Iliac artery issues in professional cycling: Verdonschot the latest to face surgery

Professional cycling has long been associated with extreme physical demands, but few injuries have proved as disruptive as iliac artery narrowing. This condition, which limits blood flow to the legs, has become an all-too-familiar adversary for many pro riders. Laura Verdonschot is the latest to announce that she will require surgery to address the debilitating issue, just a week before the Belgian cyclocross championships in Heusden-Zolder.

What is iliac artery narrowing?

Iliac artery narrowing, also known as endofibrosis, occurs primarily in endurance cyclists. The forward-leaning position on a bike places strain on the iliac arteries in the hips, creating a “kink” or compression that can damage the arterial walls over time. This leads to scarring, thickening, and, ultimately, reduced blood flow to the legs. Riders often experience severe fatigue, muscle cramping, and an inability to maintain power on the affected side.

Belgian sports doctor Kris Van der Mieren has described the condition as a common but serious issue in cycling. “Due to the typical riding posture, there’s repeated stress on the artery. Over time, small internal injuries accumulate, leading to narrowing. This restricts oxygen delivery to the muscles, especially under intense effort.”

Verdonschot’s struggle

Verdonschot, aged 28, is now dealing with this exact scenario according to Sporza. After a difficult festive racing period, where her performances fell far below expectations, she underwent tests that revealed both of her iliac arteries were almost completely blocked. “The pain this brings has been lingering for a while, but it has now become so severe that surgery is the only option, especially if I want to continue my career as a professional athlete,” she explained.

Despite the diagnosis, Verdonschot has decided to race the Belgian championships this weekend. However, her team has made it clear that her chances of success are severely limited. “Winning would require everything to go perfectly,” said her team manager, Camiel van den Bergh. “The lactic acid build-up from her condition means she can’t fully defend her chances.”

An issue unique to cycling

Unlike injuries caused by accidents, iliac artery narrowing stems from the repetitive movements and sustained posture required in professional cycling. The condition disproportionately affects riders with high training volumes, as prolonged hours in the saddle exacerbate the problem.

“This condition is almost exclusively seen in cyclists,” Van der Mieren added. “Someone who rides casually will never experience it. The pressure exerted by the position on the bike and the volume of training are unique to professional riders.”

A growing number of pro cyclists have undergone surgery to correct this problem, including Zdeněk Štybar, Fabio Aru, Annemiek van Vleuten, and Pauline Ferrand-Prévot. While surgery offers a path to recovery, it comes with risks. “No surgeon can guarantee a 100% successful outcome,” said Van der Mieren. “Careful and slow rehabilitation is crucial to avoid further complications.”

Riders affected by iliac artery narrowing

Verdonschot’s case highlights how common this condition is in the professional peloton. Below is a table of notable cyclists who have faced iliac artery issues, including the severity of their cases and their recovery outcomes. Many have come back to their former elite levels with Van Vleuten and Vos great examples from the peak of the women’s peloton.

Riders affected by iliac artery narrowing

Main photo credit: Melgaco