Acute limb ischemia secondary to radiation-induced arteritis: case report

Abstract

Radiation-induced arteritis is a rare but well-known complication of radiotherapy. This report describes the case of a 34-year-old woman with uterine cervical cancer who was diagnosed with left iliofemoral deep vein thrombosis (DVT) 2 years after radiotherapy, and 2 months later, during the treatment of DVT with effective anticoagulation, developed an episode of acute arterial ischemia of the left lower limb secondary to a long subocclusive lesion of the external iliac artery. The patient was treated with angioplasty and stenting of the lesion and recovered uneventfully after the endovascular procedure.Keywords: radiotherapy; constriction, pathologic; angioplasty. ResumoA arterite induzida por radiação é uma rara mas bem documentada complicação da radioterapia. O presente relato descreve o caso de uma mulher de 34 anos, diagnosticada com neoplasia de colo do útero, a qual, dois anos após sessões de radioterapia desenvolveu trombose venosa profunda (TVP) iliofemoral esquerda; dois meses depois, durante tratamento para TVP com devida anticoagulação, a paciente apresentou quadro de insuficiência arterial aguda do membro inferior esquerdo secundária a uma longa lesão suboclusiva da artéria ilíaca externa. A paciente foi tratada com angioplastia transluminal percutânea e implantação de stent autoexpansível, recuperando-se sem intercorrências após o procedimento endovascular. With the aid of road mapping, the left femoral artery was punctured, and the EIA lesion was easily crossed with a hydrophilic 0.035-in, 180-cm stiff shaft and an angled floppy-tip guide wire; after that, the lesion was pre-dilated using a 6-mm × 40-mm non-compliant percutaneous transluminal angioplasty (PTA) balloon. Subsequently, 2 selfexpandable nitinol stents were deployed: first, an 8-mm × 80-mm stent distally, and then a 9-mm × 80-mm stent proximally, with an overlapping zone of about 3 cm. For post-dilatation, a 7-mm × 80-mm non-compliant PTA balloon was used (Figure 2). Both balloons had to be inflated to nearly their burst pressure to open the lesion adequately. Pressure was measured across the stented region, but no pressure gradient was identified. The completion angiogram showed a satisfactory angiographic result (Figure 3). PalavrasOn the first post-procedure day, she had normal pedal pulses, and color Doppler US detected normal triphasic flow down to the foot on both left pedal arteries. Clinically, there was remission of the left foot numbness and her left foot movements were preserved. She was discharged from the hospital on the third post-procedure day with a referral for outpatient anticoagulation and INR control.

Endovascular management of TransAtlantic Inter-Society Consensus D iliac artery occlusion secondary to radiation arteritis

“…The pathogenic effects of radiation on vasculature are attributed to the high radiosensitivity of endothelial cells, fibrosis of the medial and adventitial layers, and damage to the vasa vasorum. 1 The presentation of radiation-induced occlusive arterial disease is variable, ranging from 2 to 47 years after initial radiation therapy, with a median of 11 years. 2 Presenting symptoms of pain, numbness, and tissue degeneration are similar to those of peripheral arterial disease.…”

Imaging of nonatheromatous carotid artery disease

“…The most commonly affected vessels are the cervical and cranial arteries, 48 followed by the visceral and pelvic arteries. 49 Ultrasound imaging shows an increase in carotid intimamedia thickness, carotid stenosis, and consequently leads to a higher risk of cerebrovascular events such as transient ischemic attack and stroke. Postradiation patients showed a statistically significant higher incidence of overall stenosis (pooled risk ratio ¼ 4.17 [2.44, 7.10], p < 0.00001) and an even greater incidence of significant stenosis (50% or more; pooled risk ratio ¼ 8.72 [3.53, 21.55], p < 0.00001).…”