Iliac endofibrosis or iliac kinking and popliteal artery entrapment syndrome are uncommon causes of arterial insufficiency and intermittent claudication in young physically active adults. Diagnostics can be difficult, as the symptoms often are confused with sport injuries and musculoskeletal disorders. Investigation of these patients relies on accurate clinical history and examination as well as both static and dynamic imaging. Early diagnosis and vascular intervention is essential for continued exercise and to prevent thromboembolic complications and, in worst case, limb loss.