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1.
Neuro Endocrinol Lett ; 40(3): 113-118, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31816217

ABSTRACT

We reported a case of carotid artery stenosis with stroke symptoms detected in a patient with lung cancer after radiotherapy. The patient was a 58-year-old male with a complaint of \"a single episode of temporary amaurosis in the right eye for 10 minutes". The clinical diagnosis at admission, after consideration of the patient's age, medical history, and auxiliary examination results, was as follows: lung cancer; right common carotid artery stenosis; left common carotid artery stenosis; left vertebral artery stenosis; and right subclavian artery occlusion with right subclavian steal syndrome (Grade 3). Carotid angioplasty and stenting (CAS) were subsequently performed. During the 6-month follow-up, we observed no episode of temporary vision loss or other signs of stroke. Clinicians should pay great attention to delayed radiation-induced carotid stenosis. It is recommended that patients with a history of radiotherapy should undergo regular color Doppler ultrasound examination of the cervical region to diagnose, prevent, and treat RICS in an expedient fashion. This approach should improve survival rate and quality of life.


Subject(s)
Carotid Stenosis/etiology , Lung Neoplasms/radiotherapy , Radiotherapy/adverse effects , Subclavian Steal Syndrome/etiology , Carotid Artery, Common/pathology , Carotid Artery, Common/radiation effects , Carotid Artery, Common/surgery , Carotid Stenosis/diagnosis , Carotid Stenosis/pathology , Carotid Stenosis/surgery , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Male , Middle Aged , Radiation Injuries/diagnosis , Radiation Injuries/etiology , Radiation Injuries/pathology , Radiation Injuries/surgery , Stents , Subclavian Artery/pathology , Subclavian Artery/radiation effects , Subclavian Artery/surgery , Subclavian Steal Syndrome/diagnosis , Subclavian Steal Syndrome/pathology , Subclavian Steal Syndrome/surgery , Ultrasonography, Doppler, Color , Vertebral Artery/pathology , Vertebral Artery/radiation effects , Vertebral Artery/surgery
4.
Catheter Cardiovasc Interv ; 72(4): 563-8, 2008 Oct 01.
Article in English | MEDLINE | ID: mdl-18819153

ABSTRACT

Radiation therapy is a cause of cardiovascular morbidity and mortality. This is due to the significant degree of atherosclerosis seen in the vessels in the vicinity of the area being irradiated. Radiation-induced peripheral arterial disease is increasingly being recognized as large populations of cancer patients survive longer, yet it is a problem that is often under reported. Although it has most commonly been associated with carotid artery disease, all vascular beds are prone to this form of injury. The injury is accelerated by usual risk factors for atherosclerosis. Developing a healthy lifestyle, dietary prudence and the aggressive treatment of hypertension, diabetes mellitus, and dyslipidemia should all be encouraged in this patient population. When revascularization strategies are warranted, the percutaneous approach may be superior to open surgery as technical difficulties may arise in the fibrotic, scarred tissue. Stenting with distal embolic protection devices should be considered as the treatment of choice for patients with radiation-induced carotid artery disease. Several reports also suggest good results with balloon angioplasty with or without stenting in the case of radiation-induced renal, iliac, and femoral artery disease. Lifelong antiplatelet therapy may be appropriate.


Subject(s)
Neoplasms/radiotherapy , Peripheral Vascular Diseases/etiology , Radiation Injuries/etiology , Atherosclerosis/etiology , Carotid Artery Diseases/etiology , Femoral Artery/radiation effects , Humans , Iliac Artery/radiation effects , Peripheral Vascular Diseases/physiopathology , Peripheral Vascular Diseases/prevention & control , Peripheral Vascular Diseases/therapy , Radiation Injuries/physiopathology , Radiation Injuries/prevention & control , Radiation Injuries/therapy , Radiotherapy/adverse effects , Renal Artery/radiation effects , Risk Assessment , Risk Factors , Subclavian Artery/radiation effects
5.
Vasc Endovascular Surg ; 42(2): 187-91, 2008.
Article in English | MEDLINE | ID: mdl-18421037

ABSTRACT

Radiation-induced damage to the bone, soft tissues, and vasculature represents the unfortunate consequences of radiation therapy for the treatment of malignant tumors. Complications arising from irradiation are frequently challenging to manage and may be life threatening. A case is presented of a patient with a longstanding clavicular osteoradionecrosis with an acute massive hemorrhage after rupture of the subclavian artery and subsequent management with endovascular stent placement. With over 2 years' follow-up, vascular patency was maintained with no further bleeding episodes in this surgically high-risk patient.


Subject(s)
Aneurysm, False/therapy , Aneurysm, Ruptured/therapy , Blood Vessel Prosthesis Implantation/instrumentation , Embolization, Therapeutic , Hemorrhage/therapy , Radiation Injuries/therapy , Stents , Subclavian Artery/surgery , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Aneurysm, False/surgery , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/etiology , Aneurysm, Ruptured/surgery , Clavicle/radiation effects , Fatal Outcome , Hemorrhage/diagnostic imaging , Hemorrhage/etiology , Hemorrhage/surgery , Hodgkin Disease/radiotherapy , Humans , Male , Middle Aged , Osteoradionecrosis/etiology , Radiation Injuries/diagnostic imaging , Radiation Injuries/etiology , Radiation Injuries/surgery , Radiography , Radiotherapy/adverse effects , Subclavian Artery/diagnostic imaging , Subclavian Artery/radiation effects
6.
Cardiovasc Intervent Radiol ; 29(6): 1144-7, 2006.
Article in English | MEDLINE | ID: mdl-16845557

ABSTRACT

Radiotherapy-related axillary artery occlusive disease is a relatively rare condition. This complication is usually encountered in patients with breast carcinoma treated by radiotherapy and might be frequently concealed by the presence of lymphoedema. We discuss this rare complication of radiotherapy treatment for breast cancer and present two cases and their successful treatment by a modified percutaneous transluminal angioplasty and stenting technique. A review of literature on the subject is also presented.


Subject(s)
Angioplasty, Balloon , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/therapy , Axillary Artery/radiation effects , Radiation Injuries/complications , Stents , Aged , Angioplasty, Balloon/methods , Balloon Occlusion/methods , Blood Vessel Prosthesis Implantation/methods , Breast Neoplasms/radiotherapy , Female , Humans , Radiation Injuries/etiology , Subclavian Artery/radiation effects
7.
Acta Med Croatica ; 60(5): 497-9, 2006 Dec.
Article in Croatian | MEDLINE | ID: mdl-17217108

ABSTRACT

Iatrogenic vascular traumas are increasing and their proportion exceeds 40% of all vascular injuries. We report on a rare case of iatrogenic injury of the brachiocephalic arterial trunk during surgical intervention due to postirradiation arteriopathy, which was successfully treated with a silver prosthesis graft. A 58-year-old male underwent surgery for metastases of papillary carcinoma of the thyroid gland, located in lymph nodes adjacent to the right common carotid artery and right subclavian artery. During the surgery, there was an intraoperative injury of the brachiocephalic arterial trunk that included spontaneous rupture and tear of the subclavian and common carotid artery, as the result of extreme fragility of the arterial wall, probably due to the previous irradiation therapy. Emergency sternotomy and clavicle resection were followed by blood flow reconstruction by use of an Y prosthesis that was applied for terminoterminal anastomosis between the brachiocephalic trunk to common carotid artery and subclavian artery. The authors concluded that irradiation therapy may lead to progressive arteriopathy in affected arteries.


Subject(s)
Brachiocephalic Trunk/injuries , Carotid Artery Injuries/etiology , Intraoperative Complications , Lymph Node Excision , Subclavian Artery/injuries , Blood Vessel Prosthesis Implantation , Brachiocephalic Trunk/radiation effects , Brachiocephalic Trunk/surgery , Carotid Artery, Common , Humans , Lymphatic Metastasis , Male , Middle Aged , Neck , Radiation Injuries , Subclavian Artery/radiation effects , Subclavian Artery/surgery , Thyroid Neoplasms/radiotherapy , Thyroid Neoplasms/surgery
8.
J Mal Vasc ; 26(1): 45-9, 2001 Feb.
Article in French | MEDLINE | ID: mdl-11240529

ABSTRACT

Post-irradiation axillo-subclavian arteriopathy can develop 6 months to 20 years after radiotherapy. Incidence estimated from duplex scan screening is about 30%, half of the cases having no hemodynamic significance. In our experience, asymptomatic lesions are the most common. Nevertheless, we have observed since 1978, 38 symptomatic patients including 23 with either acute ischemia (8 patients), or chronic ischemia (15 patients) requiring revascularization. We used an endovascular approach in 8 and open surgery in 15. A bypass graft was performed in 13 patients, using a vein (8 patients) rather than a prosthesis (5 patients), implanted in healthy territory, proximally or in the common carotid (11 patients) or the proximal subclavian (2 patients), and distally in the axillary artery (5 patients) or the brachial artery (8 patients). One venous bypass became occluded postoperatively. The other bypasses remained patent during follow-up of over 10 years. There of the five prosthetic bypassess gradually failed without recurrence of critical ischemia. Other revascularization procedures included endarterectomy and thrombectomy. In the long term, functional prognosis mainly depended on the frequently associated involvement of the plexus in the post-irradiation changes, which, together with the revascularization procedure, also required neurolysis in 11 patients, two omental covers and a free musculocutaneous transfer in 9 patients.


Subject(s)
Arteritis/surgery , Axillary Artery/radiation effects , Blood Vessel Prosthesis Implantation , Endarterectomy , Ischemia/surgery , Radiation Injuries/surgery , Radioisotope Teletherapy/adverse effects , Subclavian Artery/radiation effects , Thrombectomy , Veins/transplantation , Adult , Aged , Aged, 80 and over , Aneurysm/etiology , Aneurysm/surgery , Arteritis/etiology , Axillary Artery/surgery , Brachial Plexus/injuries , Brachial Plexus/radiation effects , Breast Neoplasms/radiotherapy , Cobalt Radioisotopes/adverse effects , Cobalt Radioisotopes/therapeutic use , Female , Follow-Up Studies , Humans , Ischemia/etiology , Male , Mesothelioma/radiotherapy , Middle Aged , Omentum/transplantation , Pleural Neoplasms/radiotherapy , Prognosis , Retrospective Studies , Subclavian Artery/surgery , Surgical Flaps , Time Factors , Transplantation, Heterotopic
9.
Am Surg ; 65(12): 1176-9, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10597070

ABSTRACT

Arterial occlusive disease has been recognized in association with radiation arteriopathy and, rarely, with spontaneous arterial disruption. This association results from the greater role of radiation therapy in the current management of malignant diseases coupled with longer patient survival and the lengthy latency period between radiation and clinical manifestations of radiation arteriopathy. Experience with six patients having radiation-associated arterial disease was retrospectively reviewed. There were four men and two women, with a mean age of 51 years (range, 36-74). Arteries exposed to radiation include two carotids, three subclavians, one coronary, and one femoral. The time from radiation therapy until clinical arterial disease was a mean of 14.3 years (range, 4-30). Operative repairs with polytetrafluoroethylene and saphenous vein bypass grafts were performed in four patients, stent placement in one patient, and one patient had spontaneous carotid disruption that ultimately was treated with ligation. In conclusion, elective bypass can be performed safely and successfully for arterial occlusive disease in a previously irradiated artery. In contrast, life-threatening arterial disruption secondary to radiation arteriopathy usually requires concomitant exposure to a source of bacterial contamination, and ligation may be the best choice to prevent recurrent hemorrhage.


Subject(s)
Arterial Occlusive Diseases/etiology , Radiation Injuries/etiology , Adult , Aged , Angioplasty, Balloon , Arterial Occlusive Diseases/surgery , Blood Vessel Prosthesis Implantation , Carotid Artery Diseases/etiology , Coronary Disease/etiology , Female , Femoral Artery/radiation effects , Hemorrhage/prevention & control , Humans , Ligation , Male , Middle Aged , Neoplasms/radiotherapy , Polytetrafluoroethylene , Radiation Injuries/surgery , Recurrence , Retrospective Studies , Rupture, Spontaneous , Saphenous Vein/transplantation , Stents , Subclavian Artery/radiation effects , Survival Rate , Time Factors
11.
Clin Radiol ; 49(9): 630-3, 1994 Sep.
Article in English | MEDLINE | ID: mdl-7955891

ABSTRACT

Radiation injury to subclavian and axillary arteries is a rare and late complication of radiotherapy. Until recently it has been treated almost exclusively by carotid-brachial bypass surgery. We report three cases who presented with severe upper limb ischaemia following previous axillary radiotherapy for breast carcinoma. One patient with an axillary artery occlusion failed angioplasty and required bypass surgery. A further patient with an axillary artery occlusion was successfully managed by the percutaneous placement of an arterial stent. The third patient with an isolated axillary artery stenosis responded to balloon angioplasty. All three patients remained asymptomatic. Percutaneous angioplasty and stent placement, where necessary, are appropriate first choice treatment for delayed radiation stenosis and occlusion in upper limb ischaemia.


Subject(s)
Angioplasty, Balloon/methods , Arterial Occlusive Diseases/therapy , Axillary Artery/radiation effects , Radiation Injuries/therapy , Subclavian Artery/radiation effects , Aged , Aged, 80 and over , Axillary Artery/diagnostic imaging , Breast Neoplasms/radiotherapy , Female , Humans , Ischemia/diagnostic imaging , Ischemia/etiology , Middle Aged , Radiation Injuries/diagnostic imaging , Radiation Injuries/etiology , Radiography , Stents , Subclavian Artery/diagnostic imaging
12.
Cardiovasc Surg ; 1(2): 146-8, 1993 Apr.
Article in English | MEDLINE | ID: mdl-8076017

ABSTRACT

Symptomatic occlusion of the subclavian artery is a rare complication of radiation therapy for carcinoma of the breast. The first case of revascularization of this entity using saphenous vein was described in 1974. A total of only 24 patients have been reported in the English literature, of whom 14 have undergone successful arterial reconstruction. Three additional cases of occlusion of the subclavian artery 27, 18 and 7 years after radical mastectomy and postoperative radiotherapy are reported. These patients presented with pain, coldness, paresthesia and absence of pulses in the affected arm, and angiographic evidence of complete occlusion of the subclavian artery. All patients underwent axillary-contralateral brachial artery reconstruction using a 6-mm polytetrafluoroethylene graft tunneled subcutaneously through the previously irradiated area. In each case, the patient noted complete resolution of symptoms with the return of palpable distal pulses. One patient had a thrombosed graft 5 weeks after initial surgery and underwent successful thrombectomy. There were no complications associated with the subcutaneous tunnel or the production of a subclavian steal syndrome. Although there are other possibilities for the origin of the bypass, this technique avoids extensive dissection in previously irradiated areas and does not require complicated dissection of the subclavian artery or clamping of the carotid artery.


Subject(s)
Arterial Occlusive Diseases/surgery , Axillary Artery/surgery , Brachial Artery/surgery , Breast Neoplasms/radiotherapy , Mastectomy, Radical , Radiation Injuries/surgery , Subclavian Artery/radiation effects , Aged , Breast Neoplasms/surgery , Female , Graft Occlusion, Vascular/surgery , Humans , Middle Aged , Postoperative Complications/surgery , Reoperation , Subclavian Artery/surgery , Thrombectomy
15.
Bull Cancer Radiother ; 77(1): 3-13, 1990.
Article in French | MEDLINE | ID: mdl-8703540

ABSTRACT

Published reports of arterial stenosis following radiotherapy are reviewed. In oncological practice, this complication is rare but experimental studies have demonstrated the role of irradiation in producing arterial lesions. The histological specificity and the mechanisms of radiation and related arterial lesions are discussed. Atherosclerosis risk factors and chemotherapy could have a synergic role on artery stenosis. Cases reported of arterial stenosis after radiotherapy include subclavicular artery after breast cancer, carotid artery after head and neck cancer, coronary artery and abdominal aorta or its trunks after pelvic and abdominal irradiation. The radiotherapy parameters described are not unusual. Therapeutical modalities and their indications are presented.


Subject(s)
Arterial Occlusive Diseases/etiology , Arteries/radiation effects , Radiotherapy/adverse effects , Adult , Animals , Aorta, Abdominal/radiation effects , Aortic Diseases/etiology , Arterial Occlusive Diseases/surgery , Blood Vessel Prosthesis , Carotid Stenosis/etiology , Cells, Cultured/radiation effects , Coronary Disease/etiology , Dilatation , Dogs , Endarterectomy , Endarterectomy, Carotid , Female , Humans , Male , Rabbits , Rats , Risk Factors , Subclavian Artery/radiation effects , Swine
16.
Cancer ; 61(10): 2015-8, 1988 May 15.
Article in English | MEDLINE | ID: mdl-3282639

ABSTRACT

Disturbance of the arterial circulation in the ipsilateral upper limb following mastectomy is a rare sequel attributed to adjuvant radiotherapy. A review of the literature revealed 20 such cases, and two more are presented. Different mechanisms of injury leading to arterial occlusion have been proposed. This is a late complication with a considerable time lag between irradiation and onset of symptoms. The symptoms vary in type and severity, but are consistent with peripheral occlusive arterial disease. To alleviate symptoms and prevent limb loss, reconstructive vascular surgery is advocated, and was successfully performed in one of our patients.


Subject(s)
Arterial Occlusive Diseases/etiology , Breast Neoplasms/radiotherapy , Radiation Injuries/etiology , Radiotherapy/adverse effects , Subclavian Artery/radiation effects , Aged , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/surgery , Arteriosclerosis/diagnosis , Breast Neoplasms/surgery , Combined Modality Therapy , Diagnosis, Differential , Humans , Mastectomy , Subclavian Artery/pathology
17.
Surgery ; 99(6): 658-63, 1986 Jun.
Article in English | MEDLINE | ID: mdl-3715717

ABSTRACT

Three case reports are reviewed to illustrate the possibility of treating irradiation-induced lesions of the subclavian-brachial vascular segment (aneurysm and segmental occlusions) 14, 20, and 26 years after radical mastectomy and subsequent radiotherapy. All patients had an extraanatomic vein bypass graft from the carotid to the brachial artery crossing the shoulder near the acromioclavicular joint, with the advantage that the tissue changed by radiotherapy or infected by ulceration could be circumvented. There were no postoperative complications, with adequate function of the grafts (follow-up, 17, 24, and 20 months, respectively).


Subject(s)
Axillary Artery/radiation effects , Breast Neoplasms/radiotherapy , Radiotherapy/adverse effects , Subclavian Artery/radiation effects , Aged , Axillary Artery/diagnostic imaging , Axillary Artery/pathology , Brachial Artery/surgery , Breast Neoplasms/surgery , Carotid Arteries/surgery , Combined Modality Therapy , Embolization, Therapeutic , Female , Follow-Up Studies , Humans , Mastectomy , Middle Aged , Radiography , Radiotherapy/methods , Saphenous Vein/transplantation , Subclavian Artery/diagnostic imaging , Subclavian Artery/pathology
19.
Br J Surg ; 67(5): 341-3, 1980 May.
Article in English | MEDLINE | ID: mdl-7388329

ABSTRACT

Four cases of irradiation injury to large arteries are presented and the literature is reviewed. Three patterns of injury have emerged. 1. Intimal damage resulting in mural thrombosis presenting within 5 years of irradiation. 2. Fibrotic occlusion presenting within 10 years of injury. 3. A predisposition to the development of atheroma together with periarterial fibrosis associated with a latent interval of 20 or more years. The treatment of choice is a bypass procedure of the arterial lesion.


Subject(s)
Axillary Artery/radiation effects , Iliac Artery/radiation effects , Radiation Injuries/etiology , Radiotherapy/adverse effects , Subclavian Artery/radiation effects , Adult , Arterial Occlusive Diseases/etiology , Arteriosclerosis/etiology , Female , Humans , Male , Middle Aged , Thrombosis/etiology , Time Factors
20.
Invest Radiol ; 10(4): 391-3, 1975.
Article in English | MEDLINE | ID: mdl-810458

ABSTRACT

Occlusion of the left subclavian artery was demonstrated following exposure to two courses of radiation, the patient having received 4,200 rads in 4 weeks 9 years previously, and 4,000 rads in 8 weeks almost 5 years previously. Despite other intercurrent medical conditions, this seems to be a cause-and-effect relationship, since the only segment of abnormal artery was confined to the limited volume receiving the double exposure, whereas other arteries nearby did not demonstrate abnormality.


Subject(s)
Radiation Injuries , Subclavian Artery/radiation effects , Subclavian Steal Syndrome/etiology , Adenocarcinoma/radiotherapy , Adult , Breast Neoplasms/radiotherapy , Dose-Response Relationship, Radiation , Female , Humans , Lymphatic Metastasis , Radiography , Radiotherapy Dosage , Radiotherapy, High-Energy , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery
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