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International Angiology 2021 June;40(3):222-8

DOI: 10.23736/S0392-9590.21.04606-X


language: English

Radiation-induced lower-limb arteriopathy: report of 4 cases and systematic literature review

Jonathan GRANDHOMME 1, 2, Salomé KUNTZ 1, 2, Adeline SCHWEIN 1, 2, Yannick GEORG 1, 2, Lydie STEINMETZ 1, 2, Fabien THAVEAU 1, 2, Nabil CHAKFE 1, 2, Anne LEJAY 1, 2

1 Department of Vascular Surgery and Kidney Transplantation, University Hospitals of Strasbourg, Strasbourg, France; 2 Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France

INTRODUCTION: Radiation-induced arteriopathy (RIA) is a rare complication but may become more common due to the increased use of radiotherapy and the prolonged survival of patients. There is still a lack of evidence concerning treatment options. The aim of this study is to review reported cases of lower-limb RIA in order to provide guidelines for management.
EVIDENCE ACQUISITION: We reported 4 cases treated for lower limb RIA and performed a systematic literature review without time limitation in the Medline database using the MeSh tems “iliac artery/radiation effects” OR “femoral artery/radiation effects.” Main outcomes of interest were radiation dose, time before symptoms, symptoms, involved vessels, treatment and outcome.
EVIDENCE SYNTHESIS: Twenty-five studies were included, reporting a total of 43 patients. Median time between irradiation and symptoms was 12 years (range: 9 days-49 years), with a median irradiation dose of 40Gy. Clinical presentation was claudication in 18 patients (52%), critical limb threatening ischemia (CLTI) in 4 patients (11%), acute limb ischemia (ALI) in 3 patients (9%) and hemorrhage in 6 patients (17%), the remaining 4 patients were asymptomatic (11%). Vessels involved were iliac arteries in 65% of the cases, femoropopliteal arteries in 28% of cases and concomitant supra and infrainguinal vessels in 7% of the cases. Claudication was mostly treated by open surgery (62%). Treatment of CLTI included primary amputation (50%), open surgery (25%) or endovascular surgery (25%). ALI was treated medically (33%), by open surgery (33%) or in situ thrombolysis (33%). Hemorrhagic cases or pulsatile masses were mostly treated by open surgery (66%). Follow-up was reported in 26 patients (67%), with mean follow-up of 12 months (range: 2 weeks - 5 years). During follow-up, 16% of these patients presented a recurrence of symptoms, and 8% required a reintervention.
CONCLUSIONS: There seems to be no evidence for open versus endovascular treatment, but close and long-term follow-up is needed in these patients due to the possible late presentation and recurrence of symptoms after treatment.

KEY WORDS: Radiotherapy; Arteritis; Systematic review

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