the lower limbs must increase. If this blood flow has to pass through an area that is stenotic, because the thickening narrows the lumen, obviously, the blood does not arrive and as a consequence, the primary symptom is difficulty maintaining effort and vascular suffering.
What is the main symptom?
Leg pain and lack of strength, loss of power in the leg because there is a restriction of blood flow which must reach the lower limbs.
So the diagnosis is not that difficult…
The diagnosis is twofold. First, it is clinical, in the sense that the athlete describes his problems, which all have a common characteristic: the fact of manifest only under intensive effortIt does not occur at rest. Then the diagnosis is confirmed by a diagnostic test which is an angiography, therefore an examination with a contrast medium in which the course of the iliac artery is practically verified and visualized. Generally it is discovered that at the inguinal level the artery has an anatomical malformationIt may present excessive length or a sort of curve which obviously, while sitting on the bicycle, when the forced flexion position of the back compresses the area, gives rise to the problem.
What does the surgery consist of?
Consists in remove this loop by placing a stent, generally made of synthetic material, which eliminates this narrowing of the artery and allows the blood to flow normally again.
Is the operation guaranteed to solve the problem 100%?
In a very large percentage of cases, the operation solves the problem. In my career I only remember one case that had to be operated on twice, due to the post-operative detachment at the point where the biological prosthesis had been placed, which required a second operation. However, this It is part of the surgical case history of this type of intervention.
What is the recovery time?
Not short, because it takes at least a month of absolute immobility to allow the anatomical structures to adapt to the new stent, to this new prosthesis that was inserted and then a rehabilitation. So, Those who go fast take three months. Then three to six months for complete recovery..
Have you had many cases of athletes with this type of problem?
Certainly yes. These are precisely the characteristics, a congenital anatomical malformation and a cycling or endurance activity that can also happen to triathletesBut also cross-country skiers and riders. It's always about a prolonged activity over many years. Two years ago we had Amanda Spratt who is a womanVan Vleuten also underwent surgery, although she wasn't one of my athletes, but that's known. As did Aru.
How long does it take from the first symptoms/suspicions to the actual diagnosis and decision to undergo surgery?
Initially it is something that comes slowlyBecause endometriosis is the narrowing of the artery, it doesn't happen suddenly, but slowly and progressively. So, we're talking about weeks and months. The athlete feels something strange, then maybe doesn't feel anything for a month. Then it happens again.…So reaching a diagnosis is never a quick one. Contrast angiography is not a routine test, so it must be done with a certain level of knowledge. So the diagnosis is not immediate because the disease is progressive and very slow in progressingLet's say there are predisposing and anatomical factors, including viscosity, meaning that if your blood is very thick, it can stimulate arterial stiffening. A bit like what happens with coronary arteriosclerosis or cerebral arteriosclerosis in normal people.
Can the athlete resume his career at the highest level one hundred percent in the future?
Let's say that the prognosis is always very good. Not 100%, but at least 90% of people return to their pre-pathology performance.Because it is a practically mechanical problem, once the blood problem is solved, based on its qualities it returns to what it was before.
