Radiotherapy-related axillary arteriopathy.

Treatment of breast cancer involves surgery, then perhaps radiation, hormonal or chemotherapy. Radiation-induced arterial injury is a well-known entity that represents a rare cause of arterial occlusion. We present the case of a 76-year old woman who complained of a severe intermittent claudication of the right upper limb. Twenty years before, she underwent a right-sided radical mastectomy followed by intense radiation therapy for several weeks. The patient was found to suffer of a radiotherapy-related axillary artery thrombosis and was successfully treated by angioplasty and stenting.

Abdominal aortic occlusion of young adults.

The occlusion of the infrarenal aorta is a rare event, which is potentially life threatening. We present the case of a heavy smoking, 35-year-old woman who was referred to the emergency department of our hospital because of sudden abdominal pain and urinary incontinence. She also complained of a two-year history of bilateral intermittent claudication. A computerized tomography revealed the thrombosis of the abdominal aorta and of both iliac arteries. Treatment consists of an aortoiliac thromboendarterectomy (AITE). For young patients with atheromatous occlusive disease of the infrarenal aorta, AITE is an attractive alternative to bypass grafting.

Cystic adventitial disease of the popliteal artery.

Cystic adventitial disease (CAD) is a rare condition caused by a cystic abnormality of the adventitia. It is most commonly found in young or middle-aged adults without significant risk factors for peripheral arterial disease. The disease usually affects the popliteal artery and can present with intermittent claudication. We present a case of CAD of the popliteal artery in a 65-year-old man and describe its treatment. For symptomatic patients, treatment of choice remains surgical resection of the cyst through a posterior approach.

Acute thrombosis of external iliac artery secondary to endofibrosis.

Iliac endofibrosis is a rare condition caused by chronic wall stress and a subsequent progressive fibrosis that usually affects the external iliac artery. It can present with intermittent claudication and is most commonly found in young athletes without significant risk factors for peripheral arterial disease. We present a case of acute thrombosis of the external iliac artery secondary to endofibrosis in a 38-year-old cyclist and describe the treatment options. For symptomatic patients and in case of long arterial occlusion, the treatment of choice is the surgical resection with autologous vein interposition.

Gene therapy for chronic peripheral arterial disease: what role for the vascular surgeon?

The incidence of peripheral arterial disease is rising and despite advances in clinical management, many problems remain unsolved. Better knowledge of the mechanisms and consequences associated with chronic muscle ischemia has opened the way for development of new treatment strategies, including therapeutic angiogenesis. Therapeutic angiogenesis is a promising technique based on experimental studies showing that growth factors or genes able to increase capillary density can be used to reduce the impact of muscle ischemia and increase blood flow to ischemic tissue. Enthusiasm for this technique has prompted numerous clinical trials with encouraging results, but data are still inconclusive. Optimal indications for gene therapy must be defined and further experimental progress is needed to respond to ethical issues. Therapeutic angiogenesis should be viewed as an adjunct to rather than as a competitor of current surgical revascularization techniques.

Native aortic valve thrombosis: a rare cause of acute ischemia of the lower limb.

Spontaneous native aortic valve thrombosis is an uncommon event occurring after heart valve disease, during cardiac catheterization, bacterial endocarditis, or as a hypercoagulative state as in antiphospholipid antibody syndrome. We report the case of a 55-year-old woman in whom thrombi developed on a native aortic valve with no predisposing cause. The thrombi were responsible for recurrent lower limb ischemia. Eighteen months after aortic valve replacement, the patient is doing well.