Mediastinal irradiation: A risk factor for atherosclerosis of the internalthoracic arteries

Previous radiotherapy to the thorax is a risk factor for coronary artery di sease. Patients with radiation-induced atherosclerosis tend to be young and frequently have lesions involving the coronary ostia and left anterior des cending artery. Bypass is often the most suitable method of revascularizati on, and given the young age of the patient, arterial conduits would be cons idered superior to vein grafts. However, the internal thoracic arteries can lie within the radiation field and may not be free of atherosclerosis. A 4 0-year-old man who required coronary artery bypass grafting for multivessel coronary artery disease 11 years following radiotherapy for Hodgkin's lymp homa is reported. Preoperative angiography showed that the right internal t horacic artery had significant atherosclerosis and was unsuitable as a cond uit.