Upper-limb arterial disease in women treated for breast cancer

Abstract

A 5-year cohort of patients treated 15-19 years previously for breast cancer was studied to establish the prevalence of symptoms and objective evidence of circulatory insufficiency in the upper limbs. There were 187 survivors of the original cohort of 665. In all, 102 patients were evaluated; 50 had received radiotherapy in addition to surgery. Irradiated and non-irradiated groups were comparable for age, extent of axillary dissection and vascular risk factors. Both arms were assessed for symptoms and examined by Doppler ultrasonographically derived segmental pressures and hyperaemia testing, Doppler ultrasonographic waveform analysis, pulse volume recording and venous outflow air plethysmography. Seven ipsilateral arms (14 per cent) in patients given radiotherapy were symptomatic, compared with four (8 per cent) in those receiving surgery alone, and two contralateral control arms (2 per cent). Evidence of arterial disease was found in 11 ipsilateral arms of patients given radiotherapy (22 per cent) and two ipsilateral arms of those receiving surgery alone (4 per cent) (P < 0.03). There was no association between symptoms and evidence of arterial disease, and no evidence of abnormal venous function.

Innominate to contralateral brachial artery bypass via ministernotomy with anatomic tunneling for critical ischemia of the left upper extremity

“…Extra-anatomic bypass, where feasible, is usually the preferred option due to a lower risk of vascular injury and infection. 1,3–11 Radiation-induced vasculopathy involving the subclavian, axillary, and brachial arteries following multi-modality treatment of breast cancer has been described. 2,4,7,9 Radiation is also a known risk factor for progressive atherosclerotic occlusive vascular disease.…”