Introduction:Iliac artery endofibrosis (IAE) is an uncommon disease, poorly studied pathology with devastating effects and different therapeutic approaches affecting young people who practise intensive sports, especially cyclists. The evolution of the process not only depends on the diagnosis and therapeutic action, but also on the acceptance and attitude of the patient and subsequent professional guidance. Case description:This is the case description of a professional triathlon athlete that had one previous iliac surgical revascularization for an IAE Iliac and was admitted in our department five times with subacute lower limb ischemia affecting both legs between 2013 and 2016. Clinical findings and image tests are reported, as well as medical procedures performed. Indications based on clinical, functional and imaging ratings were clear, but his professional activity was not completely abandoned. Finally, after four endovascular procedures with good immediate results, he was warned of the seriousness of the process since the etiopathogenic reason. At the present moment patient is asymptomatic, under routine controls, working as successful triathlon coach. Discussion and conclusion:The fact that an external mechanical stress is the reason of repeated iliac artery injury suggests that an open surgical approach correcting the external muscular compression or arterial deformation should be a definitive but also aggressive solution according to literature. However, endovascular procedures and new endovascular devices are an increasingly promising option with a very low surgical risk. No matter the revascularization performed, the persistence of sports intensive practice carries a high risk of recurrence. Sport practise cessation is mandatory in some cases in order to assure revascularization long-term patency, but also a well conducted professional orientation is needed to complete the therapeutic action.