Endofibrosis of the external iliac arteries (IE) occurs in some high-performance athletes can develop symptomatic arterial flow restriction in one or both (15%) legs due to kinking and/or IE, particularly female cyclists, and causes leg pain on extreme exertion. A 55-year-old female marathoner with a history of peripheral vascular disease status post angioplasty and stent of her right iliac artery in 2001, presented with a 3 week history of rapidly progressing intermittent claudication affecting her right thigh. Based on intravascular ultrasound (IVUS) and angiogram we detected that there was a little kicking at the level of the common iliac artery due to elongation on the right side with movement. She was treated successfully with angioplasty and treated aspirin and clopidogrel. Although the mechanism of IE is not known, the typical history and location of suggests that repetitive stress or bending of the vessel and high flow during extreme exercise leads to thickening of the arterial wall. We suggest that IVUS and angiogram is good diagnostic tool in IE.