Charlotte Colclough talks External Iliac Artery Endofibrosis

Charlotte leading the pack to the finish line at the Ipswich BC Spring Scramble in 2017, where she took second place behind Joscelin Lowden

Late in 2018, the former World Road Race and Cyclocross Champion Pauline Ferrand-Prévot announced that she was being forced to take four months out of cycling after what she had previously described as “a blood pressure problem” was diagnosed as External Iliac Artery Endofibrosis, also known as EIAE. The condition, which causes the arterial walls to thicken, in most often seen in heavy smokers and obese people but also affects endurance athletes, especially those whose sport involves a great deal of repetitive movement, such as cycling.

Ferrand-Prévot is not the only professional cyclist to have developed EIAE – Australian riders Travis Meyer and Stuart O’Grady have suffered from it too, as has the Dutch rider Theo Bos. So too has Charlotte Colclough, who rides for the British women’s team Bianchi Dama.

Charlotte’s first club was the Sleaford Wheelers and, since 2005, she seemed to appear high up in the results of almost every event she entered. Being far too modest to brag, she asked that a sentence declaring “it was clear a major new talent had arrived” be removed from this article – but she managed 102 top tens over the next twelve years, including eight victories (seven in a row) in 2014 alone, so readers can decide for themselves.

But then, in 2017, the results started to tail off a bit – there were still a number of good finishes, for example second at the Ipswich BC Spring Scramble and third at the National Masters’ Champs, but at several other races where she was expected to do well, she didn’t.

All cyclists have bad years, even those who have enjoyed as much success for as long as Charlotte, and so at first she wasn’t especially concerned – she’d had rough spells before, and had broken two ribs at the Essex Giro earlier in the year. An obvious conclusion would be that she had pushed herself too hard before she’d fully recovered from that crash. “Actually, for a long while I was pretty unaware that there was anything wrong,” she told us, describing how she came to realise it was something more serious. “I had been struggling to sustain intense efforts and had developed a bad habit of sitting wonky on my left side. Generally I just felt like I was getting weaker and less powerful but I just put it down to getting older!”

“There was more than just fatigue…” – at the Tour of the Reservoir, 2017 (image c/o Bianchi Dama)

Cycling is a notoriously hard sport and even those who don’t train as often as those at Charlotte’s level frequently suffer aches and pains, and doing too much can very easily lead to fatigue – but the problems she was suffering showed no sign of improvement. “During a race in August 2017, my left leg went very numb and weak. After this it was very obvious something was wrong. Just walking upstairs would bring on extreme burning from lactic acid. At rest it was OK but any sort of exercise brought on the burning.”

David Walters is the manager of Charlotte’s team, Bianchi Dama. He’s the kind of guy you instinctively like, and once you’ve talked to him for a short while it’s clear that in addition to wanting his riders to be as successful as they possibly can be on their bikes, he also has a very deep concern for their general well-being, as well as for the sport of women’s cycling. For him, the crunch came at the Tour of the Reservoir in 2017.

“The Tour of Reservoir is a hugely difficult two-stage race around the hilliest course in the UK,” he says. “After finishing Stage 1 with Georgie Panchaud – they came 23rd and 24th – Charlotte battled for the whole second stage just off the back of the second group, coming in 36th and obviously having gone very deep. ”

In such a tough race (and the Tour of the Res, as it’s popularly known, really is one of the toughest in Britain, with many of the country’s best riders out looking for glory to make it even tougher), that’s not unusual: all it takes is for a rider to feel a little less than 100% or to have over-exerted herself on the first stage and she can blow up all too easily – it happens, even to riders as experienced as Charlotte. But David, being so in-tune with his team, knew there was more to it than that. “Unusually for any rider, Charlotte just couldn’t face riding the bike back to the HQ with Georgie and Emma Cockcroft. She was physically shaking in the car, there was more than just fatigue,” he says. “Charlotte obviously knew there was more wrong than was usual or expected, and it was from that point that she sought greater information and delve deeper into what was wrong.”

“At first I thought it was maybe some sort of muscle strain,” Charlotte explains. “But I’m not a very patient person and after a week of no cycling I was on Google trying to work out what it was. It took me a few hours but eventually I came across EIAE, and I knew straight away this was what I had!”

“That was July 2017; by October, full diagnosis was done, ready for surgery by Christmas,” says David. “I think it was the Tour of the Reservoir that really made things clearer.”

Aware that a non-specialist might also put it down to fatigue or age just as she herself had done, Charlotte sought out as much information as she could find before seeing a general practitioner – it’s always worth bearing in mind that GPs are hard-pushed and work to tight time constraints, so doing some research beforehand can often be worthwhile. “I think the doctor thought I was a bit of a hypochondriac but he did decide to refer me to a vascular centre locally,” she told us. “However, the appointment would be three months away. I decided to email a top surgeon who had treated other cyclists with the condition for advice. He suggested I went to see him in Bristol to do an assessment that week.”

The specialist conducted tests and rapidly confirmed that Charlotte was correct and she did indeed have EIAE. She says that at first the confirmation came as something of a relief – at least she now knew for certain what was wrong, why she’d been feeling bad on the bike, why her results had tailed off and, most importantly, that it would now be possible to start undergoing the procedure that would rectify the problem. That relief did not last long: the surgeon informed her that the condition in her left leg had progressed to a point where the iliac artery was not just restricting blood flow but preventing it entirely. having become completely blocked, and it had begun to take hold in her right leg too.

“I was told to stop cycling immediately. It looked unlikely that I would be able to ride again at all – my case was so bad that surgery might not work and that it would be an extremely tricky high risk procedure,” she recalls. Up until this point, she had still been riding her bike when she could, now it looked like she might have to give up sport entirely. “I was obviously pretty devastated at the thought of a life of no exercise,” she says.

The surgeon understood and, realising that his patient was going to be willing to do whatever it took to maintain the lifestyle she loves, he suggested a radical potential solution which had never previously been used to treat EIAE but which, be believed, might work in Charlotte’s case: in October, she underwent an operation in which a vein in her left arm was enlarged. Then, two months later once the enlarged vein had healed and was working properly, she was back on the operating table and the vein was removed from her arm and put in her left leg to replace the artery.

It proved to be a success, and Charlotte wasted no time at all in getting herself on the road to recovery, having been unable to cycle for several months. “I had many weeks of steady walking to allow the artery to recover… and then in March 2018 I got back on my bike, a very happy day! I built back up my fitness over the following weeks and returned to racing in the summer. It was so great to be back with the team!”

First race after surgery! Leading the peloton at the VC Norwich Summer RR

Charlotte returned to racing in June at the VC Norwich Summer RR on a flat but very fast (and blisteringly hot) circuit in Thetford Forest, where she finished in sixth place. She then repeated that result a week later at Harrogate Nova’s Summer RR before going on to take respectable results at the Stockton Velo29 GP (“The ride at the Stockton GP was as good a comeback as you’ll see into National Road Series races – I was really proud of Charlotte that day!” says David) and the Berkhamsted CC RR, before finishing tenth at both the Rapha CC RR and the South-Eastern, Central & Eastern Combined Championships. However, now that her left leg was regaining its former strength, Charlotte began to realise that her right leg was feeling the effects of the endofibrosis more than she’d previously noticed. Although the surgeon had said it wasn’t as advanced as it had been in her left leg, she decided to undergo further surgery to prevent the issue progressing further. The operation was carried out in September 2018 and fortunately this time was far less complicated, so she was able to get back on her bike sooner.

“I’m now just over 4 months post surgery and it feels so great to be back riding with two legs!” she says. We’re looking forward to seeing her race, and once again start racking up those superb results, once the 2019 road racing season gets underway.

More information on External Iliac Artery Endofibrosis

Iliac artery furring: Is surgery the cure? (Cycling Weekly)

Iliac Arteriopathy Leg Pain In Elite Athletes (Verywell Health)

Ask the Doctor: Ryan Cox and iliac artery endofibrosis (VeloNews)

Bianchi Dama